Monday, 1 September 2014

ACL TEAR & PHYSIOTHERAPY MANAGEMENT :

ACL TEAR & PHYSIOTHERAPY MANAGEMENT :Anterior Cruciate Ligament (ACL) Injuries


One of the most common knee injuries is an anterior cruciate ligament sprain or tear.

Athletes suffer from this injury the most
If you have injured your anterior cruciate ligament, you may require surgery to regain full function of your knee. This will depend on several factors, such as the severity of your injury and your activity level.

Anatomy :


Three bones meet to form your knee joint: your thighbone (femur), shinbone (tibia), and kneecap (patella). Your kneecap sits in front of the joint to provide some protection.

Bones are connected to other bones by ligaments. There are four primary ligaments in your knee. They act like strong ropes to hold the bones together and keep your knee stable.
Collateral Ligaments

These are found on the sides of your knee. The medial collateral ligament is on the inside and the lateral collateral ligament is on the outside. They control the sideways motion of your knee and brace it against unusual movement.
Cruciate Ligaments

These are found inside your knee joint. They cross each other to form an "X" with the anterior cruciate ligament in front and the posterior cruciate ligament in back. The cruciate ligaments control the back and forth motion of your knee.

The anterior cruciate ligament runs diagonally in the middle of the knee. It prevents the tibia from sliding out in front of the femur, as well as provides rotational stability to the knee.

Description:


About half of all injuries to the anterior cruciate ligament occur along with damage to other structures in the knee, such as articular cartilage, meniscus, or other ligaments.

Injured ligaments are considered "sprains" and are graded on a severity scale.

Grade 1 Sprains. The ligament is mildly damaged in a Grade 1 Sprain. It has been slightly stretched, but is still able to help keep the knee joint stable.

Grade 2 Sprains. A Grade 2 Sprain stretches the ligament to the point where it becomes loose. This is often referred to as a partial tear of the ligament.

Grade 3 Sprains. This type of sprain is most commonly referred to as a complete tear of the ligament. The ligament has been split into two pieces, and the knee joint is unstable.

Partial tears of the anterior cruciate ligament are rare; most ACL injuries are complete or near complete tears.


 Cause :


acl injury
The anterior cruciate ligament can be injured in several ways:


  •     Changing direction rapidly
  •     Stopping suddenly
  •     Slowing down while running
  •     Landing from a jump incorrectly
  •     Direct contact or collision, such as a football tackle

Several studies have shown that female athletes have a higher incidence of ACL injury than male athletes in certain sports. It has been proposed that this is due to differences in physical conditioning, muscular strength, and neuromuscular control. Other suggested causes include differences in pelvis and lower extremity (leg) alignment, increased looseness in ligaments, and the effects of estrogen on ligament properties.

symptoms:

Symptoms of a severe and sudden (acute) anterior cruciate ligament (ACL) injury include:
  •     Feeling or hearing a "pop" in the knee at the time of injury.
  •     Sudden instability in the knee. ...
  •     Pain on the outside and back of the knee.
  •     Knee swelling within the first few hours of the injury.
  •     Limited knee movement because of swelling and/or pain.
  • Knee Giving Out/Instability

After an acute injury, you will almost always have to stop the activity you are doing, but you may be able to walk.
special tests:Abnormal Examination:
Your doctor can assess the ligaments of your knee with specific tests. The most commonly used tests to determine the presence of an ACL tear include:

  •     Lachman Test:    The Lachman test is performed to evaluate abnormal forward movement of the tibia. By pulling the tibia forward, your surgeon can feel for an ACL tear.
  •     Pivot Shift Maneuver:    The pivot shift is difficult to perform in the office, it is usually more helpful in the operating room with a patient under anesthesia. The pivot shift maneuver detects abnormal motion of the knee joint when there is an ACL tear present.

Test Results:

Your physician will also evaluate x-rays of the knee to assess for any possible fractures, and a MRI may be ordered to evaluate for ligament or cartilage damage. However, MRI studies may not be needed to diagnose an ACL tear. In fact, the physical examination and history are just as good as a MRI in diagnosing an ACL tear!


Nonsurgical Treatment:Nonsurgical management of isolated ACL tears is likely to be successful or may be indicated in patients:
  •     With partial tears and no instability symptoms
  •     With complete tears and no symptoms of knee instability during low-demand sports who are willing to give up high-demand sports
  •     Who do light manual work or live sedentary lifestyles
  •     Whose growth plates are still open (children)
  •  
  • EXERCISES AFTER INJURY TO THE ANTERIOR CRUCIATE LIGAMENT (ACL) OF THE KNEE:
  •  
     HEEL SLIDES:
    to regain the bend (flexion) of the knee.
  •  QUADRICEPS SETTING
    to maintain muscle tone in the thigh (quadriceps)muscles and straighten the knee.

     
  • HEEL PROP
    to straighten extend the knee
  • STRAIGHT LEG LIFT
    The quality of the muscle contraction in this exercise
    is what counts the most, not just the ability to
    lift the leg!  
  • stationary bicycle
  •  
  • standing hamstring curl :
     
  • hip abduction:

  • standing toe raise: 
  •  
  • wall slides:

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