Surgery and Treatment of the ACL

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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.

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