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ACL TEARSubmitted by:Ave, EuniceBasco, AngeloJavier, Kristine RicamarieMendoza, JaimeReyes, JoshuaValencia, ArtPT diagnosisPt is unable to go to school and play basketball d/t difficulty in ambulation, standing and initiating sitting and standing 2 to muscle guarding, gait deviation and postural deviation associated with ACL tear (R) c medial meniscus tear (R); s/p ACL reconstruction c partial menisectomy of medial and lateral meniscus.PrognosisPatient has good prognosis d/t the following prognosticating factors:

(+)(-)Pt has good mm strengthPt is activeYoung age (22 y/o)Non-smokerPt has low levels of painPt underwent PT rehab weeks after surgery(+) gait deviation(+) postural deviation(+) muscle guardingSchool activities (requires prolonged standing)Basketball training

PIPIMPAIRMENTSACTIVITY LIMITATIONSPARTICIPATION RESTRICTION(+) intermittent, acute, localized aching pain on (R) knee

Difficulty in ambulationDifficulty performing stair negotiationDifficulty in initiating sitting and standingUnable to attend school Unable to play basketballNPIPIMPAIRMENTSACTIVITY LIMITATIONPARTICIPATION RESTRICTION(+) postural deviation(+) gait deviationMuscle guarding towards (R) knee flexion and extensionWeakness in bilateral hip flexors and (R) knee flexors and extensorsDifficulty playing basketballDifficulty in transportationDifficulty in stair negotiation Anticipated ProblemANTICIPATED PROBLEMPREDICTIVE CRITERIADecreased CV enduranceThe pt will be able to play 4 quarters of basketball without feeling any fatigueQuadriceps avoidance gaitGait analysis is normalMuscle atrophyLimb girth measurementShort Term GoalPt will be able to do 15 jump shots without experiencing any pain and limitation within 12 weeks of therapy.Long term goalsPt will be able to play basketball without limitation for four quarters of game within 6 months of therapy.Refined Problem ListREFINED PROBLEM LISTGOALTESTING CRITERIAMuscle weaknessThe pt. will be able to perform 15 jump shots without weakness after 12 weeksMMT:Hip flexors 5/5Knee flexors 5/5PainThe pt. will be able to run around the court without pain after 4 weeks.VRS of 0/10Limitation of motionThe pt. will be able to clear 4 flights of stairs without difficulty within 4 weeks.ROM: Hip flexion: 90 degreesKnee flexion: 135 degreesCV enduranceThe pt. will be able to do suicide drills 5 times without feeling fatigue within 8 weeks.15 minute walk testPlanSchedule: MWF, 3:00 PM 5:00 PM

Problem: Muscle weaknessStrategies: Provide therapeutic exercises (resistance ex.) to improve LE muscle strengthTactics: Bilateral squats x 10 rep x 3 sets BID

PlanProblem: Pain on (R) knee Strategies: Provide therapeutic modalities to reduce/ eliminate painTactics: Application of cold packs on (R) knee for 20 mins x every 2 hours x everyday

PlanProblem: Limitation of motionStrategies: To provide therapeutic exercise (ROME) to maintain and regain active mobility of (B) knee and hip range of motionTo provide mobilization technique to maintain and regain active mobility of (B) knee range of motionTactics: PROM AAROM AROM of (B) knee and hip muscles within pain free range 10 reps x 3 sets BID Patellar mobilization on knee x10 reps x 3sets, BID

PlanProblems: Decreased CV enduranceStrategies: To provide cardiovascular exercises to patient to prevent decrease in CV enduranceTactics: bilateral knee ergometer x 30 mins BIDHome InstructionsWear knee support for every gameAvoid abrupt rotation or pivotingAvoid forceful hyperextension of kneeWhen landing from a jump, absorb the force by bending the knees

PrecautionsAvoid 60-90 degrees of knee flexionProgress exercises more gradually with reconstruction with hamstring tendon graft than bone-patellar, tendon-bone graftProgress knee flexors strengthening exercises cautiously if a hamstring tendon graft was harvested and knee extensor strengthening if a patellar tendon graft was harvested.