16 Questions
Explain the role of the ACL in knee joint movement and stability.
The ACL controls the anterior glide of the tibia on the femur, particularly in the anterior region of the intercondylar notch. It attaches to the medial side of the lateral femoral condyle. The anteromedial bundle is taut in flexion, while the posterolateral bundle is taut in extension, contributing to knee stability.
What are the risk factors for ACL injury?
Risk factors for ACL injury include anatomical factors such as Q angle and valgus alignment, hormonal factors like estrogen levels, biomechanical factors including genetics and collagen structure/type, and neuromuscular factors such as coordination of multiple movements.
What are the mechanisms of ACL injury?
ACL injuries can occur due to a sudden twist or pivot on a fixed foot, hyperextension of the knee, deceleration, or landing awkwardly. It is uncommon for ACL injuries to occur in isolation and often occurs with other knee injuries like meniscal or bone marrow lesions.
What is the classification of ACL injuries and how does it indicate the required treatment?
ACL injuries are classified into Grade I (minor strain), Grade II (partial tear), and Grade III (complete rupture). The classification indicates the severity of the injury and guides the required treatment, ranging from conservative management for Grade I to surgical intervention for Grade III injuries.
Name three clinical signs of ACL injury.
Audible pop, effusion/swelling, pain, instability/giving way
What are the diagnostic special tests for ACL injury?
Lachman’s test, anterior drawer, Lever’s test, pivot-shift test + palpation (looking for reproduction of pain)
What is the critical reason to manage meniscal root lesions early?
They lead to poor meniscal function, increased tibiofemoral contact forces that can cause early OA
What are the clinical signs of meniscal ramp lesions?
Popping sounds when rising from chair or squatting, pain with full knee extension, joint line tenderness, positive McMurrays
What is the treatment algorithm for ACL rupture 0-2 weeks after injury?
Address pain, thigh and calf bulk, ROM, LL strength assessment, Tampa scale goals by 6-10 weeks
What are the goals of the restoration phase in the ACL rehab pathway?
Pain is passive treatments, educate patient, modify activity accordingly
What are the treatment options for PFJ pain?
Lower limb strengthening exercises, de-loading tape, myofascial/soft tissue release, footwear/orthotics
What is the differential diagnosis for PFJ pain?
Patellar tendinopathy, fat pad irritation, patellar stress fracture, referred pain from hip, bursitis, meniscal lesions, ligamentous lesions, bone marrow/chondral lesions
What is the percentage risk of post-traumatic PFJ OA 10 years following ACL injury regardless of conservative vs surgery?
30%
What is the importance of surgery for ACL tears in patients with high demand activities?
Surgery is important for patients with high demand activities e.g. sports or episodes of giving way.
What are the common concomitant injuries to consider with ACL tears?
Meniscal root lesions, meniscal ramp lesions
What are the signs of meniscal root lesions and ramp lesions on MRI?
Ramp lesion is 4-6x more likely to occur if MRI has posteromedial or lateral bone bruising
Test your knowledge of the ACL (anterior cruciate ligament) with this quiz. Explore its role in controlling the anterior glide of the tibia on the femur, its attachment points, and risk factors for injury including anatomical, hormonal, biomechanical, genetic, and neuromuscular factors.
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