Vous êtes sur la page 1sur 4


400.000 rekonstruksi ACL/tahun
wanita : pria = 4.5 : 1
Biasanya sering berhubungan dengan ruptur meniskus (50% ruptur
meniskus lateral)
ACL kronis
Cedera sendi
Robek meniskus yang kompleks
Memberikan 85% dari stabilitas untuk mencegah proses pergerakan
anterior dari tibia ke arah femur.
Berperan sekunder sebagai kontrol rotasi tibia dan rotasi varus
maupun valgus
Ukuran 33mm x 11mm
Goes from LFC to anterior tibia
Two bundles
Anteromedial bundle (more isometric, tight in flexion)
Posterolateral bundle (tightest extension where it likely
contributes greatest to rotational stability)
Blood supply: middle geniculate artery
Innervation: posterior articular nerve (branch of tibial nerve)
Composition: 90% type I collagen &10% type III collagen
Strength: 2200 N (anterior)
felt a "pop"
Deep pain in knee
immediate swelling (70%) / hemarthrosis
Physical exam
Lachman's test most sensitive exam test
A= firm endpoint, B= no endpoint
Grade 1: < 5 mm translation
Grade 2 A/B: 5-10mm translation
Grade 3 A/B: > 10mm translation
PCL tear may give "false" Lachman due to posterior subluxation
Pivot shift
extension to flexion: reduces at 20-30 of flexion
patient must be completely relaxed (easier to elicit under

mimics the actual giving way event

Lachmans test & Anterior

Drawer Test

Usually normal
Segond fracture (avulsion fracture of the proximal lateral tibia) is a
pathognomonic for an ACL tear
ACL tear best seen on sagittal view
Bone bruising occurs in more than half of acute ACL tears
Middle 1/3 of LFC (sulcus terminalis)
Posterior 1/3 of lateral tibial plateau
Subchondral changes on MRI can persist years after injury

Physical therapy & lifestyle modifications
ACL reconstruction
Indications: younger, more active patients, children, older active
patients, Prior ACL reconstruction failure
Associated injuries:
MCL injury: allow MCL to heal (varus/valgus stability) and
then perform ACL reconstruction, varus/valgus instability
can jeopardize graft
Meniscal tear: perform meniscal repair at same time as
ACL reconstruction, increased healing rate when repaired
at the same time as ACL
Posterolateral corner injury: reconstruct at the same time
as ACL or as 1st stage of two stage reconstruction
Ligament repair: high failure rate
Revision ACL reconstruction, indications: failure to prior ACL
Femoral tunnel placement
Tibial tunnel placement
Graft placement
High tibial osteotomy
Revision ACL reconstruction
Graft Selection:
Bone patellar bone autograft
Quadruple hamstring autograft
Quadriceps tendon autograft
Early postoperative
aggressive cryotherapy (ice)
immediate weight bearing (shown to reduce patellofemoral pain)
emphasize early full passive extension (especially if associated
with MCL injury or patella dislocation)
early rehab
focus rehab on exercises that do not place excess stress on
appropriate rehab
isometric hamstring contractions at any angle
isometric quadriceps, or simultaneous quadriceps
and hamstrings contraction
active knee motion between 35 degrees and 90
degrees of flexion
emphasize closed chain (foot planted) exercises

isokinetic quadricep strengthening (15-30) during

early rehab
open chain quadriceps strengthening

Injury prevention
female athlete
neuromuscular training / plyometrics (jump training)
land from jumping in less valgus and more knee flexion
increasing hamstring strength to decrease quadriceps
dominance ratio
skier training
teach skiers how to fall
ACL bracing
no proven efficacy except for ACL-deficient skiers
Failure due to Tunnel Malposition
septic arthritis
Staph aureus most common
Presentation: pain, swelling, erythema, and increased WBC at 214 days postop
Treatment: perform immediate joint aspiration with gram stain
and cultures
immediate arthroscopic I&D
often can retain graft with multiple I&Ds and abx (6 weeks
Loss of motion & arthrofibrosis
Infrapatellar contracture syndrome
Patella Tendon Rupture
Patella fracture
Hardware failure
Tunnel osteolysis
Late arthritis
Local nerve irritation