Anterior Cruciate Ligament (ACL) Complete Tear

Anterior Cruciate Ligament (ACL) Complete Tear: 

Anterior Cruciate Ligament (ACL) Complete Tear February 10, 2012 Brittany Thomas Matt Weaver Morgan Young

Description: 

Description ACL complete tear occurs from both contact and noncontact injuries 1 Contact injuries: occurs from a valgus force applied to the lateral knee with a planted foot 1 Noncontact injuries: occurs on a planted foot with external tibial rotation 1

PowerPoint Presentation: 

Signs: Rotational instability indicated by positive pivot shift 2 Hemarthrosis Positive anterior drawer Symptoms: Significant pain Increased anterior tibio –femoral instability with WB Audible “pop” Image available at http://www.drnickcampos.com/health-newsletter/Meniscus.htm Accessed on February 10, 2012

Incidence: 

Incidence Females>Males (3:1) 1 Hormonal Differences Ie . Estrogen/Progesterone Anatomical Risk Factors 1 Femoral Notch Size ACL Size LE Alignment Ie . Genu Valgus Biomechanical Risk Factors 1 Neuromuscular control of joint Deceleration and change of direction

PowerPoint Presentation: 

Diagnosis Radiographic Findings: S ubchondral cortical plate thickness, T rabecular sclerosis, and Osteophytosis appears before or in association with changes in joint space width in conjunction to articular cartilage thickness in patients with ruptured knees 3 Prognosis Traditional rehabilitation in sagittal plane training ( ie running) requires 2 months + of rehabilitation 2 Dynamic rehabiltation for higher level athletes requires 12-15 months to return to full competitive level ( ie running and cutting/jumping) 4

Impact of Functioning: 

Impact of Functioning NWB Patient requires AD for ambulation Decreased knee Rom and quadriceps inhibition secondary to inflammation Cessation of high level work or sports 1

Role of Imaging: 

Role of Imaging MRI: most accurate for diagnosing ACL tears 5 92-100% accurate in non invasive detection Differentiates soft tissue detail and deciphers between partial vs complete ACL tear. CT- Arthogram : Can be used in the diagnosis of ACL tears when a patient cannot undergo MRI secondary to pacemaker, etc 6

PowerPoint Presentation: 

MRI of intact ACL MRI of Complete ACL Tear Image available at http://factotem.org/library/database/Knee-Articles/Knee-MRI-and-Xray-images.shtml t Accessed on February 10, 2012 Image available at http://www.sthscan.com/images/mri_img/mri_knee_01.jpg Accessed on February 10, 2012

Analysis of Imaging: 

Analysis of Imaging Complete ACL tear indicated by absence of black strip A partial tear would be manifested by thickening and increased signaling of the ligament. Image available at http://www.sthscan.com/images/mri_img/mri_knee_01.jpg Accessed on February 10, 2012

Alternate Imaging: 

Alternate Imaging Image availabe at http://www.melbourneradiology.com.au/ct-arthrography/gallery/album1/large/01-ct-arthrography-acl-tear-18.jpg Accessed on February 10, 2012 ACL tear secondary to horizontal dye across the articular surfaces Normal CT- arthrography of intact ACL would prevent dye from crossing the joint line 7

Impairments based on Imaging: 

Impairments based on Imaging Decreased ROM secondary to inflammation inhibiting quadricep contraction Increased instability with weight bearing activities Inability to participate in high level work or sporting activities

References: 

References Kisner C and Colby LA. The Knee. Therapeutic Exercise: Foundations and techniques. Philadelphia: F.A. Davis Company; 2007: 722-35. Voight ML, Hoogenboom BJ, Prentice WE. Rehab of the Knee. Mucsulskeletal Intervention: Techniques for Therapeutic Exercise. USA: McGraw Hill Companies; 2007. Buckland-Wright JC, Lynch JA, Dave BA. Early Radiographic features in patients with anterior cruciate ligament tears. Ann Rheum Dis. February 2000; 59: 641-46. Myer GD et al. Utizatioof modified NFL Combined Testing to Identify Funcitonal Defecits in Athletes Following ACL Reconstruction. JOSPT. 2011; 41(6);377-85. Unit 5. Knee. USA Imaging Course Notes. 2012. Unit 1. Principles of Orthopedic Imaging. USA Imaging Course Notes. 2012. 7. Magee DJ. Principles and Concepts. Orhopedic Physical Assessment 5 th ed . Canada: Saunders Elsevier;2008:60.

Questions: 

Questions 1. What other imaging modalities besides MRI and CT- Arthogram could be used to diagnose and ACL tear? 2. With early rehabilitation of a surgically repaired ACL tear, what precautions would you utilize in the acute stage?