Ligamentous Injury PDF

LIGAMENTOUS INJURY KHALED AYAD, PhD, RPT  SPRAINS The classification and The number of fibers disrupted grading of ligamentous injuries are base...

LIGAMENTOUS INJURY KHALED AYAD, PhD, RPT  SPRAINS The classification and The number of fibers disrupted grading of ligamentous injuries are based Subsequent instabilty of the joint upon 2 factors: involved. magnitude, The severity of the injury depends on: direction duration of the forces applied. same vision of heamartharosis take 2 hours to appear (ACL+PCL) need aspiration (the blood must remove or its enzymes destroy articular surface effusion: increase the synovial flued inside the joint take 1day to appear (MCL+LCL) don't do aspiration irritate synovial mem sec more fluid the best treatment (R isometric EX)  swilling: inc on size soft or hard Mild Some fibers of the ligament are torn. Localized tenderness and swelling over the site of the injury. (1 st degree) No clinical nor functional instability. Many but not all fibers are torn Moderate Clinical instability nd (2 degree) No functional instability Diffuse swelling and pain Severe Complete disruption of the ligament. Loss of both clinical and functional stability No swelling (3 rd degree) Severe pain or no pain by X-ray stress Joint instability stress on ligament(valgus or varus) which we test and compare with stress test for non affected and compare the difference on space (between 2 articular surface condyle opening on each joint) Graded in a 0 1 2 3 0-3 scale. instability instability: instability: instability: The degree of instability no difference. the the the is determined by difference difference difference comparing the joint is less than is 0.5-1 is greater excursion permitted by an injured ligament with 0.5 cm. cm. than 1 cm. that permitted by its uninjured counter part on the other extremity.  2012 ‫ ديسمبر‬7 ‫فيروس اغتيال الموهوبين دون سابق إنذار‬...‫الرباط الصليبي‬ ‫ صاحب الرقم القياسي‬2009 ‫وموسم‬...‫نجوم مصر أكثر ضحاياه‬ The cruciate ligament... The virus of murdering the gifted without warning Egypt has the most victims... and the season 2009 is a record holder (December 7th 2012) 2017 ‫ أبريل‬28 ACL IMPOOORTANT ‫الرباط الصليبي يهدد نجوم العالم‬ ‫ حالة من بداية الدوري المحلي‬11‫و‬...‫ابراهيموفيتش مهدد باالعتزال‬ The cruciate ligament threatens the stars of the world Ibrahimovic threatened to retire... and 11cases from the beginning of the domestic league (April 28th 2017)  ANATOMY OF KNEE JOINT tear joint capsule cause no effusion due to drainage effusion treatment synovia out of joint 1.farradic Quadri under cushion of knee 2.phonophrasis 3.R.iso ex Quad STABLITY 1.fitting articular surface (congruency) bony stability ex on hip joint most injured ligament on knee joint convex with 1.ACL convex less stability 2.MCL depend mainly on ligament 3.LCL on stability 4.PCL 2.  INTRODUCTION Some portion of the ACL remains fairly taut throughout the ROM Articular afferent nerves of the human knee Posterior afferent Anterior afferent (articular branches of ) Posterior articular nerve Femoral nerve ( from the posterior tibial nerve) Terminal branch of the Common peroneal nerve obturator nerve Saphenous nerve  Functions of ACL Translational stability of the knee MECHANICAL Rotational stability FUNCTION: Integration of rolling & gliding movement intraarticular:- on knee joint extra synovial:- isolated by synovial sheath from synovial fluid 3.8cm length 1.1 width diameter NEUROPHYSIOLOGICAL FUNCTION: Sense of position proximal attachfrom:- post part inner surface of lat.femoral condyle downward forward medially ( mechanoreceptors Sense of movement distal attach:- on ant part intercondylar area of tibia 2.5%) 3 Pendell :- 1.anat medial longest taught with full flex 2.post latral shortest taught with full ex 3.intermedat there is reciprocal relation between 1&2 Joint proprioceptors Type Name Threshold adaptation Sense I s Low Slow Position II Low Rapid Movement III Golgi apparatus High Slow End range IV High None Pain  changes in proprioception ACL postural control deficiency muscle recruitment spinal and supraspinal motor control. ACL injury might be regarded as a neurophysiological dysfunction and not a simple peripheral musculoskeletal injury. ACL is the most commonly injured knee ligament national incidences is 29 to 38 per 100,000 people 70% of ACL tears occur from noncontact injuries: - forceful quadriceps contraction - poor landing technique balance strategies 1.ankel strategi: on stable surface we ,make ankle dorsi+ planter - sudden deceleration m.work from distal to proximal 2.hip striges :on unstable surface - changing direction M.work from proximal "hip M" to distal 3.stepping strategi : when balance is disturbance  Mechanisms of ACL injury un happy triad : ACL + MCL + M.meniscus 1. External rotation of tibia with valgus stress 2. External rotation of tibia with varus stress 3. Internal rotation of tibia with valgus stress 4. Hyper extension of the knee 5. Violent quadriceps contraction Female athletes demonstrate 2-8 folds higher incidence of injury than do male athletes participating in the same sport. - The cause may be: preovulatory phase Hormonal shorter legs, Anatomic greater hip varus & knee valgus, ligametous laxity less hip and knee flexion in landing Neuromuscular lower H-Q ratio  POPING SIGNS AND HEAMARTHROSIS SYMPTOMS GIVING WAY +ve Lachman’s test Complete tear of the ACL does not heal because THE ACL IS NOT EMBEDDED IN A STRONG SOFT TISSUE ENVELOPE Operative High demand patients Failure of non-operative treatment with treatment low demand patients ANTERIOR DRAWER LATERAL PIVOT SHIFT rolling only no gliding with flex LACHMAN knee on lose back position 25 degree flexion same as ant drawer test but ant drawer is with 30 degree flex  Non-operative treatment of torn ACL 1. Hamstring set exercises 2. Quadriceps set exercise 3. Isometric exercise for the quadriceps 4. Hamstring and quadriceps co-contraction 5. SLR exercises 6. Hamstring curl exercise 7. Quadriceps curl exercise (short arch) 8. CKC exercises 9. Dynamic joint control training 10. Functional training ACL RECONSTRUCTION PATELLAR TENDON (B- T-B) Biology of Healing of the ACL Replacement Graft inflammation and necrosis. revascularization with fibroblasts (3 MONTHS). Remodeling (12- 18 MONTHS)  Despite continuous advancements in surgical techniques and rehabilitation may have 2nd ACL INJURY within 5 years 30 % 33 % return to preinjury sport level within 1 37 % year never return to preinjury sport level within 2 years The purpose of this presentation is to HIGHLIGHT most current evidence on management of patients following ACL reconstruction. THANK YOU