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    Acl Rupturer - Textbook

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    Fakhrun Nisa Witring
    acl rupture

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    Acl Rupturer - Textbook

    Uploaded by

    Fakhrun Nisa Witring
    66 views26 pages
    acl rupture

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    acl rupture

    Copyright:

    © All Rights Reserved
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    Download as pptx, pdf, or txt
    66 views26 pages

    Acl Rupturer - Textbook

    Uploaded by

    Fakhrun Nisa Witring
    acl rupture

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 26

    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.

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