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Anterior Cruciate Ligament Tear

Phase 3: Day 29-42

Phase 4: Day 43-56

Add on to previous rehab

Increases weight bearing to 100%

Air baps (4 positions) 10x

3 way heel raises and mini squats 10x

Anterior and lateral lunges- 10x

Step ups- 6 inch box10x

Treadmill walking forward and backwards- 3 mins

Lunge box- anterior lunge with the same side rotation

and lateral lunge with same side rotation 10x

Just using cold pack at this phase, unless in pain

Add to previous rehab

Add weight to lunges, mini squats and heal

raises- 5lbs

Step up- 8 inch with 5lbs

Treadmill to 4% incline- 3 mins

Joystick exercise- clockwise/counterclockwise,

foward/back/diagonal (20x)

Fast taps 10x

Heel taps- 10x (6inch step)

Lunge box- add 6lb med ball

Clock reaches 5x

Cone reaches 10x

Phase 2: Day 15-28

Presented by: Cara Harm, ATS

Adrian College

Add to previous rehab

No knee flexion past 90 degrees

Stationary bike (rock and roll) – 5 min

Stretch station- hamstring, calf 10-15x each

New step- 5 mins

Counter marching- 1 minute

Hip kicks- 3 ways 10x

Heel raises 10x

TKEs -20x with black theraband

Mini lunges- forward

Mini squats 20x

Functional Tests

Athlete did not return to play

No functional tests have been done to this point

Activity Modifications

  • Advance conditioning class (AC)- work on rehab during this time
  • No jogging or running
  • Work on upper body strengthening

Recommendations for Improved Care

Phase 1: Day 1-7

  • Could have immobilized knee instead of just wearing a brace
  • Surgery could have been scheduled sooner
  • Add more NMC to rehab

References

Ankle pumps every hour

Quad sets and SLR with no extension lag

(brace on)

Knee extension stretch with towel

Heel slides

Ice or Cyro-cuff

Patellar mobs

Weight shifts- 10x

Long arch quads- 10x

Active ROM- table slides (10x with a 3 second hold)

Prone table knee extension (2 mins)

Seated knee extension stretch (3 mins)

E-stim and Ice- (IFC-20 mins)

Arthroscopy: The Journal Of Arthroscopic & Related Surgery: Official Publication Of The Arthroscopy Association Of North America And The International Arthroscopy Association [Arthroscopy] 2013 Aug; Vol. 29 (8), pp. 1314-21. Date of Electronic Publication: 2013 Jul 04.

British Journal Of Sports Medicine [Br J Sports Med] 2013 Apr; Vol. 47 (6), pp. 367-72. Date of Electronic Publication: 2012 Aug 31.

Physical Therapy In Sport: Official Journal Of The Association Of Chartered Physiotherapists In Sports Medicine [Phys Ther Sport] 2013 Nov; Vol. 14 (4), pp. 188-98. Date of Electronic Publication: 2013 Aug 28

The Journal Of Bone And Joint Surgery. American Volume [J Bone Joint Surg Am] 2012 Oct 3; Vol. 94 (19), pp. 1737-48.

Special Tests

Anterior Drawer- Negative

Posterior Drawer- Negative

McMurray’s- Negative

Valgus stress- Negative

Varus stress- Negative

Patellar Apprehension- Negative

Because of the lateral hamstring pain and the MOI,

thought possible ACL tear

Questions????

Ligaments of the Knee

First Aid and Emergency Care

Medical Management

  • Athlete was able to walk into the AT Room
  • Athlete was evaluated
  • RICE, crutches given

Mechanism of Injury

Rehabilitation

Signs & Symptoms

Sent to 3DPT

Gary Gray- Educational Coordinator (Baps board, stretch station)

Rehab functionally in all planes of motion (frontal, saggital, transverse)

At this point she’s finished her 8th week of rehab

3x a week, 60-75 minutes

Day 1: Injured on 9/4/14 at summer basketball practice, RICE, crutches given, referred to physician, spoke to athletes mother

Day 2: Referred to physician on 9/5, he suspected a Meniscal Tear he ordered an MRI, given brace

Day 3: MRI

Day 5: Dx: ACL tear

Day 7: Started PT at 3DPT

Day 11: Went to UofM and saw different physician for a 2nd opinion, said he would do surgery in 1 month.

Day 29: Surgery done on October 2nd

Present: Continues to go to 3DPT

Medial Collateral

Lateral Collateral

Anterior Cruciate

Posterior Cruciate

Most common MOI is cutting or pivoting

80% pivoting

20% contact

Athlete went to take a jump shot, her knee “buckled” or gave out and she fell to the floor

No contact was made

Felt a pop

Knee gave out

Point tender over lateral hamstring

No swelling or ecchymosis initially, but both present the next day

ROM & MMT

Knee Anatomy

Rehab Goals

Bones

  • Femur
  • Patella
  • Tibia
  • Fibula

ROM

  • Extension- WNL
  • Flexion -WNL

MMT

  • Quad- extension - 4+/5
  • Hamstring-flexion - 4+/5

Return to play as quickly as possible

Athlete is involved in other athletics at school

Full ROM

Full strength

Able to cut and pivot

Full stability

100% weight bearing by 4-6 weeks post op

Nature of Condition

Sprain

Grade 1- Stretch, no laxity

Grade 2- Partial tear with laxity

Grade 3- Complete Tear

History

Post Op Goals

Quad set

Straight leg raise

Partial weight bearing

Put into immobilizer – locked into

slight flexion

15 year old female

Varsity basketball athlete

Position: Point

No previous injury or complications

Injury: Right knee

Dx: Anterior Cruciate Ligament (ACL) Tear

Pre Op Goals

Function of the ACL

All were met before athlete went into surgery

  • Full extension
  • Reduced pain and swelling
  • Restored normal gait
  • Restored full ROM
  • Increased quadriceps and hamstring strength

Stability

  • Prevents anterior tibial translation on the fixed femur
  • And also prevents excessive tibial rotation

Surgery

Her own hamstring was used as a graft

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