Anterior Cruciate Ligament

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Anterior Cruciate Ligament
Common Sports Injuries
Melissa Rozman
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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.

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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 doesnt require
  surgery) or complete.

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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?vlpIOMuqXWrE
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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?topica00297
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1 Week Post-Op
2 Days Post-Op
2 Weeks Post-Op
1 Month Post-Op
3 Weeks Post-Op
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-PREVENTION
-RECONSTRUCTION
-REHABILITATION
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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.

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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)

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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)

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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.

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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.

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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?vq96M0jRqn7k
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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?vUxklUobyTq8
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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?topica00297
• http//www.pamf.org/sports/king/kneerehab.html
• http//www.sportmed.ucalgary.ca/ACL
• http//www.pthealth.ca/conditions/knee-pain-treatm
  ent?ibp-adgrouptierfourgclidCMaDy_fH_LsCFclcMgo
  dRg4AUA
• http//www.youtube.com/watch?vq96M0jRqn7k
• http//www.youtube.com/watch?vlpIOMuqXWrE
• http//www.youtube.com/watch?vUxklUobyTq8