anterior cruciate ligament injuries

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anatomy of knee, knee injuries, acl tear, ligament injuries

Text of anterior cruciate ligament injuries

  • Ahmad Hakimul Ashraf Bin Roslan Hakim 12DPY0010

    presented by Zhai

  • Knee jointhinge jointMade up by 4 bones knownas femur, tibia, fibula, andpatella.

  • Bony AnatomyLower LegTibiaFibulaUpper LegFemurPatella

    PatellaTibia & FibulaFemur

  • Thigh MusclesAnteriorQuadricepsVastus LateralisVastus MedialisVastus IntermediusRectus Femoris

    PosteriorHamstringsBiceps FemorisSemitendinosusSemimembranosus

  • Lower Leg MusclesAnterior Tibialis Anterior

    MedialTibialis AanteriorExtensor Digitorum LongusExtensor Hallucis Longus


    PosteriorGastrocnemiusSoleusTibialis Posterior

  • LigamentsMedial Collateral Lateral Collateral Anterior Cruciate Posterior CruciateMeniscusMedialLateral

  • ACL reconstruction is a surgical tissue graft replacement of the ACL.

    To restore its functions after an injuryTorn ligament cant simply be repaired by sewing it togetherThe torn ligament will be remove before the graft inserted.The surgeon usually perform an arthroscopic procedure but some of them prefer to open the knee.

  • Type of Graft

  • Grafting procedures

  • Deep Vein Thrombosis (DVT)Occurs when blood clots flow into deep vein of the leg.DVT may cause the leg to become swelling, warmth, and painful.

    InfectionsChance of getting is very lowAntibiotic will be given before and after surgery to prevent this complication.

    StiffnessThe excessive scaring inside the knee joint after surgery can lead to the stiffness.ROM exercise after the surgery is improtant to prevent it.

  • Rehabilitation ProgramPhysiotherapy play an important role in this programBegin immediately after surgery.Involves in crutches training, teaching the exercise (isometric) and attempt the patient to lift their leg independently.By one week almost all the patient will be able to lift their leg without assistance and by the second week they can walk without crutches.They will need an immobilizer such as knee ranger depend on the surgery and the preference of the surgeon.

  • Post- surgical ProgramOne of the examples of rehabilitation program :

    Phase 1 This period is called Early Rehabilitation This phase focused more on decreasing the pain and swelling following surgery.The exercise in this phase focused more on improving the ROM and promote muscle activities and strength.Improve the blood circulation by using Ankle Pumps and Ankle Circle exercise.Example exercise is SQE and SLR.

  • Phase 2 More attention is placed on joint protection as the pain had mostly disappeared.The patient should able to bend the knee 0 100 degreesExercise balancing activities can be performed.Gait training using parallel bar and also the treadmill if patient able.

    Phase 3 Also know as controlled ambulation phaseExercises on this phase includes all the former exercise plus few more depend on patient abilities.Teach more balance activities.

  • Phase 4 Also known as moderate protection phase.Being able to do full range of motion.Gradually increase the weight to give more resistance on existing exercise

    Phase 5 Known as light activity phaseEmphasis on strengthening exs and concentration more on balance and mobility.

  • Final phase Should be begin at 10 week after surgery.This phase continues until the desired activities level is reach.If necessary ,using a functional brace during sport activities and work situation.

    After all this phase patient can return to their normal activities such as work, sport with a general guidelines to prevent the injury back.

  • Subjective Information

    Name : Mdm.NAge: 52 years oldSex : FemaleRace : MalayOccupation: teacherMRN : 424424D.O.A : D.O.AX: DR. Diagnosis : Rt. Facial palsyDR. MX :

  • 1.Chief complaint Pt c/o discomfort at Rt. Side of facePt c/o difficulty to close her Rt. Eyes and mouth since 2/7 ago

    2.Current Hx :pt. woke up at 5am in the morning to prepare for her work when she realize he Rt. Side of face dropped and unevenShe then went to PSH with her husband on 10.4.14 @ 7.00am for further medical attention3.Past Hx :Pt. suffers massive headache on and off since 10 years agoThe pain became regular lately since 3/7ago She went to local clinic at larkin for medical attention but no improvement in her headache

  • Medical hxMigrain since 10years ago

  • 3.Social Hx :Nature of work : prolong walking and sittingMarital status : Married Smoking/alcohol: NILType of house: single storey terrace houceTransportation : car (auto)

    4.Medication Hx :Pain killer

  • Pain ScaleOn rest

  • Rt LtLt Rtswelling, and pain noted at Lt. knee joint

  • 6.Type of Pain :Dull aching pain at lt. knee jt.

    7.Aggravating Factor :Pain increase when flex over 90 degree.Prolong standing and walking will increase the pain.

    8.Ease factor :Supine ly. or relax / no movement on at the affected side.

    9.24 Hours :Pain increase during exerciseOther period, pt feel mild pain.

  • Objective Information

    1.General ObservationA mesomorph size Malay man come to physiotherapy department independentlyFull weight bearing with brace at Lt. legPt came with normal facial expressionPt is very cooperative

    2.Local ObservationPatient has scar at his Lt infrapatella regionswelling at Lt Knee joint

    3.On PalpationWarmness noted at Lt Knee joint.Tenderness grade 1 on medial and laterak side of knee Jt.No muscle spasm noted Lt.thigh and calf muscle

  • 4.Range of Motion

    Decrease knee flexion ROM in Lt Knee joint due to surgical pain

    JointMovementRight LeftActivePassiveActivePassiveKneeFlexionExtension FROM0FROM00-90 degree00-120 degree0

  • 5.Muscle Bulk

    swelling noted at 5cm from mid patellamuscle wasting at 10cm and 15cm from midpatella

    Region PointRightLeft(affected)Differences

    Supra patella5cm from mid-patella42.0cm44.0cm>2.0cm10cm from mid- patella51.0cm48.5cm

  • swelling noted at 5cm and 15cm from mid-patella of Lt. knee Jt.

    Region PointRightLeftDifferences

    Infra patella5cm from mid-patella38.0cm40.0cm>2.0cm10cm from mid-patella39.0cm36.0cm2.5cm

  • Indicates decrease in muscle power of left side knee jt. d/t muscle weakness

    datejointmusclegradesRt.Lt.16/10/2013Knee Jt.quadriceps5/54/5hamstring5/54/5 (within 90 degree ROM)

  • 7.Problem ListingPain at Left knee joint d/t post operative ACL reconstructionSwelling at Left knee joint d/t ACL reconstructionDecrease ROM at Left Knee joint d/t surgical painReduce muscle power d/t pain

  • Short Term GoalsTo Decrease pain To reduce swellingTo Increase ROM within 1 weekTo Regain muscle power/strength within 1 wek

    Long Term GoalTo prevent secondary complication e.g. tightness, muscle atrophy

  • Plan of TreatmentFaradic currentTo prevent muscle weaknessCPMTo increase ROM to spesific degree

    Strengthening exerciseto improve muscle power and ROMCryotherapy To reduce swelling and reduce pain

  • Intervention Inner range quadPt in supine., place towel under the knee, straighten the leg 30 reps 10 sec holdSqePt in supine., lock the knee., 30 reps 10 sec holdSlrPt in supine., lock the knee flex the hip., 30 reps 10 sec holdHeel slidePt in supine., flex the knee until pain range., 30 reps 10 sec holdCyclingpt cycle at static cycle, 10 minCryo cuffPt in long sitt.,lt. knee jt., 20 minutes

  • EvaluationPt claimed reduce in pain at lt. knee jt.Pt was able to perform all activities that had given

    ReviewKiv muscle bulk on next ass.Kiv rom on next ass.Kiv muscle power on next ass.

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