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