Text Book Reading

(D)
Anterior Cruciate Ligament
Rupture

Fakhrun Nisa
111 2015 1120
SUPERVISOR:
dr. Ariyanto Arief, Sp.OT, M.Kes
ADVISOR:
dr. Stefan AGP Kambey
Stability of knee
Introduction
 The Anterior Cruciate Ligament (ACL) is one of four major
ligaments (ligaments connect bone to bone) of the knee
joint that coordinate function and promote stability of the
knee joint.

 In an adult knee, the ACL prevents forward movement of

the tibia. It also provides roughly 90% of stability in the
knee joint.
 Attachment
 On the Femur, the ACL is attached to:
a fossa on the posteromedial edge of the lateral
femoral condyle.
 Function of ACL
 primary (85%) restraint to limit
anterior
translation of the tibia.

 secondary restraint to tibial

rotation and
varus/valgus angulation at full
extension.
 Risk Factor to ACL rupture

 High-risk sports:
football, baseball, soccer, skiing, and
basketball
 Sex:

F>
M
 Foo

twe
ar:
 Clinical picture
 Non-contact injury:
- often occurs while changing direction

or landing
from a jump.
- "popping" noise.

-Within a few hours, a large

hemarthrosis develops.
- pain, swelling, and instability or giving

way of the knee.

- - unable to return to play.
 Clinical picture
 Contact and high-energy
traumatic injuries:
- often are associated with other

ligamentous and
meniscal injuries.
- - Terrible Triad !!
 Examinations
1.Inspection:
- immediate effusion >> intra-
articular trauma.

2.Assess ROM:
Lack of complete extension.

3.Palpation:
Any meniscus or collateral tears or
sprain.
 Lachman test: most sensitive test
 Pivot shift test:
 Anterior drawer test : least
reliable
 Investigations
 Laboratory
Studies
 Imaging

Studies
 Other Tests
 Laboratory Studies
Arthrocentesis (rarely
performed)
 Imaging
Studies:
 - Plain
 radiographs.
- MRI
* Gold standard
* 90-98%
sensitivity.
* identify bone
bruising.
Treatment
 Acute Phase
 Recovery

Phase
 Maintenance

Phase
 Acute Phase
Physical Therapy
Before any treatment, encourage
strengthening of the quadriceps and
hamstrings, as well as ROM exercises
 Acute Phase
 Non-Surgical intervention:
who are elderly or have a very low
activity level.
 Surgical intervention:

- surgical intervention be delayed at

least 3 weeks following injury to

prevent the complication of
arthrofibrosis.
 Recovery Phase
 Physical Therapy:
Therapy protocols divided into the following 4
categories:
Phase I: preoperative period when the goal is to
maintain full ROM.
Phase II (0-2 wk): The goal is to achieve full
extension, maintain quadriceps control, minimize
swelling, and achieve flexion to 90o.
Phase III (3-5 wk): Maintain full extension and
increase flexion up to full ROM.
Phase IV (6 wk): Increase strength and agility,
progressive return to
sports.
 Maintenance Phase
Physical Therapy
Once quadriceps strength reaches
65% of the opposite leg, sports-
specific activities may be 5-8
performed; weeks
>>>>>>>>>>>>>>>>>>>
The athlete may return to activity
when the 3-4
quadriceps strength has reached month
80% >>>
Re-growth to takes time, it may be 6
need >>>> month
 Lifestyle and home
remedies

-Rest
-Ice. at least every two hours for 20
minutes at a time.
-Compression
-Elevation
RICE principles (Rest, Ice, Compression, and Elevation)
 Complications
The 3 major categories of failure in an ACL
reconstruction

(1)arthrofibrosis (due to inflammation of the

synovium and fat pad),
(2)pain that limits motion,
(3)recurrent instability, secondary to
significant laxity in the reconstructed
ligament.
 Summary
 ACL is one of the ligament that stabilize the
knee.
 ACL tear is a popular injury in high risk sports.
 History & clinical examination is the most
important tools in diagnosis.
 MRI is the gold standard in diagnosis.
 The goal of surgery is to stabilize the knee.
 Success rate of ACL reconstruction is up to 95
%.
 Physiotherapy is an important factor in
treatment.