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 monthsRoad biking 4-5 monthsRun in a straight line at 5

monthsAgility drills with brace at 6-8

monthsSport 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