ANTERIOR CRUCIATE

LIGAMENT-INJURY
CAUSE OF 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 because of Differences in
- Physical conditioning
- Muscular strength
- Neuromuscular control
- pelvis and lower extremity
(leg) alignment
and
- the effects of estrogen on
ligament properties.
 ACL injuries occur in combination with damage to

-The meniscus
-Articular cartilage or
-Other ligaments

 Secondary damage may occur in patients who have

repeated episodes of instability due to ACL injury.

 With chronic instability, up to 90 percent of
patients will have meniscus damage when
reassessed 10 or more years after the initial injury.

 Similarly, the prevalence of articular cartilage

lesions increases up to 70 percent in patients who
have a 10-year-old ACL deficiency
 Grade 1 Sprains.
The ligament is mildly damaged . It has been slightly
stretched, but is still able to keep the knee joint stable.
 Grade 2 Sprains.
The ligament is stretched 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.
SYMPTOMS
 When ACL is injured , pt might hear a "popping"
noise.

 Other typical symptoms include:

-Pain with swelling.
-Loss of full range of motion
-Tenderness along the joint line
-Discomfort while walking
PHYSICAL EXAMINATION
INCLUDE
 ANTERIOR DRAWER TEST

 LACHMAN’S TEST

 PIVOT SHIFT TEST

 KT-2000 ARTHROMETER TEST

INVESTIGATIONS
 MRI
 Arthroscopy
TREATMENT

 NON-SURGICAL METHOD
 SURGICAL METHOD
 Immediately after injury
 R.I.C.E ( Rest Ice Compression Elevation ()
 Non surgical treatment
 Exercise (after swelling decreases and weight-bearing
progresses)
 Braces
 Rehabilitation Brace
 Functional Brace
Nonsurgical Treatment
 Nonsurgical management is indicated in patients
with
- partial tears and no instability symptoms
- complete tears and no symptoms of knee
instability
- Who do light manual work or live sedentary
lifestyles
- Whose growth plates are still open (children)
Surgical Treatment
 Timing of Surgery
 1) Swelling in the knee must go down to near-normal
levels
 2) Range-of-motion (bending and straightening) of the
injured knee must be nearly equal to the uninjured knee
 3) Good Quadriceps muscle strength must be present.
 Usually it takes a couple of weeks after injury before
ACL reconstruction can be performed.
 The presence of any associated injuries to the knee joint
involving cartilage, meniscus, or other ligaments may
change the time-frame for surgery.
Surgical Treatment
 ACL tears are not usually repaired using suture to
sew it back together, because repaired ACLs have
generally been shown to fail over time

 Therefore, the torn ACL is generally replaced by a

substitute graft made of tendon
 Patients treated with surgical reconstruction of the
ACL have long-term success rates of 82 %- 95%

 The goal of the ACL reconstruction surgery is to

prevent instability and restore the function of the
torn ligament, creating a stable knee.

 Recurrent instability and graft failure are seen in

approximately 8% of patients.
 Lauren H. Redler, M.D., Rebecca T. Brafman, B.A., Natasha
Trentacosta, M.D., Christopher S. Ahmad, M.D.(Department of
Orthopaedic Surgery, Columbia University Medical Center,
New York, New York, U.S.A.)
 Arthroscopy Volume 28, Issue 11, Pages 1710–1717,
November 2012
 Moises Cohen, M.D., Ph.D., Mario Ferretti, M.D.,
Ph.D., Marcelo Quarteiro, M.D., Frank B. Marcondes,
M.D., João P.B. de Hollanda, M.D., Joicemar T. Amaro,
M.D., Rene J. Abdalla, M.D., Ph.D.(Orthopedic Sports
Medicine Division, Department of Orthopaedic Surgery and
Traumatology, Universidade Federal de São Paulo–Escola
Paulista de Medicina, São Paulo, Brazil)
 Arthroscopy Volume 25, Issue 8, Pages 831–838, August 2009
Conclusions
 ACL reconstruction by use of the transphyseal

technique in an immature skeleton with a hamstring

autograft, with careful attention being paid to the
technique, resulted in good clinical outcomes and
no growth abnormalities.