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CASE REPORT
RIGHT ACL AND MENISCUS TEAR
Andi Adirfah Aenaputri Ameriyani
Andi Risky Ramadani
Abdul Muha
Muhammad Radhi Siriwa
Supervisor Resident

dr. Dewi Kurniati, Sp.OT dr. Ardianto Arsadi Ali

dr. Alsyahrin Manggala Putra
dr. Akhmad Muhajir
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PATIENT IDENTITY

❑ Name : Mr. R
❑ Gender : Male
❑ Age : 24 years old
❑ Registration : 134896

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AUTOANAMNESIS
Chief Complaint : Feel unstable in the right knee
Unstable feeling in the right knee since 9 months ago. Complaints were also accompanied by
pain in the inner right knee which felt intermittent, did not radiate, was exacerbated when
walking and going down stairs. Complaints were experienced when the patient played futsal
and slipped when he was about to kick the ball with his feet rotated outwards. After the
incident the patient felt severe pain and swelling in his right knee
• There was history checked at Primaya Hospital then referred to Wahidin Hospital for
further treatment.
• Bone setter history 3 times.
• There was no history of hypertension.
• There was no history of diabetes mellitus.

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GENERAL STATUS AND VITAL SIGN

❑ General Status ❑ Vital Sign

• GCS 15 E4M6V5 • Blood Pressure : 120/80 mmHg
• Pulse Rate : 85 beats per min
• Respiratory Rate : 21 rates per min
• Temperature : 36.5 °Celcious
• NRS : 3/10

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CLINICAL FINDINGS

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CLINICAL FINDINGS

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LOCAL STATUS

Right Knee Region

❑ Look : Deformitas (-), swelling (-), haematoma (-), wound (-)
❑ Feel : Tenderness (-)
❑ Move : Active and passive movement of knee joint is 0 in extension and
138 in flexion
❑ NVD : Sensibility is good. Dorsalis pedis and posterior tibial arteries are
palpable. Capillary refill time <2 seconds.
❑ Special Test : Lachman test (+), Anterior drawer test (+).

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RADIOLOGIC FINDINGS

AP & Lateral View

of Right Knee

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RADIOLOGIC FINDINGS

Skyline
View of
Right Knee

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RADIOLOGIC FINDINGS

MRI Of Knee

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LABORATORY FINDINGS
Parameter Nilai Nilai Normal
WBC 7.100/mm3 4.000 – 11.000/mm3
HGB 16,9 g/dL 12 – 16 gr/dL
PLT 297.000/mm3 150.000 – 450.000/mm3
HCT 49% 37 – 48 %
GDS 87 mg/dl <140 mg/dl
Ureum 29 mg/dl 10 – 50 mg/dl
Kreatinin 0,75 mg/dl <1,1 mg/dl
SGOT 23 U/L <31 U/L
SGPT 17 U/L <32 U/L

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DIAGNOSIS

Right ACL and Mesniscus Tear

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MANAGEMENT

- Physiotheraphy
- Referred to Orthopaedic Surgeon

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DISCUSSION

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DEFINITION
ACL ➜ ligament in the knee that has the
main function of stabilizing the knee.

ACL RUPTURE ➜ ACL tissue tear

(Partial/Total) can be caused by direct or
indirect trauma.

Hsu, H., Siwiec, R.M., 2023. Knee Osteoarthritis, in: StatPearls. StatPearls Publishing, Treasure Island
(FL).
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EPIDEMIOLOGY
WORLDWIDE ➜ Annually incidence of ACL tears is
74.6 per 100,000 person.

INDONESIA ➜ Exact data regarding the incidence rate is

still lacking, however, the number of ACL surgeries
increased by 42% in 2019 compared to the previous year.

SPORT INJURY ➜ The common cause.

Svantesson E, Hamrin Senorski E, Webster KE, et al. Clinical outcomes after anterior cruciate ligament injury: panther symposium ACL injury clinical outcomes consensus group. Knee Surg Sports
Traumatol Arthrosc. 2020;28(8):2415-2434

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ANATOMY

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ETIOLOGY

Most ACL tears occur in athletes by noncontact mechanisms

versus contact mechanisms.

The most at-risk athletes for noncontact injury include skiers,

soccer players, and basketball players, while the most at-risk
athletes for contact injury are football players.

Hoogeslag RAG, Brouwer RW, Boer BC, de Vries AJ, Huis in ‘t Veld R. Acute Anterior Cruciate Ligament Rupture: Repair or Reconstruction? Two-Year Results of a
Randomized Controlled Clinical Trial. American Journal of Sports Medicine. 2019 Mar 1;47(3):567–77.

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RISK FACTORS

MODIFIABLE NON-MODIFIABLE
● Environmental ● Genetic risk factors
● Job ● Anatomical factors
● Activities ● Sex differences
● Previous injury
Smith , H. , Vacek , P. , Johnson , R. , Slauterbeck , J. , Hashemi , J. , Shultz , S. , & Bruce , D.( 2012 ). Risk factors for anterior cruciate ligament injury: A review of
the literature – part I: Neuromuscular and anatomic risk . Sports Health: A Multidisciplinary Approach, 4( 1 ), 69 – 78 .

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PATHOPHYSIOLOGY

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DIAGNOSIS

History Taking Physical Examination

Some Questions to ● Look

Ask: ● Feel
● Movement
● Chief complaint ● Neurovascular Distal
● Trauma history (NVD)
● Patient job
● Family history

Smith , H. , Vacek , P. , Johnson , R. , Slauterbeck , J. , Hashemi , J. , Shultz , S. , & Bruce , D.( 2012 ). Risk factors for anterior cruciate ligament injury: A review of the literature – part I: Neuromuscular and anatomic risk . Sports Health: A Multidisciplinary Approach, 4( 1 ), 69 – 78 .

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SPECIAL TEST: LACHMAN TEST

Smith , H. , Vacek , P. , Johnson , R. , Slauterbeck , J. , Hashemi , J. , Shultz , S. , & Bruce , D.( 2012 ). Risk factors for anterior cruciate ligament injury: A review of the literature – part I: Neuromuscular and anatomic risk . Sports Health: A Multidisciplinary Approach, 4( 1 ), 69 – 78 .

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ANTERIOR DRAWER TEST

Smith , H. , Vacek , P. , Johnson , R. , Slauterbeck , J. , Hashemi , J. , Shultz , S. , & Bruce , D.( 2012 ). Risk factors for anterior cruciate ligament injury: A review of the literature – part I: Neuromuscular and anatomic risk . Sports Health: A Multidisciplinary Approach, 4( 1 ), 69 – 78 .

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PIVOT SHIFT TEST

Smith , H. , Vacek , P. , Johnson , R. , Slauterbeck , J. , Hashemi , J. , Shultz , S. , & Bruce , D.( 2012 ). Risk factors for anterior cruciate ligament injury: A review of the literature – part I: Neuromuscular and anatomic risk . Sports Health: A Multidisciplinary Approach, 4( 1 ), 69 – 78 .

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DIAGNOSIS

MRI
It is usually considered as the main
modality, due to its 90-98% of sensitivity
to identify ACL tear.

Evans J, Nielson JI. Anterior Cruciate Ligament Knee Injuries. StatPearls. 2022.

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MANAGEMENT

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NON- OPERATIVE MANAGEMENT

1. The first weeks focus on resolving the inflammatory process and restoring range of
motion.
2. During the following months, it is important to restore neuromuscular control by
improving muscle strength, stability and proprioception
3. The last phase of rehabilitation concentrates on a return to the previous level of
activity, while also minimizing the risk of re-injury and other complications.

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OPERATIVE MANAGEMENT
✔ In general, surgical reconstruction is
recommended for an athletic individual with a
high activity level and an obvious need for
satisfactory knee function
✔ Arthroscopy is a technique that employs minimal
incision during surgical operation minimum,
where all procedures are carried out using
camera, without causing major knee injuries.
✔ Surgical treatment is normally performed using
arthroscopic reconstruction of the ACL using a
tendon autograft or allograf

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THANK YOU

DEPARTEMEN ORTOPEDI DAN TRAUMATOLOGI 23 MEI 2023