Introduction Rehabilitation after anterior cruciate ligament (ACL) injury and surgery has evolved in the past 2 decades from programs that recommended 6 to 8 weeks of immobilization, restricted range of motion (ROM) and strengthening exercises, and a delay in return…
Clinical Concepts Critical Points Clinical Concepts Protocols are evaluation based: Progression is based on continual evaluation using the principles of anatomy, physiology, biomechanics, and surgery. Goals Regain normal knee stability Control joint pain, swelling, and hemarthrosis Regain normal range of…
Introduction Considerable advances have been made in the treatment of complete anterior cruciate ligament (ACL) ruptures and reconstruction methods. These include the appropriate selection of patient candidates and criteria for goals that should be achieved before surgery, such as resolving…
Introduction Mid-substance anterior cruciate ligament (ACL) injuries in the skeletally immature athlete are being recognized with increasing frequency. ACL injury has been reported in 10% to 65% of pediatric knee injuries with acute hemarthroses. This increased incidence is largely attributed…
Indications Critical Points Indications Determine factors that caused the prior ACL reconstruction to fail Address all pathologies before surgery: lower limb malalignment, muscle atrophy, limitation knee motion, gait abnormalities, misplaced tunnels. Goals, outcome of surgery depend on preexisting joint damage,…
Indications Critical Points Indications Complete ACL rupture: >5 mm of increased anterior tibial translation, positive pivot shift test. Profile patient for desired future activity level. High-risk activities (pivoting, cutting, twisting, and turning): reconstruct. Acute ACL rupture and concomitant displaced bucket-handle meniscus…
Introduction Critical Points Introduction The purpose of this chapter is: To develop some fundamental gait analysis principles. To illustrate the application of gait analysis to the issues related to the evaluation and treatment of ACL injury. To describe the cause…
Introduction Traumatic rupture of the anterior cruciate ligament (ACL) can be a common source of knee instability and dysfunction in athletes. Reconstruction of a torn ACL, to restore function and limit injury to the menisci, has become a common orthopedic…
Ligament Fiber Length-Tension Properties Critical Points Ligament Fiber Length-Tension Properties Numerous publications demonstrate how ligament fiber function depends on the initial length and attachment site and the specific joint position of both flexion-extension and tibial rotation. These concepts form the…
Classification System for Knee Ligament Injuries Critical Points Classification System for Knee Ligament Injuries Purpose of a Classification System Make accurate distinctions between separate pathologic conditions in laboratory and clinical studies. Provide a common descriptive tool for investigators who wish…