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Case
Summary
1.
A rupture or tear of the anterior cruciate ligament is one of the
most common sports related injuries. Usually a non-contact
injury, the tear occurs from turning or changing direction on a
weight-bearing leg. Usually the injured person feels a snap
or a pop in the knee.
2.
Symptoms include swelling that is immediate or within 4 hours of
the injury. The athlete may feel they can return to the
sport shortly after the injury, only to have the leg collapse
again. The patient will not be able to fully extend the
knee.
3.
Diagnosis can be made by the Anterior
Drawer, Lachman, and Pivot Shift Tests.
An MRI may be necessary if the knee is too swollen to perform the
field tests or if the clinician wishes to obtain further
information as to the extent of the injury.
4.
Treatment may consist of a conservative or non-conservative
approach. The conservative approach consists of extensive
physical therapy to strengthen the knee, but no surgery is
performed. This approach is often best for an older or
non-athletic patient. If surgery is not performed, the
patient runs the risk of arthritis and further knee
injury. The non-conservative approach requires surgery to
replace the ACL ligament. The ligament is often replaced
with a graft from the patellar tendon. Surgery is followed
by extensive physical therapy.
See Operative
and Nonoperative treatment of ACL tears
5.
With sufficient time, prognosis for a surgically repaired ACL
tear is good. Most patients can return to full activity 6-9
months after surgery. In most patients the knee does not
reach maximum strength for 1-2 years following surgery.
6.
Any athlete that participates in a sport requiring sudden
twisting and turning of the knees is at risk for an ACL tear.
This injury is common in sports such as football, basketball,
skiing, soccer, and gymnastics.
7.
A team approach to medicine is very evident in this case.
The athletic trainer was responsible for the initial diagnosis
and treatment. An MRI of the knee was performed by a
radiology technician. The radiologist interpreted the MRI
and sent the results to the orthopedic surgeon. This
physician confirmed the diagnosis and performed surgery with the
help of an operating team consisting of the surgeon, surgical
nurses, operating room technicians, and an anesthesiologist.
The physical therapist played a key role in this case.
Responsibilities of the therapist included a presurgical
strengthening program, and a rehabilitative, post-surgical
program to strengthen the knee and restore full function.
The physical therapist worked with Derrick for over a year.
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