ACL Tears

Randi M. HaupertPED 488

Overview

• “Anterior Cruciate Ligament”

– 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

Key Components/ Factors of Topic

• 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

Causes

• Sports – Related Injury

• Motor Vehicle Accidents

• Falls• Work – Related Injury

ACL TEARS OCCUR MOST FREQUENTLY WHEN PIVOTION OR

LANDING STRAIGHT LEGGED FROM A JUMP

Sports Related Injuries

• 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

Severity

• Position of the knee at time of injury

• Direction of blow

• Force of blow

Signs/ Symptoms• 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

Lachman Test

• 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&index=51&playnext=3

Treatment

• 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

• 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

Surgery• 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

Post Surgery• 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

Benefits of Exercise

• 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

Risk with Exercise

• 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

How It Relates to Me

• Sports Medicine Physician

•Work with Olympic athletes

Works Cited

• 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