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Anterior Cruciate Ligament Injuries

The anterior cruciate ligament (ACL) stabilizes the knee and prevents excessive rotation of the tibia. ACL injuries are common, especially in sports involving quick changes in direction. Mechanisms usually involve sudden deceleration or impact. Grades range from mild stretches to complete tears. Treatment depends on activity level, from physiotherapy and bracing for sedentary individuals to prehabilitation and surgery for those with intense physical demands. The main goals are to alleviate symptoms, restore function, and minimize complications.

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Almas Prawoto
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78 views16 pages

Anterior Cruciate Ligament Injuries

The anterior cruciate ligament (ACL) stabilizes the knee and prevents excessive rotation of the tibia. ACL injuries are common, especially in sports involving quick changes in direction. Mechanisms usually involve sudden deceleration or impact. Grades range from mild stretches to complete tears. Treatment depends on activity level, from physiotherapy and bracing for sedentary individuals to prehabilitation and surgery for those with intense physical demands. The main goals are to alleviate symptoms, restore function, and minimize complications.

Uploaded by

Almas Prawoto
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPTX, PDF, TXT or read online on Scribd
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Anterior Cruciate

Ligament Injuries

Knee Anatomy
Anterior cruciate ligament (ACL) one of four
stabilizing ligaments
Protects integrity of menisci and articular cartilage
ACL prevents excessive internal or external
rotation of the tibia on the femur

Epidemiology
An estimated 1 in 3,000
Females > Males
Incidence highest in
population aged 15-45
years old
Average return to full
activity is 6 to 8 months

Mechanism of Injury
Usually from a noncontact injury
(70%)
Common in any
physical activity
that requires quick
change in direction
or a contact sport
Soccer, basketball,
volleyball, football,
and skiing

Mechanism usually
involves sudden
deceleration, and
tibial torsion

Classifications
Injured ligaments are considered "sprains" and are graded on a severity
scale.
Grade 1 Sprains.The ligament is mildly damaged in a Grade 1 Sprain. It
has been slightly stretched, but is still able to help keep the knee joint
stable.
Grade 2 Sprains.A Grade 2 Sprain stretches the ligament to the point
where it becomes loose. This is often referred to as a partial tear of the
ligament.
Grade 3 Sprains.This type of sprain is most commonly referred to as a
complete tear of the ligament. The ligament has been split into two pieces,
and the knee joint is unstable.

Risk Factors
Individuals participating in high risk sports
Playing surface
Neuromuscular deficits of the female sex
Increased incidence of female injury is NOT
associated with sex specific hormones
Females tend to activate their quadriceps near full
knee extension, thus landing with smaller angles of
knee flexion than their male counterpart
Females show earlier neuromuscular fatigue

Injury Presentation
History
Excessive swelling
Decreased range of motion (ROM)

Physical Examination
Anterior Drawer Test:
The test is performed with the
patient in a relaxed supine position
with knees bent to approximately
90 degrees. The examiner sits on
the both feet of the subject and
places his hands around the upper
tibia of one leg. The thumbs of both
hands are on the supero-anterior
aspect of tibia.
From the starting position the
examiner pulls anteriorly on the
proximal tibia.
Excessive displacement of the tibia
anteriorly suggests that the ACL is
injured

Physical Examination
Lachmans Test:
The knee is flexed at 2030 degrees with the
patient supine.
The examiner should place one hand behind
thetibiaand the other grasping the patient's
thigh.
The tibia is pulled forward to assess the
amount of anterior motion of the tibia in
comparison to thefemur.
An intact ACL should prevent forward
translational movement ("firm endpoint")
while an ACL-deficient knee will demonstrate
increased forward translation without a
decisive 'end-point' - a soft or mushy endpoint
indicative of a positive test.
Compare both knees

Imaging
X-ray: will be taken to rule out any
injuries to a bone
An MRI allows us to see all of the soft
tissue of the kneethe ligaments,
the cartilage and the muscle. Any
tear in the ACL will show up clearly
on an MRI.

Management
The main goals of treatment for an
ACL tear are the following:
Alleviate symptoms
Restore function
Minimise complications.

Immediate conservative measures


include the RICE regimen:
R: rest (with crutches)
I: ice
C: compression bandaging
E: Elevation of the affected limb to
minimize acute swelling and
inflammation

Patients can be broadly divided into


the following 3 groups:
Sedentary
Intense dynamic demands
Moderate intensity demands

Sedentary individuals
The first group consists of sedentary
people who have low physical demands,
are poor surgical candidates, and/or are
not interested in pursuing high-level
treatment. Such patients may be best
treated with home physiotherapy
exercises, knee bracing, and activity
modification to minimise risk of instability
episodes.

Intense dynamic demands


Operation
Prehab (Gold-standard)

Implemented immediately after diagnosis


Decrease pain and swelling
Increase ROM, quad strength
Prehab allows for quicker post-operative return to
ADLs and physical activity

Rehab
focuses on decreasing pain and swelling,
while increasing ROM, strength, and
proprioception

Moderate intensity demand


Depending upon the severity of the
injury and the specific lifestyle
demands, formal physiotherapy and
customised ACL bracing may work
best for this group.
Activity modification may also be
necessary if these patients continue
to have instability episodes despite
this approach.

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