Rehabilitation of anterior cruciate ligament

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Rehabilitation of anterior cruciate ligament

• Dr. Ali Abd El-Monsif Thabet

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Introduction

• Anterior Cruciate ligament (ACL)
• Attachments
• ? The ACL is attached to the anterior part of the
  intercondylar area of the tibia (tibial spine)
  where it extends superiorly and posteriorly to
  attach to the posteromedial aspect of the
  lateral femoral condyle
• The ACL may also be considered to consist of two
  separate bands that wrap around each other. Each
  of these bands is thought to have a different
  role in controlling tibiofemoral motion.

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• The ACL is supplied by genicular arteries, which
  are branches of the popliteal artery. A vascular
  plexus in the synovial membrane serves as a
  secondary source of tissue nutrition .
• The ACL is innervated by branches of the tibial
  nerve.
• Mechanoreceptors that resemble Golgi tendon
  organs are present throughout the ligamentous
  substance and create a reflex network influences
  the dynamic stabilization of the knee as muscle
  firing is initiated whenever the ACL is subjected
  to excessive load forces.

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• Biomechanics
• Kinetic
• The ACL can withstand tensile forces of up to
  1730 N before rupturing, the average tensile load
  on the ACL is 454 N during normal activities of
  daily living.

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Kinematics

• The kinematics of the knee are modulated by the
  restraining effects of the cruciate and
  collateral ligaments.
• Together, the cruciate ligaments provide the
  primary static restraint for antero-posterior
  stability of the tibiofemoral joint

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Pathomechanics

• The ACL is perhaps the most commonly injured
  ligament in the knee.
• Tears of the ACL occur in the midsubstance of the
  ligament about 75 percent of the time, with 20
  percent of the tears at the femur and 5 percent
  at the tibia.

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Mechanism of Injuries

• The most common mechanism of ACL injury involves

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Mechanism of Injuries

• External rotation of the femur on fixed tibia

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Unhappy triad O'Donohue

• The unhappy triad O'Donohue refers a sprain
  injury that involves three structures of the
  knee. These are the medial collateral ligament,
  anterior cruciate ligament, and the medial
  meniscus.
• Occur with contact

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• The severity of the injury indicated by the
  degree of laxity or instability.
• A grade 1 sprain
• A grade 2 sprain
• A grade 3 sprain

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Differential diagnosis

• The Lachman and Pivot shift tests are the most
  reliable noninvasive indicators of ACL damage

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Anterior drawer test
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Thank you