The knee joint is formed by the femur, tibia, and the patella. The anterior cruciate ligament (ACL) is one of the four main ligaments within the knee that connect the femur to the tibia, and is one of the most commonly injured. The knee is basically a hinged joint held together by the medial collateral (MCL), lateral collateral (LCL), posterior cruciate and ACL. The ACL is positioned diagonally at the knees middle, and prevents the tibia from slipping in front of the femur. The incidence of ACL damage is higher in people who participate in high-risk sports, like basketball, football, skiing and soccer. Injury often occurs during deceleration, coupled with cutting, pivoting or sidestepping movements and awkward landings.
Examination and recovery
Immediately after an ACL injury, patients typically experience pain, swelling, and instability. Within a few hours, patients generally have considerable swelling, a loss of full mobility, pain or tenderness in the joint, and discomfort walking.
When a patient appears with a suspected injury, a doctor will first order x-rays to look for potential fractures. A magnetic resonance imaging (MRI) scan may also be used to check the ACL and other knee ligaments. Meniscus cartilage, or articular cartilage. If the ACL is indeed torn, the doctor will note increased movement of the tibia as it relates to the femur. Another possible test for injury is the picot shift test. If the ACL is torn, the tibia will start to move forward if the knee is straightened fully and will shift back into the correct position with the femur when the knee is bent more than 30-degrees.
Recovery from a partially torn ACL is often good, with the rehabilitation period approximately three months. Complete ACL tears often have a much less favorable recovery. After a full tear, some patients are unable to participate in fast moving sports, while others have problems with normal activities like walking.
Treatment Considerations
In some cases, progressive physical therapy and rehabilitation activities can get the knee back to a state close to its original and educate the patient on instability prevention. This can be helped by incorporating a hinged knee brace. Those patients who choose to forego surgery may experience a second injury due to repetitive damage. Deciding against surgery is acceptable for some patients like those with partial tears and no instability, those with complete tears and no signs of instability, those who do light manual work or are mostly sedentary, and children whose growth plates are still open and may lead to bone growth problems.
Types of Surgery
Patellar tendon autograft the middle third of the patients patellar tendon is used, along with a bone plug from the shin and kneecap. Hamstring tendon autograft the semitendinosus hamstring tendon on the inner side of the knee is used to create the autograft. Quadriceps tendon autograft middle third of the quadriceps tendon and a bone plug from the upper end of the knee cap are used. Allografts Patellar tendon autografts taken from cadavers instead of from the patients themselves. Allografts have become popular in the last several years as they eliminate tendon harvesting from the patient but carry the increased risk of infection. Complications from all of these surgical options include infection, viral transmission, bleeding and numbness, blood clotting, instability, stiffness and kneecap pain.
by: Mark Sample
welcome to Insurances.net (https://www.insurances.net)
