Annually, 30 in 100,000 people in the UK suffer an anterior cruciate ligament (ACL) injury making it the most common knee ligament to be injured (National Health Service Choices 2013). Incidences of ACL injury are higher in females than in their male counterparts. Surgical reconstruction of the ACL is standard practice however it is yet to be determined what the most effective rehabilitation technique is. An untreated injury to a cruciate ligament or stiffness following surgical repair could alter its mechanical function within the knee joint, affecting both the damaged and normal ligaments (Moglo and Shirazi-Adl 2004).
Anatomy
The ACL is one of 5 ligaments of the knee joint, coursing from the distal femur to the proximal tibia as seen in figure 1. The fifth, anterolateral ligament (ALL) not seen in figure 1 is hypothesisd by Claes et al. (2013) as being injured at the same time as the ACL, reducing knee stability on leg rotation. The ACL has two bundles: the anteromedial (lengthens) and posterlateral (shortens) bundles which change length during flexion at the knee joint (Duthon et al. 2006).
Function
The ACLs function is to prevent unwarranted anterior tibial translation during flexion of the leg at the knee joint (Liu-Ambrose 2003). In anterior drawer the ACL is the primary restraint, providing 86% of the total resisting force to anterior displacement of the tibia at 30 and 90 degrees of flexion at the knee joint. Butler et al. (1980) quantifiably measured individual restraining forces of the anterior cruciate ligament in 14 cadaveric knee preparations by measuring the reduction in restraining force after the cutting of the ligament, defining its contribution. It was found in the intact knee joint the average restr...
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... surgery, it is physiotherapy techniques like OKC and CKC exercises that allow patients to regain full motility with the hope of attaining pre-injury status. Although there is still debate over each method of rehabilitation, cryotherapy is the standard strategy immediately after surgery and long term, for symptom prevention. However this alone is not sufficient to regain ROM in the knee joint, so physiotherapeutic techniques are still vital.
It is important to take in to consideration the patients individual requirements on the need to get back to sport. Combining OKC and CKC has been shown to be more efficacious long term than OKC alone. There is little research in to unilateral vertical jump in patients with ACL deficiency, however the implications after ACL reconstruction could be considered more beneficial for further developing rehabilitative treatments.
The cruciate ligaments are so named because of their cross-configuration within the joint. The anterior cruciate ligament attaches to the tibia on its anterior-superior surface, crossing through the joint from the medial side to its lateral attachment on the femur. The posterior cruciate ligament attaches on the posterior-superior aspect of the tibia, crossing diagonally and medially to its lateral attachment on the femur. The anterior and posterior cruciates protect against hyperextension and hyperflexion, respectively.
In order for athletes to save their active lifestyles they need understand the ACL. The ACL is the most important ligament in the knee because it provides stability to the knee. Athletes have to be aware of the importance of the ACL and know its functions in order to preserve the ligament. The ACL otherwise know as the anterior cruciate ligament is the ligament in the knee that connects the upper leg bone which is the femur to the lower leg bone which is the tibia. The anterior cruciate ligament crosses with the posterior cruciate ligament inside the center of the knee joint to stabilize to the knee in movement.
The most common knee injury in sports is damage to the anterior cruciate ligament (ACL) through tears or sprains. “They occur in high demand sports that involve planting and cutting, jumping with a poor landing, and stopping immediately or changing directions” (University of Colorado Hospital). The ACL is a ligament that runs diagonally in the middle of the knee and found at the front of the patellar bone. Its function involves controlling the back and forth motion of the knee, preventing the tibia from sliding out in front of the femur, and providing rational stability to the knee. Interestingly, women are more prone to ACL injuries than men. The occurrence is four to six times greater in female athletes.
To understand the importance of the ACL, the knee as a whole must be examined. The knee is formed by the femur, the tibia, and the patella. Several muscles and ligaments control the motion of the knee and protect it from damage at the same time. Ligaments are dense structures of connective tissue that fasten bone to bone and stabilize the knee. Two ligaments on either side of the knee, called the medial and lateral collateral ligaments, stabilize the knee from side-to-side. The ACL along with the posterior cruciate ligament are of a pair of ligaments in the center of the knee joint that form a cross. T...
The anterior cruciate ligament is the reason that the knee only has one pattern of movement. Instead of moving sideways and up and down, the knee only serves as a pivot for flexion (bending) and extension (straightening); it holds the tibia and femur in place (northstar). In the northstar web page it is stated that, “The anterior cruciate ligament is one of the most important ligaments to athletes because of its main function, stabilization of the joint while decelerating.” In other words, it is the reason that we can stop abruptly without our leg collapsing. Obviously this asset makes it an essential to have a functioning ACL while playing sports. It is an especially common injury in soccer, which is a game of constant abrupt stops. Not only is soccer a danger to the ACL because of its constant stops and starts, it is also a...
Ligaments are tough, non-stretchable fibers that hold bones together. Damage to cruciate ligaments, which crisscross the knee to give it stability, is one of the most common sports injuries. The “tear” occurs from changing direction rapidly, slowing down from running, or landing from a jump improperly. The A.C.L tear is one injury that worries athletes in all sports at all levels because of its devastating effects. People ages 15-25 that participate in basketball and other sports that require pivoting are especially at risk.
...cient knee during activities of daily living, as they have yet to be determined ⁷². In understanding the factors contributing to the mechanism of non-contact ACL injury, investigators should consider whether the kinematics, kinetics and muscle activation strategies observed are the cause of increased ACL strain or compensation for other kinetic chain insufficiencies ²⁹. Further knowledge on how movement patterns and other kinetic chain structures affect ACL loads prove critical in enhancing future prevention strategies ²⁹ ³⁴. As with reconstruction, rehabilitation should aim to aid the knee in attaining its near-normal function ⁵⁵. Through producing rehabilitation programmes built around existing knowledge on the biological and mechanical properties of the ACL, objectives such as reduced pain, greater ROM and improved muscle function can be achieved ⁵⁵.
Everyday an athlete goes to practice or game, putting on a possibility of getting injured. A common one of those injuries is the tear of the anterior cruciate ligament, better known as the ACL. When sports that require quick pivoting and harsh landings became more popular such as soccer and basketball, ACL injuries quickly multiplied. Since kids, teens, and even adults usually focus on one sport it often occurs that they can overuse and exert their body causing injury to the ACL (Young Athletes 10).
In order to know how bad a dislocated knee is, the anatomy of the knee should be known. The top bone in the joint is called the femur and the bone that is connected to is the tibia, which is distal it (Prentice, 20142013). Next to the tibia laterally is the fibula (Prentice, 20142013). These bones form the knee joint. I...
Athletics are sometimes blamed completely for knee injuries, but athletics are not always the main cause of knee injuries. Knee inju...
“Doc, I fell and twisted my knee. I heard a pop. It hurt briefly. When I stood up, the knee felt as if it was not underneath me, and the knee gave way. It swelled up by the next day and ever since feels as though it would pop out when I twist or even cross the street quickly.” In almost all cases the above complaints occur due to an injury to the ACL (Anterior Crucial Ligament) of the knee. The ACL is a very important ligament in the knee that controls the pivoting motion of the knee. This joint guides the femur and tibia through a regular range of motion. It is the most common and serious of injury sustained to the knee (Duffy, f9). How this injury happens, who is most susceptible, and how it is treated are a few questions athletes are becoming heavily concerned with.
A 16 year old, female high school soccer player, Lindsey Robinson tore her anterior cruciate ligament (ACL) from a soccer game. Interestingly, she was not the only one in her team who injured her ACL, but also several of her teammates have torn the same ligament as well during the soccer season. Lephart (2002) found that women involved in physical activity are more susceptible to acquire the ACL injuries than men who are involved in the same physical activity (as cited in Ogden, 2002). According to “ACL Injury Prevention” (2004), the numbers on female ACL ruptures have been increased for the past ten year. Over 1.4 million women have been suffered from the ACL rupture which is twice the rate of the previous decade. Therefore, female ACL injuries are now a growing problem in the nation (Anonymous, 2004). Back in 1950s and 1960s, female participation in sports was rare; therefore, the rate of injuries was very low. However, according to “ACL Injuries and Female Athletes” (n.d), as Title IX was implemented in 1972, female participation in numerous sports has dramatically increased. Moreover, the rate of acquiring injuries to the ACL also has dramatically increased (Anonymous, n.d). In terms of comparing the rate of acquiring ACL injuries between two genders, females have higher rate than males do. According to the “Physical Therapy Corner” (2007), “women suffered anterior cruciate ligament injuries more often than men, nearly 4 times as often in basketball, 3 times as often in gymnastics, and nearly 2 and a half times as often in soccer” (Knee Injuries section, para.1). There are various risk factors that contribute to the high rate of acquiring injuries to the ACL for female athletes. External factors such as improper sh...
Graft retention following an infected ACL reconstruction is a viable option as a recent meta-analysis and systematic review reported a success rate of 85%.5 Matava et al surveyed 61 orthopaedic surgeons and found that graft removal was no popular as initial treatment, with only 6% and 33% doing this for
The ACL is a dynamic structure whose main function is to provide primary restraint to anterior tibial subluxation. It provides secondary restraint limiting internal rotation and restraint with the knee in full extension. Along with the posterior crutiate ligament, it provides the axis for knee rotation and links rotation with flexion and extension.
ACL injury is quite prevalent in the United States. About every 1 in 3,000 people suffer from an ACL injury in their lifetime, and approximately 95,000 new incidences of ACL injury occur each year. The largest amount of these injuries occurs during sports which involve twisting, cutting, jumping and deceleration. The mechanisms that can cause an ACL injury are excessive valgus (outside of knee) stress, forced hyperextension, or forced external rotation of the femur on the a fixed tibia (Evans, 2001). Many associate the tearing of the ACL with a large impact or collision, however 80% of all ACL injuries are non-contact injuries. This statistic shows that ACL injuries are mostly caused by the individual themselves as opposed to an opponent or other person. The exact mechanism of noncontact ACL tears consists of poor knee positioning (e.g. landing with an extended knee) and a strong, unopposed quad contraction (Murray, 2013).