Case Study : Skiing Injury : Health History

An anterior cruciate ligament tear can be confirmed by the Lachman test, the dynamic extension test, and the Pivot jerk test. The Lachman test and dynamic extension test is helpful in, “making a diagnosis, particularly in the acute injury.” (1) The lateral pivot test reproduces, “the rotatory subluxation that occurs in ACL defiency. The test is difficult to perform and takes residents and fellows in my practice approximately three months of intensive training to be able to adequately perform the jerk test in the unanaesthetised patient.”(1) The test is important because the demonstration of the lateral pivot jerk is the replication of the instability that the patient has. The initial goals of treatment immediately after injury are to reduce pain, reduce

His dressings are removed along with the brace and his incision is a curvilinear laceration through the medial retinacular region. Extensor mechanism of the knee is intact and a straight leg raise is painful but normal. Range of motion is grossly limited in flexion secondary to pain but full extension is easily achieved. He is stable with varus and valgus stress testing at 0 and 30 degrees. Gentle Lachman's test does not demonstrate any gross instability. The ankle shows some dependent edema but no acute injury. Range of motion, dorsiflexion, plantar flexion, inversion, and eversion are all intact with adequate strength. Extensor hallucis longus, dorsiflexion, plantar flexion function of the ankle are all intact with 5/5 strength, L3-S1 sensory dermatomes are intact to light touch, though the patient does describe some mild periwound numbness. There is no streaking erythema. Wound is benign and shows no signs or symptoms of infection. Vascular tone is full and compartments are

Figure (14): Anteromedial view of the left knee, showing the injury grading scale established by the American Medical Association Standard Nomenclature of Athletic Injuries. Isolated grade-I injuries present with localized tenderness and no laxity. Isolated grade-II injuries present with a broader area of tenderness and partially torn medial collateral and posterior oblique fibers. Isolated grade-III injuries present with complete disruption, and there is laxity with an applied valgus stress. ( 70 )

In recent years is has become one of the most rehabilitated ligament is in the body right up there with the bicep tendon. Over the past few years anterior cruciate ligament injuries have increased and are spreading across different age and gender lines. Most of the ACL injuries that we see can be classified as a contact injury. I use a contact injury here to mean that two people or even a person and an object, such as a ball, collide with a massive force and cause the movement of the knee in a way that tears the ligament. An example of this would be when two soccer players collide as they are going for the ball and the force of player one hits player two on the back of the knee causing the tibia to move in that anterior motion further than the limits of the anterior cruciate ligament and causing the tear. The fix for this is through surgery known and an ACL Reconstruction.

As stated earlier, the patient admitting challenge was right total knee replacement related to history of osteoarthritis as evidenced by unrelieved pain. Osteoarthritis (OA) is a disease that “results from cartilage damage that triggers a metabolic response at the level of the chondrocytes” (Lewis, Dirksen, Heitkemper, Barry, Goldsworthy & Goodridge, 2011, p. 1881). As it progress, it causes the cartilage to become “dull, yellow, and granular” instead of being “smooth, white, translucent” (Lewis et al., 2011; Gulanick & Myers, 2014, p. 1881).As a result, it eventually becomes softer, less elastic, and less capable to resist wear during heavy use. Moreover, as the “central cartilage becomes thinner, cartilage and bony growth increases at the joint margins … that results to uneven distribution of stress across the joint” that contributes to a decrease in motion. (Lewis et al., 2011; Gulanick & Myers, 2014, p. 1882). According to this patient, OA has been giving her pain for about two years that lead her to the decision of having the knee replacement.

The Anterior Cruciate Ligament also known as the ACL is deemed the most commonly torn ligament in the knee and can result from both contact and noncontact injuries. Most Anterior Cruciate Ligament injuries result from an extreme force on the lateral side of the person’s knee causing a valgus force which pushes the knee inward (Kisner & Colby, 2012, pp. 802-803). This injury to the side of the knee can also cause a “Terrible Triad” injury which also injures both the medial meniscus and the medial collateral ligament (Kisner & Colby, 2012, p. 803). Our textbook further states that “the most common noncontact mechanism is a rotational mechanism in which the tibia is externally rotated on the planted foot….this mechanism can account for as many as 78% of all ACL injuries” (Kisner & Colby, 2012, p. 803). If the person does not seek medical help with this injury they are susceptible to also injuring the remaining support ligaments as well. Patients usually present with joint effusion; possibly 25 degrees of flexion, joint swelling if blood vessels are involved, limited ROM, stress pain and instability along with quads avoidance gait patterns (Kisner & Colby, 2011, p. 208)

Lastly, the pivot shift test could distinguish 21 of the 28 patients had an ACL injury, with a sensitivity of 75, specificity of 100%, and efficiency of 75%. Under anesthesia the pivot test recognized all 28 patients with an ACL injury, giving it a 100% efficiency, sensitivity of 100, and specificity of 100%. The Lachman and AD test both identified 26 of the 28 with an ACL injury, giving them both the efficiency of 92.9%, a sensitivity of 92.9 and specificity of 100%. Conclusion: For outpatient, the AD and Lachman test are great for recognizing an ACL injury, and laxity in the ligament. The pivot shift test is outstanding in recognizing ligament laxity, and ACL injury in those under anesthesia. All three tests can be used in an outpatient setting with good results, but some are more consistent that others depending on the

The knee is a complex joint. There are many different injuries that can occur during sports. The most predominant type of injuries to the knee is those done to the Meniscus and the ligaments. There are two areas of ligaments that are commonly affected; the cruciate ligaments and the Collateral ligaments. Within the Cruciate ligaments there are posterior and anterior injuries, and within the Collateral ligaments there are medial and lateral injuries. It is very important that these injuries be taken seriously in athletics due to the seriousness of their affects to the knee.

The medical evidence shows the claimant had twisting injury to left knee with lateral meniscus tear on 7/1/13. He was also noted to have preexisting osteoarthritis of the left knee. The claimant underwent arthrosopic partial meniscectomy on the left knee on 2/27/14 with some symptomatic relief. An orthopedic report on 1/13/14 noted ongoing left knee pain. The physical exam showed tenderness; pain with flexion and extension; positive McMuray's test and negative Drawer's test. X-rays of left knee on 1/13/15 showed mild left knee osteoarthritis.

There are also the Anterior Cruciate Ligament (ACL) and the Posterior Cruciate Ligament (PCL). These two ligaments coexist in the center of the knee and balance out the weakness of the other; the ACL “prevents the shin bone from sliding out in front of the thigh bone” while the PCL “prevents the shin bone from sliding backwards under the femur” (Vorvick). Despite how the ACL and the PCL work together, the ACL is one of the most well-known major injuries in sports.

The anterior cruciate ligament (ACL) is a ligament that can be found in the knee. The ACL attaches two of three bones that link to form the knee joint. These bones are the tibia, which is the larger bone in the calf area, and the femur, which is the bone found in the thigh. The third, non-connected bone is the patella, which is the kneecap that offers protection to the overall area. The knee joint houses four primary ligaments, which are separated into the following two groups. The collateral ligaments, which consist of the lateral collateral ligament (LCL) and the medial collateral ligament (MCL), can be found toward the left and right of the patella. Collateral ligaments regulate sideways movements along with bracing for atypical

DOI: 3/14/2014. Patient is a 57-year-old female lead operator who sustained a work-related injury when she twisted her right knee as she stepped down off a chase cart. As per OMNI, the patient was diagnosed with chronic right knee pain status post anterior cruciate ligament repair, and significant degenerative joint disease of the knee. She is s status post right knee anterior cruciate ligament (ACL) reconstruction on 07/15/14.

The purpose of this study was to demonstrate the diagnostic value of MRI in diagnosing the presence or absence of the most common injuries of the knee; the meniscus tears, the cruciate ligament

The ACL is the most common knee ligament to get injured. The ACL injury causes from taking a hard hit on

Differential Diagnosis: Could be an injury to the deltoid ligament, CF, or the ATF ligament.