Anterior Cruciate Ligament Injury
Anterior Cruciate Ligament Injury
HPE 101
February 22, 2010
The anterior cruciate ligament, or ACL, is one of four major knee ligaments. The ACL is critical to knee stability, and people who injure their ACL often complain of symptoms of their knee giving-out from under them. Therefore, many patients who sustain an ACL tear opt to have surgical treatment of this injury. An ACL tear is most often a sports-related injury. ACL tears can also occur during rough play, mover vehicle collisions, falls, and work-related injuries. About 80% of sports-related ACL tears are "non-contact" injuries. This means that the injury occurs without the contact of another athlete, such as a tackle in football. Most often ACL tears occur when pivoting or landing …show more content…
from a jump. The knee gives-out from under the athlete when the ACL is torn. Female athletes are known to have a higher risk of injuring their anterior cruciate ligament, or ACL, while participating in competitive sports. Unfortunately, understanding why women are more prone to ACL injury is unclear. The diagnosis of an ACL tear is made by several methods. Patients who have an ACL tear often have sustained an injury to the knee. The injury is often sports-related. They may have felt a "pop" in their knee, and the knee usually gives-out from under them. ACL tears cause knee swelling and pain. On examination, your doctor can look for signs of instability of the knee. These special tests place stress on the ACL, and can detect a torn ligament. An MRI may also be used to determine if the ligament is torn, and also to look for signs of any associated injuries in the knee.ACL tears do not necessarily require surgery. There are several important factors to consider before undergoing ACL surgery. First, do you regularly perform activities that normally require a functional ACL? Second, do you experience knee instability?
If you don't do sports that require an ACL, and you don't have an unstable knee, then you may not need ACL surgery. The is also a debate about how to treat a partial ACL tear. If the ACL is not completely torn, then ACL reconstruction surgery may not be necessary. Many patients with an ACL tear start to feel better within a few weeks of the injury. These individuals may feel as though their knee is normal again, but the problems with instability may persist.
The usual surgery for an ACL tear is called an ACL reconstruction. A repair of the ligament is rarely a possibility, and thus the ligament is reconstructed using another tendon or ligament to substitute for the torn ligament. The are several options for how to perform ACL surgery. ACL reconstruction surgery uses a graft to replace the ligament. The most common grafts are autografts using part of your own body, such as the tendon of the kneecap (patellar tendon) or one of the hamstring tendons. Other good choices include allograft tissue, which is donor material. Repair surgery generally is only used in the case of an avulsion fracture (a separation of the ligament and a piece of the bone from the rest of the bone). In this …show more content…
case, the bone fragment connected to the ACL is reattached to the bone. ACL surgery is done by making small incisions in the knee and inserting instruments for surgery through these incisions (arthroscopic surgery) or by cutting a large incision in the knee (open surgery).ACL surgeries are done by orthopedic surgeons. Many orthopedic surgeons use arthroscopic surgery rather than open surgery for ACL injuries because it is easy to see and work on the knee structures, it uses smaller incisions than open surgery, it can be done at the same time as diagnostic arthroscopy (using arthroscopy to determine the injury or damage to the knee), it may have fewer risks than open surgery. Arthroscopic surgery is performed under spinal or general anesthesia. During arthroscopic ACL reconstruction, the surgeon makes several small incisions-usually two or three- around the knee. Sterile saline (salt) solution is pumped into the knee through one incision to expand it and to wash blood from the area. This allows the doctor to see the knee structures more clearly. The surgeon inserts an arthroscope into one of the other incisions. A camera at the end of the arthroscope transmits pictures from inside the knee to a TV monitor in the operating room. Surgical drills are inserted through other small incisions. The surgeon drills small holes into the upper and lower leg bones where these bones come close together at the knee joint. The holes form tunnels through which the graft will be anchored. The surgeon will take the autograft (replacement tissue) at this point. If it comes from the knee, it will include two small pieces of bone called "bone blocks" on the ends of the tissue. One piece of bone is taken from the kneecap and the other piece is taken from a part of the lower leg bone near the knee joint. If the autograft comes from the hamstring, bone blocks are not taken. The graft may also be taken from a deceased donor (allograft). The graft is pulled through the two tunnels that were drilled in the upper and lower leg bones. The surgeon secures the graft with screws or staples and will close the incisions with stitches or tape. The knee is bandaged, and you are taken to the recovery room for 2 to 3 hours. During ACL surgery, the surgeon may repair other injured parts of the knee as well, such as ligaments, cartilage, or broken bones.
Arthroscopic surgery is often done on an outpatient basis, which means that you do not spend a night in the hospital. Other surgery may require staying in the hospital for a couple of days. To care for your incision while it heals, you need to keep it clean and dry and watch for signs of infection. Physical rehabilitation after ACL surgery may take several months to a year. The length of time until you can return to normal activities or sports is different for every person. It may range from 4 to 6 months. About 60% of people who have ACL surgery return to the full level of activity they had before their injury. But between 80% and 90% of people who have ACL surgery have favorable results, with reduced pain, good knee function and stability, and a return to normal levels of activity. ACL repair is usually successful for an ACL that has torn away from the upper or lower leg bone (avulsion).Between 3% and 10% of people who have ACL surgery still have knee pain and instability and may need another surgery (revision ACL reconstruction). Revision ACL reconstruction is generally not as successful as the initial ACL reconstruction. The rehabilitation process is the most important part of the surgery. There is a long and rigorous process involved in getting back to one hundred percent. The doctor will start the patient on the rehabilitation program, which is broken down into phases:
Phase 1: This step is called the early rehabilitation phase. This is basically the things that were covered in short term, things to reduce pain and swelling while gaining movement.
Phase 2: This phase covers weeks 3 and 4. At this point the pain should be subsiding and the patient will be ready to try more things that their knee isn’t willing perform. That is why there is a lot of emphasis put on joint protection during this step. The patient will be able to start doing exercises such as mini wall sits and riding stationary bikes. The aim of this is to be able to bend the knee 100 degrees.
Phase 3: This phase is known as the controlled ambulation phase and it covers weeks 4 to 6. At this point the patient will be doing the same exercises from phase 2 plus some more challenging ones. The patient will try to get their knee to bend 130 degrees during this stage. The aim during this period is to focus heavily on improving balance.
Phase 4: This is the moderate protection phase and it covers weeks 6 to 8. In this period the patient will try to obtain full range of motion as well as increase resistance for the workouts.
Phase 5: This is the light activity phase and it covers weeks 8 to 10. This period will place particular emphasis on strengthening exercises with increased concentration on balance and mobility.
Phase 6: This is the return to activity phase and it lasts from week 10 until the target activity level is reached. At this point the patient will be able to start jogging and performing moderately intense agility drills. Somewhere between month 3 and month 6 the surgeon will probably request that the patient perform physical tests so s/he can monitor the activity level. When the doctor feels comfortable with the progress of the patient, s/he will clear that person to resume a fully active lifestyle.
ACL injuries occur when an athlete rapidly decelerates, followed by a sharp or sudden change in direction (cutting).
ACL failure has been linked to heavy or stiff-legged landing; as well as twisting or turning the knee while landing, especially when the knee is in the valgus (knock-knee) position.Women in sports such as football (soccer), basketball, tennis and volleyball are significantly more prone to ACL injuries than men. The discrepancy has been attributed to differences between the sexes in anatomy, general muscular strength, reaction time of muscle contraction and coordination, and training techniques. A recent study suggests hormone-induced changes in muscle tension associated with menstrual cycles may also be an important factor ). Women have a relatively wider pelvis, requiring the femur to angle toward the knees .The majority of ACL injuries occur in athletes landing flat on their heels. The latter directs the forces directly up the tibia into the knee, while the straight-knee position places the lateral femoral condyle on the back-slanted portion of the tibia. The resultant forward slide of the tibia relative to the femur is restrained primarily by the now-vulnerable
ACL.
Works cited: http://www.sportsinjuryclinic.net/cybertherapist/front/knee/anteriorcruciate.htm http://www.ehealthmd.com/library/acltears/acl_whatis.html http://emedicine.medscape.com/article/89442-overview http://www.webmd.com/a-to-z-guides/anterior-cruciate-ligament-acl-injuries-topic-overview
HPE 101
February 22, 2010
The anterior cruciate ligament, or ACL, is one of four major knee ligaments. The ACL is critical to knee stability, and people who injure their ACL often complain of symptoms of their knee giving-out from under them. Therefore, many patients who sustain an ACL tear opt to have surgical treatment of this injury. An ACL tear is most often a sports-related injury. ACL tears can also occur during rough play, mover vehicle collisions, falls, and work-related injuries. About 80% of sports-related ACL tears are "non-contact" injuries. This means that the injury occurs without the contact of another athlete, such as a tackle in football. Most often ACL tears occur when pivoting or landing …show more content…
from a jump. The knee gives-out from under the athlete when the ACL is torn. Female athletes are known to have a higher risk of injuring their anterior cruciate ligament, or ACL, while participating in competitive sports. Unfortunately, understanding why women are more prone to ACL injury is unclear. The diagnosis of an ACL tear is made by several methods. Patients who have an ACL tear often have sustained an injury to the knee. The injury is often sports-related. They may have felt a "pop" in their knee, and the knee usually gives-out from under them. ACL tears cause knee swelling and pain. On examination, your doctor can look for signs of instability of the knee. These special tests place stress on the ACL, and can detect a torn ligament. An MRI may also be used to determine if the ligament is torn, and also to look for signs of any associated injuries in the knee.ACL tears do not necessarily require surgery. There are several important factors to consider before undergoing ACL surgery. First, do you regularly perform activities that normally require a functional ACL? Second, do you experience knee instability?
If you don't do sports that require an ACL, and you don't have an unstable knee, then you may not need ACL surgery. The is also a debate about how to treat a partial ACL tear. If the ACL is not completely torn, then ACL reconstruction surgery may not be necessary. Many patients with an ACL tear start to feel better within a few weeks of the injury. These individuals may feel as though their knee is normal again, but the problems with instability may persist.
The usual surgery for an ACL tear is called an ACL reconstruction. A repair of the ligament is rarely a possibility, and thus the ligament is reconstructed using another tendon or ligament to substitute for the torn ligament. The are several options for how to perform ACL surgery. ACL reconstruction surgery uses a graft to replace the ligament. The most common grafts are autografts using part of your own body, such as the tendon of the kneecap (patellar tendon) or one of the hamstring tendons. Other good choices include allograft tissue, which is donor material. Repair surgery generally is only used in the case of an avulsion fracture (a separation of the ligament and a piece of the bone from the rest of the bone). In this …show more content…
case, the bone fragment connected to the ACL is reattached to the bone. ACL surgery is done by making small incisions in the knee and inserting instruments for surgery through these incisions (arthroscopic surgery) or by cutting a large incision in the knee (open surgery).ACL surgeries are done by orthopedic surgeons. Many orthopedic surgeons use arthroscopic surgery rather than open surgery for ACL injuries because it is easy to see and work on the knee structures, it uses smaller incisions than open surgery, it can be done at the same time as diagnostic arthroscopy (using arthroscopy to determine the injury or damage to the knee), it may have fewer risks than open surgery. Arthroscopic surgery is performed under spinal or general anesthesia. During arthroscopic ACL reconstruction, the surgeon makes several small incisions-usually two or three- around the knee. Sterile saline (salt) solution is pumped into the knee through one incision to expand it and to wash blood from the area. This allows the doctor to see the knee structures more clearly. The surgeon inserts an arthroscope into one of the other incisions. A camera at the end of the arthroscope transmits pictures from inside the knee to a TV monitor in the operating room. Surgical drills are inserted through other small incisions. The surgeon drills small holes into the upper and lower leg bones where these bones come close together at the knee joint. The holes form tunnels through which the graft will be anchored. The surgeon will take the autograft (replacement tissue) at this point. If it comes from the knee, it will include two small pieces of bone called "bone blocks" on the ends of the tissue. One piece of bone is taken from the kneecap and the other piece is taken from a part of the lower leg bone near the knee joint. If the autograft comes from the hamstring, bone blocks are not taken. The graft may also be taken from a deceased donor (allograft). The graft is pulled through the two tunnels that were drilled in the upper and lower leg bones. The surgeon secures the graft with screws or staples and will close the incisions with stitches or tape. The knee is bandaged, and you are taken to the recovery room for 2 to 3 hours. During ACL surgery, the surgeon may repair other injured parts of the knee as well, such as ligaments, cartilage, or broken bones.
Arthroscopic surgery is often done on an outpatient basis, which means that you do not spend a night in the hospital. Other surgery may require staying in the hospital for a couple of days. To care for your incision while it heals, you need to keep it clean and dry and watch for signs of infection. Physical rehabilitation after ACL surgery may take several months to a year. The length of time until you can return to normal activities or sports is different for every person. It may range from 4 to 6 months. About 60% of people who have ACL surgery return to the full level of activity they had before their injury. But between 80% and 90% of people who have ACL surgery have favorable results, with reduced pain, good knee function and stability, and a return to normal levels of activity. ACL repair is usually successful for an ACL that has torn away from the upper or lower leg bone (avulsion).Between 3% and 10% of people who have ACL surgery still have knee pain and instability and may need another surgery (revision ACL reconstruction). Revision ACL reconstruction is generally not as successful as the initial ACL reconstruction. The rehabilitation process is the most important part of the surgery. There is a long and rigorous process involved in getting back to one hundred percent. The doctor will start the patient on the rehabilitation program, which is broken down into phases:
Phase 1: This step is called the early rehabilitation phase. This is basically the things that were covered in short term, things to reduce pain and swelling while gaining movement.
Phase 2: This phase covers weeks 3 and 4. At this point the pain should be subsiding and the patient will be ready to try more things that their knee isn’t willing perform. That is why there is a lot of emphasis put on joint protection during this step. The patient will be able to start doing exercises such as mini wall sits and riding stationary bikes. The aim of this is to be able to bend the knee 100 degrees.
Phase 3: This phase is known as the controlled ambulation phase and it covers weeks 4 to 6. At this point the patient will be doing the same exercises from phase 2 plus some more challenging ones. The patient will try to get their knee to bend 130 degrees during this stage. The aim during this period is to focus heavily on improving balance.
Phase 4: This is the moderate protection phase and it covers weeks 6 to 8. In this period the patient will try to obtain full range of motion as well as increase resistance for the workouts.
Phase 5: This is the light activity phase and it covers weeks 8 to 10. This period will place particular emphasis on strengthening exercises with increased concentration on balance and mobility.
Phase 6: This is the return to activity phase and it lasts from week 10 until the target activity level is reached. At this point the patient will be able to start jogging and performing moderately intense agility drills. Somewhere between month 3 and month 6 the surgeon will probably request that the patient perform physical tests so s/he can monitor the activity level. When the doctor feels comfortable with the progress of the patient, s/he will clear that person to resume a fully active lifestyle.
ACL injuries occur when an athlete rapidly decelerates, followed by a sharp or sudden change in direction (cutting).
ACL failure has been linked to heavy or stiff-legged landing; as well as twisting or turning the knee while landing, especially when the knee is in the valgus (knock-knee) position.Women in sports such as football (soccer), basketball, tennis and volleyball are significantly more prone to ACL injuries than men. The discrepancy has been attributed to differences between the sexes in anatomy, general muscular strength, reaction time of muscle contraction and coordination, and training techniques. A recent study suggests hormone-induced changes in muscle tension associated with menstrual cycles may also be an important factor ). Women have a relatively wider pelvis, requiring the femur to angle toward the knees .The majority of ACL injuries occur in athletes landing flat on their heels. The latter directs the forces directly up the tibia into the knee, while the straight-knee position places the lateral femoral condyle on the back-slanted portion of the tibia. The resultant forward slide of the tibia relative to the femur is restrained primarily by the now-vulnerable
ACL.
Works cited: http://www.sportsinjuryclinic.net/cybertherapist/front/knee/anteriorcruciate.htm http://www.ehealthmd.com/library/acltears/acl_whatis.html http://emedicine.medscape.com/article/89442-overview http://www.webmd.com/a-to-z-guides/anterior-cruciate-ligament-acl-injuries-topic-overview