Acl Injury Rm

8/17/2019 Acl Injury Rm

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ACL RUPTURE

IO/RM


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Anatomy Intra-articular ligament

Inserts just anterior to andbeteen tibialintercondylar eminences

Attac!es to "osteromedialas"ect o# lateral #emoralcondyle

$$ mm long% && mm indiameter

To bundles

anteromedial bundle "osterolateral bundle

ACL PCL

T!ig!t In'le(ion

AM AL

T!ig!t In

E(tension

PL PM


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'unction◦ "ro)ides *+, o# t!e stability to

"re)ent anterior translation o# t!etibia relati)e to t!e #emur

◦ acts as secondary restraint to tibialrotation and )arus/)algus rotation

.lood su""ly

◦

middle geniculate arteryInner)ation

◦ "osterior articular ner)e branc! o# tibialner)e0


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Clinical features

Mec!anism o# injury 1lo )elocity%deceleration and"i)otal injury% usually

non-contact2algus e(ternal rotation

or !y"ere(tension #orcein contact injury

Audible or #eeling o#3"o""ing4

Acute !aemart!rosis inyoung


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Clinical features

Inability to continue"laying s"ort

'emales moresusce"tible

56, o# ACL injuryassociated it! MCLinjury

*6, incidence o# lateralmeniscal injury it!

combined ACL1MCLIn c!ronic ACL de7ciency

medial meniscal injury ismore common


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Inside t!e 8nee joint

T!e ACL intact T!e ACL torn


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&9 LAC:MA;

C!ec8 PCL sag andmedial tibial ste"-o<be#ore t!e test

Maintain t!e 8nee inneutral rotation duringt!e test

At 56-$6 = 'le(ion

more sensiti)e0

ACL E(am


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ACL E(am

59 PI2OT >:I'TPlace a )algus stress%

a(ial load and internalrotation on t!e tibia ast!e 8nee is sloly ?e(ed9

In #ull e(tension% gra)ity"ulls t!e #emur "osteriorlyresulting in anteriorsublu(ation o# t!e tibia9

@it! #urt!er ?e(ion%

"osterior "ull by t!eiliotibial tract reduces t!etibia at about 56=1$6=s!i#t09


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$9 A;TERIOR RA@ER

T!e "atient s!ould be su"ineit! 8nees ? e(ed to B6=9

T!e #eet are stabilied in aneutral "osition and t!ee(aminer sits at t!e #ore#eeto# t!e "atient9

Dras" t!e 8nee it! bot!!ands t!e ti" o# your t!umbs

s!ould be just belo t!e jointline

T!e amount o# anteriortranslation o# tibia and Fualityo# end "oint is assessed9

ACL E(am


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Radiogra"!ic 'indings

A)ulsion o# t!eintercondylartubercle

Anteriordis"lacement o#t!e tibia it!res"ect to t!e#emur

>egond #racture


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ACL MRI

B+, accurate

Lo signal

intensity>aggital )ie

Acute injury !ig!

signal intensity on T5 image


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Management

Non OperativeAssociated it! !ig! incidence o#

instability in younger "atients

Potentially may lead to meniscaltear% articular injury andsubseFuent degenerati)e

c!anges


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Management

Operative◦ ACL reconstruction indications

in younger% more acti)e "atientsreduces incidence o# mensical orc!ondral injury0

older acti)e "atients Age GH6 is not

contraindication i# !ig! demand at!lete0ACL reconstuction #ailure

lattem"ted ligament re"air !as !ig!#ailure rate


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Management

OperativeTreatment of associated injuries

◦ MCL injury

nono"erati)e

allo MCL to !eal )arus/)algus stablity0 andt!en "er#om ACL reconstruction

)arus/)algus instability can je"ardie gra#t

◦ Meniscal tear

o"erati)e

"er#orm meniscal re"air at same time as ACLreconstuction

increased !ealing rate !en re"aired at t!esame time as ACL


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Surgical technique

Dra#t "laced in t!e #oot"rint o#t!e "osterolateral bundle o# ACL

;otc!"lasty is unnecessary i# t!e

gra#t is correctly "laced9Remo)e osteo"!ytes

Tensioned in e(tension


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Complications

Anterior "lacement o# t!e #emoraltunnel limits ?e(ion

Anterior "lacement o# t!e tibial

tunnel limits e(tensionDra#t ru"ture #rom im"ingement

'le(ion contracture and art!ro7brosis

'ailure o# 7(ationIn#ection

Osteoart!ritis


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T!an8s

Acl Injury Rm

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