Acl Pcl Presentation
-
Upload
safwan-idham-ramlan -
Category
Documents
-
view
241 -
download
0
Transcript of Acl Pcl Presentation
-
8/2/2019 Acl Pcl Presentation
1/17
SOFT TISSUE INJURY:
ACL/PCL
NURUL FARHANA BT HASHIM2010840364
-
8/2/2019 Acl Pcl Presentation
2/17
ANATOMY: ACL & PCL
-
8/2/2019 Acl Pcl Presentation
3/17
Functions ACL :
Prevent anterior movement of the tibia on thefemur.
Control normal rolling and gliding movementof the knee.
Functions PCL :
Primary stabilizer of the knee against posteriormovement of the tibia on the femur
Maintain rotary stability and as the kneescentral axis of rotation.
(Magee D. J, 2002)
-
8/2/2019 Acl Pcl Presentation
4/17
MECHANISMS OF INJURY
ACL : External rotation with abduction of theflexed knee/hyperextension of knee in internal
rotation. (Sports, MVA, falls, work-related
injuries)
PCL: severe rotational injury, dashboard injury
(knee is bent, and an object forcefully strikesthe shin backwards) or complete dislocation of
the knee.(Ebnezar J. , 2011)
-
8/2/2019 Acl Pcl Presentation
5/17
CLINICAL FEATURES
A "popping" sound at the time of injury
Knee swelling within 6 hours of injury due tohemarthrosis
Pain, especially when you try to put weight onthe injured leg or on certain activity. (walkingdownhill)
The knee feels unstable or may feel like itwants to slip backwards.
(Ebnezar J. , 2011)
-
8/2/2019 Acl Pcl Presentation
6/17
DIAGNOSISACL:
Physical assessment: Lachman Test, AnteriorDrawer Test & Pivot shift test
Radiographs: MRI and KT-1000 (higher
accuracy than clinical examination in detectingACL tears when multiple ligaments are torn)
PCL:
Physical assessment: Posterior Drawer Test
Radiographs: X-rays and MRI (clarifying thediagnosis and detecting any other structuresof the knee that may be injured)
-
8/2/2019 Acl Pcl Presentation
7/17
PHYSICAL ASSESSMENT
TEST HOW TO PERFORM INFERENCE
PIVOT SHIFTTEST
Patient is supine.
Knee is extended, with valgus stress
applied on the knee and the tibia is
internally rotated
The knee is slowly flexed.
If the tibias position onthe femur reduces as the
knee is flexed in the range of
30 to 40 degrees or if there
is an anterior subluxation
felt during extension the test
is positive for a tear of theACL.
LACHMAN S
TEST
The patient supine with the knee flexed
between 15 and 30 degrees.
The practitioner grips the outside of the
lower Femur (thigh) with the upper handand the inside of the upper Tibia with the
lower hand.
The Femur is stabilised with the upper
hand as the lower hand applies an anterior
force on the Tibia
A positive result is found if
the Tibia moves excessively
forward compared to the
healthy knee.Used in acute injuries of
knee where knee cannot be
flexed to 90
-
8/2/2019 Acl Pcl Presentation
8/17
TEST HOW TO PERFORM INFERENCE
ANTERIOR
DRAWER TEST
With the patient supine with the
injured knee bent to 90 degrees andthe foot flat on the table.
The practitioner may stabilise the foot
by sitting on it.
The practitioner will grasp the upper
Tibia (shin bone) with both hands.
They will then attempt to pull theTibia forwards, towards them.
A positive result is if the
Tibia moves excessivelyforwards (more than 6 to 8
mm).
All test should always be
compared with normal knee.
POSTERIOR
DRAWER TEST
Same as the Anterior Drawer Test but
tibia is pushed backwards.
Positive test indicates by the
movement of the tibia
backwards.
-
8/2/2019 Acl Pcl Presentation
9/17
DOCTOR MANAGEMENT
ACL: Surgery
ACL reconstruction
Using tendons from other parts of the body as asubstitute for the ACL; patella tendon graft andhamstring muscle tendon graft techniques.
Patella tendon graft procedure is the central 1/3 ofthe patella tendon is removed along with a piece ofbone at the attachment sites on the kneecap andtibia.
Hamstring graft procedure uses two tendons(semitendinosus or gracilis tendons)are taken fromthe hamstring muscles and wrapped togetherforming the new ACL.
-
8/2/2019 Acl Pcl Presentation
10/17
PCL: surgery
required in complete tears of the ligament
with other associated ligament injury.
Controversial due to the technical difficulty of
the surgery, because of the position of the PCL
in the knee. Trying to place a new PCL graft inthis position also difficult.
In arthroscopic surgery, the surgeon uses
several small incisions in the knee joint toreconstruct the ligament.
-
8/2/2019 Acl Pcl Presentation
11/17
PHYSIOTHERAPY TREATMENT
Rehabilitation after surgery
Patient immobilized in knee POP cast for 6-8
weeks.
Goals in initial stages:
minimize swelling
Decrease pain and inflammation
Control stiffness and prevent DVT
-
8/2/2019 Acl Pcl Presentation
12/17
Intervention during the initial stages:
Icing frequently/cryotheraphy
Elevating the affected knee
Compression bandage to control edema
Active exercise to ankle and toes
Knee swinging exercises with the patient
sitting at the edge of the bed/chair.
Leg hanging, small rhythmic active knee flexionand extension.
Speed of the movement is gradually increased to
gain greater mobility
-
8/2/2019 Acl Pcl Presentation
13/17
Goals in post-acute stages:
to regain full range of motion
improves strength, motion and aerobic
activity
gaining hamstring and quadriceps control
Restore strength and dynamic stability
increased concentration on balance and
mobility.
-
8/2/2019 Acl Pcl Presentation
14/17
Intervention during the post-acute stages:
Isometric quadriceps exercises
Patients in long sitting position, keeps a soft rollbeneath the knee, and press it downwards.
Passive exercise
Feel heel drag: heel is dragged to the buttocks by
self assistive method.
-
8/2/2019 Acl Pcl Presentation
15/17
work on gait training (walking)
Gradual weight-bearing
gentle strengthening
aerobic work
patients on a stationary bicycle
strengthening exercise
balance and proprioceptive exercises.
Proprioceptive work progresses from static todynamic techniques including balance exercises
on the wobble board and eventually jogging on a
mini-tramp.
-
8/2/2019 Acl Pcl Presentation
16/17
Goals in functional stages:
Return to functional activities.
Intervention during the post-acute stages:
some sport-specific activities can be started.
light jogging
cycling outdoors
-
8/2/2019 Acl Pcl Presentation
17/17
REFERENCES
Ebnezar J. (2011)Essentials of Orthopedics for
Physiotherapists. New Delhi: Jaypee Brothers MedicalPublisher (P) Ltd.
Magee D. J. (2002) 4th edition Orthopedic PhysicalAssessment. Canada. Saunders.
Retrieved from:http://orthopedics.about.com/od/aclinjury/tp/acl.htm
Retrieved from:http://sportsci.org/encyc/aclinj/aclinj.html#7
Retrieved from:http://orthopedics.about.com/cs/kneeinjuries/a/pcl.htm
Retrieved from:http://orthoinfo.aaos.org/topic.cfm?topic=a00420
http://orthopedics.about.com/od/aclinjury/tp/acl.htmhttp://orthopedics.about.com/od/aclinjury/tp/acl.htmhttp://sportsci.org/encyc/aclinj/aclinj.htmlhttp://sportsci.org/encyc/aclinj/aclinj.htmlhttp://orthopedics.about.com/cs/kneeinjuries/a/pcl.htmhttp://orthopedics.about.com/cs/kneeinjuries/a/pcl.htmhttp://orthopedics.about.com/cs/kneeinjuries/a/pcl.htmhttp://orthopedics.about.com/cs/kneeinjuries/a/pcl.htmhttp://orthoinfo.aaos.org/topic.cfm?topic=a00420http://orthoinfo.aaos.org/topic.cfm?topic=a00420http://orthoinfo.aaos.org/topic.cfm?topic=a00420http://orthoinfo.aaos.org/topic.cfm?topic=a00420http://sportsci.org/encyc/aclinj/aclinj.htmlhttp://orthopedics.about.com/cs/kneeinjuries/a/pcl.htmhttp://orthopedics.about.com/cs/kneeinjuries/a/pcl.htmhttp://sportsci.org/encyc/aclinj/aclinj.htmlhttp://sportsci.org/encyc/aclinj/aclinj.htmlhttp://sportsci.org/encyc/aclinj/aclinj.htmlhttp://orthopedics.about.com/od/aclinjury/tp/acl.htm