acl pcl presentation

8/2/2019 Acl Pcl Presentation

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SOFT TISSUE INJURY:

ACL/PCL

NURUL FARHANA BT HASHIM2010840364


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ANATOMY: ACL & PCL


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Functions ACL :

Prevent anterior movement of the tibia on thefemur.

Control normal rolling and gliding movementof the knee.

Functions PCL :

Primary stabilizer of the knee against posteriormovement of the tibia on the femur

Maintain rotary stability and as the kneescentral axis of rotation.

(Magee D. J, 2002)


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MECHANISMS OF INJURY

ACL : External rotation with abduction of theflexed knee/hyperextension of knee in internal

rotation. (Sports, MVA, falls, work-related

injuries)

PCL: severe rotational injury, dashboard injury

(knee is bent, and an object forcefully strikesthe shin backwards) or complete dislocation of

the knee.(Ebnezar J. , 2011)


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CLINICAL FEATURES

A "popping" sound at the time of injury

Knee swelling within 6 hours of injury due tohemarthrosis

Pain, especially when you try to put weight onthe injured leg or on certain activity. (walkingdownhill)

The knee feels unstable or may feel like itwants to slip backwards.

(Ebnezar J. , 2011)


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DIAGNOSISACL:

Physical assessment: Lachman Test, AnteriorDrawer Test & Pivot shift test

Radiographs: MRI and KT-1000 (higher

accuracy than clinical examination in detectingACL tears when multiple ligaments are torn)

PCL:

Physical assessment: Posterior Drawer Test

Radiographs: X-rays and MRI (clarifying thediagnosis and detecting any other structuresof the knee that may be injured)


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PHYSICAL ASSESSMENT

TEST HOW TO PERFORM INFERENCE

PIVOT SHIFTTEST

Patient is supine.

Knee is extended, with valgus stress

applied on the knee and the tibia is

internally rotated

The knee is slowly flexed.

If the tibias position onthe femur reduces as the

knee is flexed in the range of

30 to 40 degrees or if there

is an anterior subluxation

felt during extension the test

is positive for a tear of theACL.

LACHMAN S

TEST

The patient supine with the knee flexed

between 15 and 30 degrees.

The practitioner grips the outside of the

lower Femur (thigh) with the upper handand the inside of the upper Tibia with the

lower hand.

The Femur is stabilised with the upper

hand as the lower hand applies an anterior

force on the Tibia

A positive result is found if

the Tibia moves excessively

forward compared to the

healthy knee.Used in acute injuries of

knee where knee cannot be

flexed to 90


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TEST HOW TO PERFORM INFERENCE

ANTERIOR

DRAWER TEST

With the patient supine with the

injured knee bent to 90 degrees andthe foot flat on the table.

The practitioner may stabilise the foot

by sitting on it.

The practitioner will grasp the upper

Tibia (shin bone) with both hands.

They will then attempt to pull theTibia forwards, towards them.

A positive result is if the

Tibia moves excessivelyforwards (more than 6 to 8

mm).

All test should always be

compared with normal knee.

POSTERIOR

DRAWER TEST

Same as the Anterior Drawer Test but

tibia is pushed backwards.

Positive test indicates by the

movement of the tibia

backwards.


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DOCTOR MANAGEMENT

ACL: Surgery

ACL reconstruction

Using tendons from other parts of the body as asubstitute for the ACL; patella tendon graft andhamstring muscle tendon graft techniques.

Patella tendon graft procedure is the central 1/3 ofthe patella tendon is removed along with a piece ofbone at the attachment sites on the kneecap andtibia.

Hamstring graft procedure uses two tendons(semitendinosus or gracilis tendons)are taken fromthe hamstring muscles and wrapped togetherforming the new ACL.


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PCL: surgery

required in complete tears of the ligament

with other associated ligament injury.

Controversial due to the technical difficulty of

the surgery, because of the position of the PCL

in the knee. Trying to place a new PCL graft inthis position also difficult.

In arthroscopic surgery, the surgeon uses

several small incisions in the knee joint toreconstruct the ligament.


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PHYSIOTHERAPY TREATMENT

Rehabilitation after surgery

Patient immobilized in knee POP cast for 6-8

weeks.

Goals in initial stages:

minimize swelling

Decrease pain and inflammation

Control stiffness and prevent DVT


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Intervention during the initial stages:

Icing frequently/cryotheraphy

Elevating the affected knee

Compression bandage to control edema

Active exercise to ankle and toes

Knee swinging exercises with the patient

sitting at the edge of the bed/chair.

Leg hanging, small rhythmic active knee flexionand extension.

Speed of the movement is gradually increased to

gain greater mobility


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Goals in post-acute stages:

to regain full range of motion

improves strength, motion and aerobic

activity

gaining hamstring and quadriceps control

Restore strength and dynamic stability

increased concentration on balance and

mobility.


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Intervention during the post-acute stages:

Isometric quadriceps exercises

Patients in long sitting position, keeps a soft rollbeneath the knee, and press it downwards.

Passive exercise

Feel heel drag: heel is dragged to the buttocks by

self assistive method.


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work on gait training (walking)

Gradual weight-bearing

gentle strengthening

aerobic work

patients on a stationary bicycle

strengthening exercise

balance and proprioceptive exercises.

Proprioceptive work progresses from static todynamic techniques including balance exercises

on the wobble board and eventually jogging on a

mini-tramp.


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Goals in functional stages:

Return to functional activities.

Intervention during the post-acute stages:

some sport-specific activities can be started.

light jogging

cycling outdoors


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REFERENCES

Ebnezar J. (2011)Essentials of Orthopedics for

Physiotherapists. New Delhi: Jaypee Brothers MedicalPublisher (P) Ltd.

Magee D. J. (2002) 4th edition Orthopedic PhysicalAssessment. Canada. Saunders.

Retrieved from:http://orthopedics.about.com/od/aclinjury/tp/acl.htm

Retrieved from:http://sportsci.org/encyc/aclinj/aclinj.html#7

Retrieved from:http://orthopedics.about.com/cs/kneeinjuries/a/pcl.htm

Retrieved from:http://orthoinfo.aaos.org/topic.cfm?topic=a00420
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