Anterior Cruciate Ligament Injuries.pptx

in this ppt is about acl injury mechanism the operative and non operative management for that and recent advances for that

1. Anterior Cruciate Ligament Injuries: PT Assessment & Management Nishita Patel SY MPT

2. Outline Anatomy of knee and its ligaments Mechanisms of injury Grades of injury Symptoms Diagnostic evaluation Surgical management Non surgical management Physiotherapy assessment Rehabilitation R ecent advances/Guidelines

3. Anatomy

4. Prevalence Gender: F> M Common in 20-40 years age group Common Sports: Soccer , Football, Skiing, Basketball. Mostly twist injury

5. Why in female ? Anatomical Differences Knee Alignment Bone Structure Hormonal Factors Relaxin   Estrogen Muscular Differences Muscle Strength and Muscle Activation Movement Patterns Landing Mechanics Psychological Factors

6. Mechanism of Injury The ACL can be injured by having the tibia forced forward, the femur forced backward or some twisting movements . Common scenarios include: Having a planted foot and being tackled front on. Landing with a hyper extended knee. Quickly changing directions and twisting the body with the foot remaining planted. Being slide tackled from behind and forcing the lower leg forwards.

7. Feature Contact Injury Non-Contact Injury Cause Direct blow to the knee Forceful twisting or rotation of the knee Common Sports Football, hockey, basketball Basketball, soccer, volleyball, skiing Mechanism Valgus force, hyperflexion , hyperextension Planting the foot and rotating the knee Risk Factors Direct collision with another player Sudden changes in direction, jumping

8. G rades of injury

9. Symptoms

10. Diagnostic evaluation (MRI)

11. Diagnostic evaluation (MRI)

12. Diagnostic evaluation (ULTASONOGRAPHY )

13. ARTHOSCOPY

14. Manual Arthrometers : Lachmeter : A simpler, handheld device that measures knee laxity. Rolimeter : Another manual option with a different design. The KT-1000 arthrometer . It's a specialized device used to measure the amount of anterior-posterior displacement (laxity) of the knee joint, specifically related to the Anterior Cruciate Ligament (ACL). Advanced Robotic Arthrometers : DYNEELAX: Offers precise and standardized measurements with robotic control. GNRB: Another robotic option with advanced features.

15. Indications for Surgery No rigid criteria for patient selection> indications for ACL reconstruction: a complete or partial acute tear or chronic laxity Frequent episodes of the knee giving way (buckling) during routine ADL A positive pivot-shift test Injury of the MCL at the time of ACL injury to prevent lax healing of the MCL High risk of re-injury because of participation in high demand , high joint-load activities related to work, sports, or recreational activities

16. Surgical management ACL surgery typically involves reconstructing the torn ligament rather than repairing it. The main types of ACL reconstruction surgery are based on the type of graft used to replace the torn ligament

17. Relative C/Is to ACL Reconstruction Not very active person Can change habits: They can change their lifestyle to avoid risky Advance arthritis of knee joints Poor likelihood of complying with postoperative restrictions and adhering to a rehabilitation program

18. Assessment Personal information Name: Age Gender Occupation Address : Socio-economic condition : Chief complain : knee pain , feel instability while walking, or, pain while walking, difficulty in knee bending

19. History Contact injury Noncontact injury Past history : Medical history: Surgical history: if any around knee Family history- Personal history: Investigation :

20. Pain history : Site of pain: Onset: Duration of pain: Type of pain : Intensity : NPRS Aggravating factor Reliving factor :

21. On observation : Body built Posture Gait :may be antalgic gait Wasting : Swelling: present in acute Redness : Scar : On palpation : Tenderness Temperature Swelling / edema: present

22. On Examination : ROM MMT Girth or scar measurement

23. Special test Lachman test: Considered the gold standard for diagnosing acute ACL injuries. It involves assessing anterior tibial translation Anterior drawer test: Similar to the Lachman test but less sensitive. It involves pulling the tibia forward in relation to the femur. Pivot shift test: Evaluates rotational instability of the knee, indicative of ACL damage.

24. Functional outcomes

25. Immobilization and Bracing After ACL Reconstruction Why immobilize and brace? How long? Types of braces: Rehabilitative brace: Functional brace : Decision factors: Surgeon's preference. Type of ACL graft used. Overall knee health. Patient's ability to follow rehab plan. Bracing and knee movement: Brace might be locked straight initially. Gradually unlocked as knee flexibility improves. Worn during daily activities and sometimes sleep for early protection.

26. Weight-bearing after ACL surgery :

27. Non-Operative Management of Ligament Injuries Ligament injuries in the knee, such as sprains, partial tears, or even complete ruptures of a single ligament, can often be treated without surgery. This approach is known as non-operative management .

28. Kinesiophobia

29. Recent Advances in Physiotherapy for ACL Injuries Physiotherapy has made significant strides in managing ACL injuries. Here are some of the recent advancements : Plyometric exercises : Personalized Rehabilitation Programs: Earlier Return to Sport: Sport-specific drills : Virtual reality :

30. Reference