ACL/PCL injury

1
ACL/PCL injury

• Adam Spaulding, Ryan Steiner, Amelia Teffeteller

2
Pt. History

• 19 yr. old female
• Injury occurred at soccer practice earlier this
  morning.
• She went to pivot and her cleat/foot remained
  stationary and at the same time her teammate fell
  into the front of her leg.
• She felt and heard a loud pop in her knee and
  fell to the ground in pain.
• She now presents with swelling, pain, and
  instability

http//romesentinel.com/dailyImages/2009/10/22/200
91022-141021-001_medium.jpeg
3
ACL/PCL injury

• From the description of the method of injury
  given by the pt. and the special tests performed
  it is believed that the pt. may have suffered
  anterior cruciate and posterior cruciate ligament
  sprains.
• Imaging techniques would be beneficial to
  determine the grade and other possible tissue
  involvement in the knee.

4
Radiograph

• Radiographs are not the best imaging technique
  for diagnosing soft tissue injuries such as the
  anterior and posterior cruciate ligaments.
• However, given that she did undergo a traumatic
  injury it would be beneficial to see if there is
  any bony involvement in the injury.
• Radiographs provide a quick and relatively cheap
  view of the knee.
• Although the radiograph is not the best soft
  tissue imaging technique it can show potential
  tears of the ACL and PCL in the form of avulsion
  fractures.
• AP and lateral views of the knee would be most
  beneficial.

5
Avulsion of the intercondylar tubercle (arrow),
indicating injury of the anterior cruciate
ligament.
http//www.aafp.org/afp/991201ap/2599.html
6
Avulsion at the site of origin on the posterior
tibia (arrow), resulting from injury of the
posterior cruciate ligament.
http//www.aafp.org/afp/991201ap/2599.html
7
Post surgery radiographs

• Radiographs may also be implemented post surgery
  to monitor the integrity of the screws or bone
  plugs used in anchoring the ACL/PCL repairs.

8
Example of a metal tibial screw used in ACL
reconstruction.
http//factotem.org/library/database/Knee-Articles
/Knee-MRI-and-Xray-images.shtml
9
Ultrasound

• Pros
• Multiple Plane imaging
• Harmless at diagnostic levels
• Painless and non-invasive
• Inexpensive
• Portable
• Cons
• Reader dependent

10
Ultrasound

• Low cost
• High availability
• Sensitivity 96
• Specificity 98
• Reader dependent

Gebhard F., et. al. 1999
11
Ultrasound - ACL
ACL - ruptured
ACL - intact
Gebhard F., et. al. 1999
12
Ultrasound sagittal view
PCL - intact
PCL - ruptured
Suzuki S., et. al. 1991
13
Physical Therapy Relevance

• Pt is an athlete, so imaging choice that is quick
  and conclusive is most beneficial so appropriate
  rehab process can begin.
• If a severe enough sprain or rupture is present,
  surgery will be necessary before any rehab is
  done.
• Rehab must be aggressive to prepare pt for sport
  as soon as possible.

14
References

• Gebhard F, Authenrieth M, Strecker W et. al.
  Ultrasound evaluation of gravity induced anterior
  drawer following anterior cruciate ligament
  lesion. Knee Surg Sports Traumatol Arthrosc
  7(3)166-172, 1999.
• Suzuki s, et. al. Ultrasound diagnosis of
  pathology of the anterior and posterior cruciate
  ligaments of the knee joint. Arch Orthop Trauma
  Surg 110 200-203, 1991.
• http//factotem.org/library/database/Knee-Articles
  /Knee-MRI-and-Xray-images.shtml
• http//www.aafp.org/afp/991201ap/2599.html
• http//romesentinel.com/dailyImages/2009/10/22/200
  91022-141021-001_medium.jpeg