The Anterior Cruciate Ligament (ACL)
The anterior cruciate ligament (ACL) is a ligament named for the cross it forms with its counterpart, the posterior cruciate ligament (PCL). Along with two others—the medial and lateral collateral—these ligaments act as stabilizers of the knee joint. In general, ligaments are fibrous cords of dense regular connective tissue that connect bones across a joint, thereby stabilizing the joint and maintaining the bones in their proper anatomical alignment.
What is an ACL injury ? and How do they Occur ?
Certain motions like twisting and pivoting predispose the ligament to sprains, and in famous cases you hear of Tiger Woods or Tom Brady, to tears. Diagnosed in more than 250,000 athletes each year, ACL injuries are increasing in frequency. A sprain is a stretching and tearing of a ligament, and tears may be partial or complete depending on the severity of the injury.
Excessive strain to the knee joint is the major mechanism of injury. Implicated movements include:
- Torquing and twisting motions as seen in soccer, skiing.
- Valgus stress, like a football tackle to the lateral lower extremity.
- When the tibia is thrust forward while the femur is stationary, e.g. when a skier falls
backwards on his skis. - Hyperextension of the knee
ACL Tear and Reconstruction Breakdown Video
Works Cited
- “Anatomy of an Injury: ACL Injuries.” PTontheNet.com – Online Education for Fitness Professionals, www.ptonthenet.com/articles/Anatomy-of-an-Injury-ACL-Injuries-3903.
- Drdavidgeier. “ACL Injury: The Injury and Its Significance.” Dr. David Geier - Sports Medicine Simplified, Dr David Geier, 3 Mar. 2018, www.drdavidgeier.com/injury-acl-significance/.
Ways to repair ACL tear:
ReplyDeleteA.Physical Therapy:
- partial ACL tear
- option is best for people that are generally inactive
engage in moderate exercise
recreational activités
play sports that put less stress on the knees
B. Arthroscopic Surgery:
- full ACL tear
- you're an athlete that wants to continue in your sport
- if the sports consist of jumping, cutting or pivoting
- if more than 1 ligament is torn and/ or the cartilage in the knee is also injured
- patient is young and active
- if during everyday activity the knee is buckling
C. Anterior Cruciate Ligament repair:
- partial ACL tear
- minimally invasive approach
- preserves torn ACL
2. Arthroscopic surgery how it works:
- arthroscopic surgery: a surgical procedure that consist of making small incision in the patients skin and inserting straw size instrument that contains a small lens and lighting system to magnify and illuminate the joint.
- attach the arthroscope to a screen to project on a television screen for surgeon, without "opening" up the joint cavity
- threw arthroscope, surgeon can make final diagnosis
- threw arthroscopic holes surgeon can insert tools to repair ligament within the knee
A. Anterior Cruciate Ligament Reconstructive Arthroscopic Surgery:
1. How it works:
- orthopeadic surgeon removes damaged ligament threw arthroscopic hole
- damaged ligament is replaced with an ACL graft
- types of grafts used: allograft and autografts
- Allograft: donor tissue
- Autograft:
A. Patellar Tendon: theoretical advantage is faster healing
B. Quadrupled Hamstring Tendon: minimize donor site morbidity and theoretically cause less anterior knee pain
C. Quadriceps Tendon: include a bone block from the patella
- drill tunnels into 10 o'clock position of femur and tibia to accurately position the graft
- graft is secured to femur and tibia with scews or another fixation device
- the graft serves as scaffolding on which new ligament tissue can grow
2. Recovery after surgery:
- insertion sites will heal within days
- physical therapy and/or a program at a rehabilitation center may help speed up recovery and strengthen the area around the joint for better stabilization
3. Pros for ACL reconstructive arthroscopic surgery:
- easier on patient than "open" surgery
- patients can have as outpatient
- home within hours after surgery
4. Cons to ACL reconstruction arthroscopic surgery:
- most common complication: instrument breakage ( < 1% occurrence)
- infection
- phlebitis = blood clots within a vein
- excessive bleeding or swelling
- damage to blood vessels or nerves
3. Anterior Cruciate Ligament Repair:
ReplyDelete1. How it works:
- suture ACL together
- place Kavlar-laced "scaffolding" around the injury site to provide additional support
- provide scaffolding for ligament to rebuild
- allows for earlier return to motion
- providing enhanced protection for ACL ligament to heal
2. Recovery after surgery:
- recovery time cut ing half compared to reconstructive surgery
3. Pros for ACL repair:
- less muscle atrophy
- faster recovery (by 1 month compared to ACL reconstructive surgery)
- preservation of nerves and blood vessels
- small pinholes into femur and tibia
- less chance of ACL failure
4. Cons for ACL repair:
- not appropriate for patients with fully tone ACL
Work Cited:
"Arthroscopy," OrthoInfo American Academy of Orthopaedic Surgeons: Last Reviewed: May 2010, Contributed and/or updated by: Rick Wilkerson, DO, peer-reviewed by: Colin F. Moseley, MD
A. Macaulay, MD, D. Perfetti, W. Levine, MD, Anterior Cruciate Ligament Graft Choices. Sports Health. 2012 Jan; 4(1): 63-68