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ANTERIOR CRUCIATE LIGAMENT TEAR

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September 14, 2020 0 3 minutes, 49 seconds read
Dr. Ramneek Mahajan - Max Hospitals
Senior Director (Orthopaedics) & Head Joint Reconstruction (Hip & Knee) Unit
Orthopaedics and Joint Replacement, Arthroscopic Surgery, Arthroscopy & Sports Injury

Anterior cruciate ligament (ACL) is located in the center of the knee, that controls rotation and forward movement of the tibia (shin bone).

ACL rupture is a common sports related injury but can also occur in road traffic accidents, falls and work-related injuries occurring during changing the direction rapidly and during a jerky action like landing from a jump or stopping suddenly.

It is more commonly seen in female athletes.

ACL injury is often associated with damage to articular cartilage, meniscus or other ligaments.

GRADES OF INJURY

ACL tear can be classified into three grades:

   

Grade 1

Grade 2 Grade 3
Pathology  

Minor tear around the ligament

 

Single Bundle tear but not completely torn

-Fibres of ligament are completely torn

-Ligament completely torn into two parts

 

Examination

-Tenderness +

-Swelling +

 

 

-Increased anterior translation around the knee joint

-Tenderness +

-Swelling+

 

-Joint Instability 

-No end field

-Tenderness++

-Swelling++

Symptoms  

-Pain +

-No knee buckling

-Pain ++

-Difficulty in walking

-Pain

-Knee buckling +

 

MRI Findings

 

-Fluid around the ligament

 

-Fluid around ligament

-Partial disruption of the ligament fibres

 

-Complete disruption of fibres

 

CAUSES

An ACL tear is usually sudden and is regularly seen in high thrust sports. It often occurs:

  • An athlete plants a foot & suddenly shifts direction
  • When a person lands on one leg
  • When the hyperextended knee is hit directly
  • Repeated stress on the knee
  • Sudden change of movement
  • Due to a fall

RISK FACTORS

Gender 

The rate of ACL injuries is three times higher in females than in males

Athletes ACL tear commonly occurs in high thrust sports like:

  1. Football
  2. Basketball
  3. Volleyball
  4. Tennis

Previous ACL Injury 

The risk of re-tearing a previously repaired ACL is 15% more than the risk of tearing a normal ACL.

The risk of ACL tear in the opposite knee is also higher once the injury has occurred in the first.

Age Factor

Due to the active lifestyle & high participation in sports activities, age group of 15-45 is a vulnerable group for ACL tear

When to see a doctor

  • A loud “popping sound” in the knee joint
  • Severe pain around the knee
  • Knee buckling
  • Rapid Swelling

DIAGNOSIS

  • Medical history and a physical examination.
  • During examination, clinician checks all the structures of the injured knee, and compare them with the non injured knee.
  • MRI scan of the knee. Commonly there is damage to  the meniscus and other ligaments at the same time as the ACL.
  • X- ray are done to rule out bony avulsions a/w the tear.

TREATMENT

  • Initial management after an injury to the knee can help in reducing pain & swelling. This can be achieved by R.I.C.E. model of self-home care of the injury:
  • Rest the muscles and avoid activity causing contraction of the injured region
  • Ice pack application for around 20 minutes can reduce pain and inflammation
  • Compression wrap around the knee
  • Elevation of the limb

Surgery is generally recommended if patient wishes to get back to sports but it is not absolutely

ACL Reconstruction:

In general, this surgery is very successful, and it does stop the knee from repetitively dislocating and makes it feel stable.

Damaged Ligament is removed & is replaced with a segment of tendon. This replacement tissue is known as Graft.

necessary to have this ligament reconstructed. Treatment for an ACL tear depends on the patients need. Non-surgical treatment maybe effective for patients who having low functional demands such as elderly. Nonsurgical options include: [Text Box: ACL Reconstruction: In general, this surgery is very successful, and it does stop the knee from repetitively dislocating and makes it feel stable. Damaged Ligament is removed & is replaced with a segment of tendon. This replacement tissue is known as Graft.]

Sockets or tunnels are drilled into the thighbone and shinbone to accurately position the graft, which is then secured to your bones with screws or other fixation devices.

Rehabilitation

It is divided into 2 phases:

  1. Acute Phase/Conservative Management
  2. Postoperative Phase

Acute Phase

Goals:

  • ­-To reduce swelling
  • -To maintain muscle power
  • -To maintain blood circulation

Exercises:

  • -Static quads/SLR
  • -Ankle Movements
  • -Knee flexion/extension in sitting
  • -Patellar mobilizations
  • -Knee bending in prone
  • -Weight transfers in standing

Postoperative Phase

Goals:

  • ­-Educating the patient about the rehabilitation protocol
  • -Quadriceps exercises to reduce swelling
  • -Knee Swinging for early return of function
  • -Knee Strengthening
  • -To improve posterior stability of the knee

Exercises:

  • -Isometrics exercises
  • -Straight leg raises
  • -Range of motion

-Knee extension exercises:

  • Heel Props
  • Prone hang exercise

-Knee bending exercises:

  • Passive knee bending
  • Wall slides
  • Heel slides

-Strengthening Exercises: Once 100 degrees of flexion has been achieved you may begin to work on muscular strength.

This can be achieved by:

  • -Stationary Bicycle
  • -Swimming
  • -Treadmill

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