Randi M. HaupertPED 488
“Anterior CruciateLigament”
1 of 4 major ligaments in the knee
Primary function is stabilization
Prevents extreme motion within the knee
http://www.orthoinfo.org/topic.cfm?topic=A00549
200,000 annual injuries
½ result in ACL reconstruction surgery
50% occur in correlation with meniscus, articular cartilage, or ligament damage
Able to perform DTL without a properly functioning ACL
Sports – Related Injury Motor Vehicle Accidents Falls Work – Related Injury
ACL TEARS OCCUR MOST FREQUENTLY WHEN PIVOTION OR
LANDING STRAIGHT LEGGED FROM A JUMP
Hyperextension: Over Straightening
More than 10° beyond normal extension
Skiing, volleyball, basketball, soccer, football
Pivoting (Inward Rotation of lower leg) : Plant and twist combination
Football, tennis, basketball, soccer
Other common sports
Wrestling, gymnastics, martial arts, running
• 80% “Non Contact” Injuries • Female athletes are at higher risk
•Most frequently opt for surgery
•Tom Brady, Tiger Woods
Position of the knee at time of injury
Direction of blow
Force of blow
Knee usually gives-out from underneath
“Pop” in the knee Pain and Swelling Discomfort while walking Reduced range of motion Physician Examination Instability of the knee
▪ Lachman Test
MRI Pain and swelling can
reduce within a couple weeks
http://www.google.com/imgres?imgurl=http://factotem.org/library/images/Knee-MRI-and-Xray-images/f5-MRI-fully-torn-ACL-side-view.jpg&imgrefurl=http://factotem.org/library/database/Knee-Articles/Knee-MRI-and-Xray-images.shtml&usg=__dPwX0fIVW5MhIkMdO3EtWxCmbe0=&h=496&w=372&sz=27&hl=en&start=0&sig2=ffm3jrvL9B96qowUXtcQiA&zoom=1&tbnid=gfK5_AwRSMV92M:&tbnh=152&tbnw=114&ei=Ff79TLitJ4a8lQef0Z2fCA&prev=/images%3Fq%3Dmri%2Bof%2Ba%2Btorn%2Bacl%26hl%3Den%26sa%3DG%26biw%3D1362%26bih%3D533%26gbv%3D2%26tbs%3Disch:1&itbs=1&iact=hc&vpx=541&vpy=156&dur=203&hovh=259&hovw=194&tx=106&ty=129&oei=Ff79TLitJ4a8lQef0Z2fCA&page=1&ndsp=15&ved=1t:429,r:3,s:0
Knee flexed 30° Pull tibia to assess anterior range of
motion
Positive: Increased forward ROM
http://www.youtube.com/watch?v=dH_jnTy1rNk&list=PL09D0DFA4E90D92B7&ind
ex=51&playnext=3
Not all ACL tears require surgery
“Do you routinely perform activities that normally require a functional ACL?”
“Is there knee instability?”
If ACL is not completely torn
Sedentary lifestyle or light manual work load
Growth plates
Physical Therapy and Rehabilitation
Very important
▪ Restores motion
▪ Builds up strength
▪ Improves stability of joint
▪ Learn techniques to keep from reinjuring
Individualized progression
Hinged knee brace
Many experience second injury
ACL Reconstruction
Tendon or ligament from patella or hamstrings
Standard treatment for young, active population
Patellar tendon graft Hamstrings graft Allograft
• 90% have no complications post – op• Concern with children: Can disrupt growth and
development
Jog at 4 months Road biking 4-5 months Run in a straight line at 5 months Agility drills with brace at 6-8
months Sport specific activities at 4-24
months
Strengthen muscles surrounding ACL to reduce risk of re-injury
Maintain (or lose) weight
Reduces stress on knees and lower extremities
Keeps blood circulation to reduce risk of developing clots post - op
Progressing too quickly (or slowly) during rehabilitation
Risk of re-injury Avoid twisting exercises
▪ Balancing exercises
▪ One leg weight bearing exercises
Avoid weight bearing lunges
Avoid elevation jumping exercises
Sports Medicine Physician
Work with Olympic athletes
http://www.ehealthmd.com/library/acltears/ACL_activities.html
www.orthoinfo.aaos.org/topic.cfm?topic=a00297
www.orthopedics.about.com/od/aclinjury/tp/acl.htm
Top Related