ACL tear

 ANTERIOR CRUCIATE LIGAMENT (ACL)

TEAR 

Diagnosis , Rehabilitation 

• Main stabilizer of knee

• Primary function: resisting hyperextension and anterior tibial

translation in fl exion, some rotator control

• Tears result from rotational twisting, pivoting, valgus motion, or

hyperextension force that overcomes strength of ligaments.

• Most commonly from a sudden deceleration during high-velocity

movements in which a forceful contraction of the quadriceps is

needed.

• Can also occur with tears of meniscus or medial collateral ligament.

Anatomy :

• Origin: anterior base of the tibia to the postero lateral corner of the

inter condylar notch of the femur

Symptoms :

• Sudden pain and swelling

• Giving way of the knee, buckling, or locking

• Audible pop

• Instability of knee

Physical Exam :

• Inspection: acutely swollen ( first 24 h)

• ROM: limited due to swelling and guarding

• Sensation: intact

• Provocative Maneuvers 

° Lachman test—knee flexed at 25°; forward translation of tibia

while femur stabilized. Increased motion of tibia with no solid

endpoint indicates a tear of ACL

° Anterior Drawer test—knee flexed 90°. Anterior translation of

tibia on femur.

° Pivot-Shift test—reproduce anterolateral instability by internally rotating the leg applying a valgus stress to the knee as it is

flexed (looking for anterior migration of the tibia on the femur)

Imaging :

• Radiographs: AP, Lateral, Tunnel View

• MRI: most sensitive

Treatment:

• Initially rest, ice, compression, elevation, crutch walking

• Analgesic or anti-in fl ammatory (Naprosyn 500 mg po Bid × 5 days

with food then prn afterwards)

• Sterile aspiration if knee effusion present

• Knee immobilizer or range-of-motion brace (ex. DonJoy Knee

Braces)

• Surgery is the definitive treatment for younger patients (may not

be needed in older patients who lead a more sedentary life).

An ACL-deficient knee has a high incidence of instability in an

active knee and can lead to further meniscal injury, articular injury,

and degenerative changes if untreated.

Rehabilitation Program :

Initial Phase

• Goals: Allow tissue healing, reduce pain/inflammation, increase

ROM

• Modalities: cyrotherapy, E-stim

• Equipment: Knee stabilizing brace—Early weight-bearing

attempts with brace

• ROM: AAROM flexion and extension while patient in sitting position , maintain ROM is important prior to surgery to avoid

arthro fibrosis

• Strengthening: Static quadriceps and hamstrings exercises

• Bicycle/Pool exercises—general conditioning

• Start Neuromuscular and Proprioceptive retraining

• Crutch Ambulation

After (2–8 weeks)

• Goals: obtaining normal AROM, and muscle balance

• Modalities: Superficial heat, pulsed ultrasound, E-stim

• ROM, flexibility exercises

• Strengthening: Dynamic lower extremity strengthening

° Closed kinetic chain exercises, multi-planar lower extremity

joint exercises

• Gradual return to sports-specific training with functional bracing

After Reconstruction:

• Goal: Maintain ROM and strength

• Modalities: Cryotherapy, compression, and elevation to reduce

swelling and pain

• ROM (most often patients lose more extension than fl exion).

AAROM in knee fl exion and extension while patient is in sitting

position

• Strengthening Exercises: Strength program including initial

Isometric Quadriceps and Hamstring exercises for first few days

progressing to closed chain kinetic exercises followed by dynamic

and open chain exercises weeks later

• Gradual return to sports-specific training