Anterior Cruciate Ligament

ANTERIOR CRUCIATE LIGAMENT

Melissa Rozman

Common Sports InjuriesCommon Sports Injuries

HUMAN KNEE THE KNEE IS ONE OF THE LARGEST AND MOST COMPLEX JOINTS IN

THE BODY. THE KNEE IS ESSENTIALLY A HINGED JOINT THAT IS HELD TOGETHER

BY THE MEDIAL COLLATERAL, LATERAL COLLATERAL, ANTERIOR CRUCIATE, AND POSTERIOR CRUCIATE LIGAMENTS.

ON EITHER SIDE OF THE JOINT, BETWEEN THE CARTILAGE SURFACES ARE THE MEDIAL MENISCUS AND LATERAL MENISCUS. THEY ACT AS “SHOCK ABSORBERS.”

THE SMALLER BONE THAT RUNS ALONGSIDE THE TIBIA AND THE KNEECAP (PATELLA) ARE THE OTHER BONES THAT MAKE THE KNEE JOINT.

WHAT IS THE ACL? THE ACL IS ONE OF THE 4 MAIN LIGAMENTS WITHIN THE KNEE THAT

CONNECT THE FEMUR TO THE TIBIA (MCL, LCL, ACL, PCL.) THE ACL RUNS DIAGONALLY IN THE MIDDLE OF THE KNEE,

PREVENTING THE TIBIA FROM SLIDING OUT IN FRONT OF THE FEMUR, AS WELL AS PROVIDING ROTATIONAL STABILITY TO THE KNEE.

THE ACL IS ONE OF THE MOST COMMONLY INJURED LIGAMENTS OF THE KNEE.

APPROXIMATELY 200 000 ACL RECONSTRUCTIONS PREFORMED A YEAR.

50% OF ACL INJURIES OCCUR IN COMBINATION WITH DAMAGE TO THE MENISCUS.

ACL TEARS CAN BE PARTIAL, (WHICH DOESN’T REQUIRE SURGERY) OR COMPLETE.

WHAT ARE THE CAUSES OF ACL

TEARS?70% OF ACL INJURIES OCCUR THROUGH NON-CONTACT MECHANISMS SUCH AS PIVOTING, SHARP CUTS/TURNS, JUMPING AND LANDING UNEVENLY, OR SIDE STEPPING MANEUVERS.

ACL INJURIES ARE HAVE A HIGHER RISK WITH ATHLETES WHO PLAY BASKETBALL, FOOTBALL, VOLLEYBALL AND SOCCER.

SEVERAL STUDIES HAVE SHOWN THAT FEMALE ATHLETES HAVE A HIGHER RISK OF THIS INJURY THEN MALES BECAUSE OF THE DIFFERENCES IN PHYSICAL CONDITIONING, AND MUSCULAR STRENGTH.

http://www.youtube.com/watch?v=lpIOMuqXWrE

DOCTOR EXAMINATION

• X-ray• MRI• Movement Tests• Lachman's Test• Pivot Shift Test• Your doctor will evaluate your knee injury based on questions about pain, swelling, and giving way. Also if you

heard a painful "pop" or tear, or if your knee felt like it feel out of joint at the time of injury.

http://orthoinfo.aaos.org/topic.cfm?topic=a00297

2 Days Post-Op

1 Week Post-Op

3 Weeks Post-Op 1 Month Post-Op

2 Weeks Post-Op

-PREVENTION

-RECONSTRUCTION

-REHABILITATION

PREVENTION WHEN LOOKING AT ACL INJURY PREVENTION ATHLETES HAVE TO REMEMBER

THAT EACH INDIVIDUAL IS DIFFERENT, WHAT IS GOOD FOR ONE PERSON MAY NOT BE GOOD FOR ANOTHER.

ATHLETES CAN REDUCE THEIR RISK OF ACL INJURIES BY PERFORMING TRAINING DRILLS THAT REQUIRE BALANCE, POWER AND AGILITY.

ADDING EXERCISES, SUCH AS JUMPING, AND BALANCE DRILLS HELPS IMPROVE NEUROMUSCULAR CONDITIONING AND MUSCULAR REACTIONS AND ULTIMATELY SHOWS A DECREASE IN THE RISK OF ACL INJURY.

YOU CAN ALSO PREVENT ACL TEARS BY WARMING UP AND STRETCHING PROPERLY BEFORE AND AFTER ANY PHYSICAL ACTIVITY YOU ARE PARTICIPATING IN.

THERE ARE MANY ACL PREVENTION PROGRAMS YOU COULD BE APART OF TO LOWER YOUR RISK.

PREVENTION EXCERSIES

• 1.Single leg sit to stand

• 2.Single or double leg ball hamstring curl

• 3.Resisted side stepping (elastic tubing around knees and/or feet)

• 4.Walking lunges with torso rotation (slowly)

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RECONSTRUCTION

ACL TEARS ARE NOT USUALLY REPAIRED USING SUTURE TO SEW IT BACK TOGETHER BECAUSE THEY HAVE GENERALLY FAILED OVER TIME.

THERE ARE FOUR SURGICAL TREATMENTS TO REPAIR ACL TEARS:-PATELLAR TENDON AUTOGRAFT-HAMSTRING TENDON AUTOGRAFT-QUADRICEPS TENDON AUTOGRAFT-ALLOGRAFT TENDON AUTOGRAFT (TAKEN FROM A CADAVER)

PATELLAR TENDON AUTOGRAFT

CONSIDERED THE “GOLD STANDARD” THE MIDDLE THIRD OF THE PATELLAR TENDON OF THE PATIENT, ALONG THE

KNEECAP. THE RATE OF GRAFT FAILURE IS THE LOWEST OUT OF ALL TREATMENTS (1.9%)

HAMSTRING TENDON

AUTOGRAFT HAMSTRING TENDON ON THE INNER SIDE OF THE KNEE.

THIS CREATES A TWO- OR FOUR-STRAND TENDON GRAFT.

THERE ARE FEWER PROBLEMS WITH ANTERIOR KNEE PAIN OR KNEECAP PAIN AFTER SURGERY.

QUADRICEP TENDON

AUTOGRAFT THE QUADRICEPS TENDON AUTOGRAFT IS OFTEN USED FOR

PATIENTS WHO HAVE ALREADY FAILED ACL RECONSTRUCTION.

THE MIDDLE THIRD OF THE PATIENT'S QUADRICEPS TENDON AND A BONE PLUG FROM THE UPPER END OF THE KNEE CAP ARE USED.

ALLOGRAFT TENDON

AUTOGRAFT ALLOGRAFTS ARE GRAFTS TAKEN FROM CADAVERS AND ARE

BECOMING INCREASINGLY POPULAR. ALLOGRAFT OPTIONS INCLUDE THE PATELLAR TENDON AND THE

ACHILLES TENDON, WHICH ARE AVAILABLE WITH BONE BLOCKS .

http://www.youtube.com/watch?v=q96M0jRqn7k

REHABILITATION A FULLY HEALED ACL TEAR TAKES ANYWHERE FROM 9 MONTHS TO A

YEAR TO BE HEALED. YOU SHOULD SEE A PHYSIOTHERAPIST 10 DAYS AFTER YOUR SURGERY

AND THEN ONCE A WEEK FOR 3-6 MONTHS. AFTER APPROXIMATELY 6 MONTHS YOU SHOULD SEE YOUR PHYSIOTHERAPIST 2-3 TIMES A WEEK.

YOUR PHYSIOTHERAPIST WITH STRENGTHEN YOUR QUADRICEPS, HAMSTRING, AND CALF MUSCLES.

THE FOWLER KENNEDY SPORTS MEDICINE CLINIC IS ONE OF THE TOP SPORT REHABILITATION CENTERS IN CANADA.

http://www.youtube.com/watch?v=UxklUobyTq8

REHABILITATION EXERSICES

Stretching or Range of Motion Exercises

• 1. Hamstring Stretches

• 2. Quadriceps Stretch

Strengthening Exercises

• 1. Leg Extension Exercises and Straight Leg Raises

• 2. 1/4 Squats- Progressing from double leg to single leg

• 3. Step-ups- Forward and Lateral

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• http://fowlerkennedy.com/physiotherapy

• http://orthoinfo.aaos.org/topic.cfm?topic=a00297

• http://www.pamf.org/sports/king/kneerehab.html

• http://www.sportmed.ucalgary.ca/ACL

• http://www.pthealth.ca/conditions/knee-pain-treatment?ibp-adgroup=tierfour&gclid=CMaDy_fH_LsCFclcMgodRg4AUA

• http://www.youtube.com/watch?v=q96M0jRqn7k

• http://www.youtube.com/watch?v=lpIOMuqXWrE

• http://www.youtube.com/watch?v=UxklUobyTq8

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