Ligamentous Injury Analysis PDF

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. magnitu...

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.  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  Joint instability Graded in a 0 1 2 3 0-3 scale. instability instability: instability: instability: comparing joint no difference. the the the excursion permitted by difference difference difference an injured ligament with is less than is 0.5-1 is greater that permitted by its uninjured counter part 0.5 cm. cm. than 1 cm.  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 ‫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  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 NEUROPHYSIOLOGICAL FUNCTION: Sense of position ( mechanoreceptors Sense of movement 2.5%) 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 - sudden deceleration - changing direction Mechanisms of ACL injury 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 LACHMAN  THANK YOU ‫ ص‬09:00 18/11/2024