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19.1 Update on Anterior Cruciate Ligament Injuries
Table of Contents

RISK FACTORS FOR ANTERIOR CRUCIATE LIGAMENT INJURY

Abstract:

CONTENT: In their monograph, Drs. Sigward, Pollard, and Shultz define the anatomical, hormonal, and neuromuscular risk factors for anterior cruciate ligament injury. Current theories on mechanisms for anterior cruciate ligament injuries are then discussed, with the intent to apply such knowledge of these risk factors to clinical practice. Throughout the monograph, the authors have provided an evidence-based methodology in deciphering the current literature on anterior cruciate ligament injury. This monograph fits nicely with the rest of the topics in this series, and you will be able to immediately apply the content to your clinical practice.

Keywords:​

anterior cruciate ligament, knee, prevention

References:

Click here.

DESIGNING AN ANTERIOR CRUCIATE LIGAMENT INJURY
PREVENTION TRAINING PROGRAM

Abstract:

CONTENT: In the monograph, Dr. Sigward goes into detail on explaining the importance of key neuromuscular risk factors for anterior cruciate ligament (ACL) injury and how such risk factors can be used in the design of effective injury prevention strategies. She also discusses the key components that are needed to carry out a successful injury prevention program. A unique portion of the paper is the author's clear and systematic writing style that discusses principles underlying the appropriate progression of exercises. In addition, the inclusion of a DVD demonstrates comparative performances of an ACL injury prevention program, which will help readers implement their own program. Throughout the monograph the author has provided an evidence-based methodology in deciphering the current literature on ACL injury.

Keywords:​

anterior cruciate ligament, knee, risk factors

References:

Click here.

PEDIATRIC ANTERIOR CRUCIATE LIGAMENT INJURIES

Abstract:

CONTENT: In the monograph, the authors initially discuss the knee anatomy of skeletally immature patients, with special anatomical emphasis on the growth plate and anterior cruciate ligament. An informative discussion follows regarding the epidemiology and risk factors underlying anterior cruciate ligament (ACL) injury in the skeletally immature population and diagnosis of ACL injury. Nonoperative and operative alternatives are discussed, with details provided for developing effective physical therapy programs and also descriptions of common surgical procedures unique to this patient population. Rehabilitation concepts following an all-epiphyseal sparing ACL reconstruction are discussed using a 5-phase approach to help the clinician develop a logical clinical progression to return patients to optimal function. The authors then shed light on how to avoid some of the research design shortcomings of previous work in this area. An emphasis is placed on determining quantifiable surgical outcomes and rehabilitation outcomes, and the role of criteria-based progression guidelines. CASE ANALYSES: The authors conclude with 2 excellent case studies to apply the decision-making process inherent in dealing with this patient population. The first is a 9-year-old boy who sustained a hyperextension contact knee injury while playing football. The final case is a 12-year-old girl who sustained a midsubstance ACL tear while participating in physical education class.

Keywords:​

anterior cruciate ligament, knee, youth

References:

Click here.

REHABILITATION FOR THE ANTERIOR CRUCIATE
LIGAMENT-DEFICIENT KNEE

Abstract:

CONTENT: In their monograph, Drs. Chmielewski and Hurd describe the historical findings one can expect in individuals with an anterior cruciate ligament (ACL)-deficient knee. The differences and clinical decision-making considerations regarding nonoperative versus surgical management for acute ACL rupture are then discussed. The authors identify factors that influence the outcome of nonoperative management of ACL rupture, in particular those that contribute to dynamic knee stability after ACL rupture. A unique and distinguishing portion of the monograph is the section in which the authors compare and contrast outcomes of nonoperative management for ACL rupture when patients are self-selected versus selected using an algorithm-guided decision-making scheme. The important components of a nonoperative rehabilitation program for patients with acute ACL rupture are also highlighted. Key points related to returning to preinjury activities after ACL rupture are then discussed along with pertinent topics related to counseling patients who sustain an ACL injury. The authors do an excellent job describing the factors that impact disability following ACL rupture, the realistic outcomes that can be expected with nonsurgical and surgical interventions, and the importance of comprehensive rehabilitation in returning patients to optimal function. CASE ANALYSES: The authors conclude with 2 excellent case studies detailing the management and rehabilitation guidelines that demonstrate how to apply information presented from the previous portions of the monograph. The first case involves a 45-year-old woman who injured her right ACL while playing outside with her dog. The second case is a 17-year-old football player who ruptured his ACL in a contact injury during a scrimmage.

Keywords:​

anterior cruciate ligament, injuries, nonoperative

References:

Click here.

ANATOMIC ANTERIOR CRUCIATE LIGAMENT
DOUBLE-BUNDLE RECONSTRUCTION

Abstract:

CONTENT: In their monograph, Drs. Bradley and Tejwani take the reader through a detailed review of the anatomy of the anterior cruciate ligament (ACL) and then discuss the types of graft selection and fixation options available for ACL reconstruction. Single-bundle and double-bundle techniques are then reviewed, as is all-inside ACL reconstruction. In addition, the authors have included numerous images to assist the reader in understanding the details of each procedure. A separate section discusses physeal-sparing surgical techniques for the skeletally immature patient. The knowledge of these surgical techniques will allow the rehabilitation professional to appreciate the healing process and more completely understand the basis for exercise progression. The authors' phasic breakdown of the postoperative rehabilitation process also should have particular relevance for the rehabilitation specialist.

Drs. Forsythe, Shen, and Fu focus on double-bundle reconstruction but first provide the reader with a thorough review of the anatomical and biomechanical attributes of the ACL. Examination, imaging, and clinical reasoning underlying diagnosis of ACL injury are then discussed. The specific indications and contraindications for double-bundle ACL reconstruction are then presented. Preoperative planning and a detailed technical description of surgical intervention provide the reader with an appreciation for how the ACL double-bundle technique is carried out. Patient outcomes and potential complications are explained, along with principles of postoperative management and rehabilitation guidelines. CASE ANALYSES: Drs. Bradley and Tewjani describe 3 cases. The first is a 32-year-old tennis player who twists her left knee during a singles match in her weekly league. The second is a 20-year-old college football wide receiver who twists his knee attempting to avoid a tackle during a bowl game. The third case involves a 14-year-old high school varsity cross-country runner who suffered an injury to her knee 5 months ago. In the companion monograph by Drs. Forsythe, Shen, and Fu, 2 case studies highlight the clinical decision-making process for determining the proper surgical procedure following ligament trauma. The first case describes a 19-year-old collegiate javelin athlete who was in competition. The second case is a 20-year-old collegiate basketball player who underwent right ACL reconstruction 3 years ago but reinjures his knee.

Keywords:​

anterior cruciate ligament, injuries, knee

References:

Click here.

REHABILITATION FOLLOWING ANTERIOR CRUCIATE
LIGAMENT RECONSTRUCTION

Abstract:

CONTENT: In the monograph, the authors discuss the rehabilitation priorities following primary and revision anterior cruciate ligament (ACL) reconstruction. Each area is organized into phases that progress the reader through preoperative and early and end postoperative phases. The authors propose criterion-based guidelines and stress the importance of such criteria in progressing patients at the proper functional pace. Their discussion of clinical milestones is predi-cated on evidence-based principles of healing and also account for individual variance in the healing process. All rehabilitation schemes are discussed in detail, thus providing the reader with specific and useful information on how to prioritize preoperative and postoperative impairments, and a rationale for interventions and progression criteria aimed at resolving identified impairments. In addition, the authors have included a separate section on accompanying meniscal, chondral, and ligamentous injuries that can often complicate an ACL rehabilitation program. There is also a section on management of the stiff knee following ACL surgery. CASE ANALYSES: Two interesting case studies conclude the monograph. One case focuses on outcomes following revision ACL. The other case describes a patient who has undergone a primary ACL reconstruction that was accompanied by poor immediate postsurgical management. This case highlights the orthopaedic challenges that result in delayed achievement of important rehabilitation milestones.

Keywords:​

anterior cruciate ligament, injuries, knee

References:

Click here.

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