MRI of the knee -Anterior Cruciate Ligament Tear
Introduction
The anterior cruciate ligament (ACL) is an important structure in maintaining the normal biomechanics of the knee and is the most commonly injured knee ligament. ACL tears may be partial or complete. A partial tear can involve both or only a single bundle to varying degree, can range from a minor tear involving just a few fibers to a high grade near-complete tear involving almost all of the ACL fibers.
Anatomy and physiology
The ACL originates from the medial and anterior aspect of the tibial plateau and runs superiorly, laterally, and posteriorly toward its insertion on the lateral femoral condyle. Together with the posterior cruciate ligament (PCL), the ACL guides the instantaneous center of rotation of the knee, therefore controlling joint kinematics. To a lesser degree, the ACL checks extension and hyperextension. The ACL is not as strong as the posterior cruciate ligament (PCL), and it is less strong at its femoral origin than at its tibial insertion. Muscles surrounding the knee joint contribute to knee stabilization during lower extremity movements.
Mechanism of injury
Mechanisms of anterior cruciate ligament (ACL) injury are numerous.These injuries plague both athletes and non athletes. ACL injury is most prevalent (1 in 1,750 persons) in patients 15-45 years of age. It is more common in this age group in part because of their more active lifestyle as well as higher participation in sports.
An injury to the ACL is classified as a sprain. A sprain is a joint injury that causes a stretch or a tear in a ligament. Sprains are graded I, II, or III depending on how severe the injury is. A grade I sprain will have pain with minimal damage to the ligaments. A grade II sprain is going to have more ligament damage and mild looseness of the joint. Finally, in a grade III sprain, the ligament is completely torn and the joint is very loose or unstable. A grade III sprain, simply called an ACL tear, is most often a sports-related injury. Still, The ACL can be torn in other instances such as during rough play, vehicular collisions, falls, and work –related injuries. According to a study performed by Jonathan Cluett, M.D., about 80% of sports-related ACL tears are “non-contact” injuries. This means that the injury does not result from any contact with another athlete. A rupture to the ACL is the result of the ligament within the knee being overstretched. This is usually caused by a “plant-pivot” mechanism (a stop and twist motion) of the knee, or a blunt force to the front of the knee. Other factors include quick changes of motion, twisting or torquing, or landing from a jump. Hyperextension is most
Abby describes when athletes typically tear their ACL they are rolling around screaming, unable to walk off. This was not the case for her, however something was wrong so she went to an orthopedic doctor. Due to her stability the doctor did not order an MRI and assumed it was a strained PCL.
The anterior cruciate ligament (ACL) is one of the four main ligaments in the knee joint that connect it to the shin bone (tibia) and thigh bone (femur). It 's located deep within the joint, behind the kneecap (patella), above the shinbone, and below the thighbone. The ACL lies diagonally across the middle of the knee and plays a role in keeping the knee stable during movement. Partial tears of the ACL can occur, but are rare. Most ACL tears are either near-completes or complete tears. After experiencing an ACL tear, an athlete has a 15 times
The foremost cruciate ligament (ACL) gives security and quality to the knee by averting front interpretation of the tibia under the femur and inordinate pivot through the knee it essentially keeps the knee from turning the distance around. The ACL is harmed amid running ball games, skiing, or bouncing game, so this is discovered more in more youthful grown-ups. It is frequently joined by damage to the average security ligament (MCL) and the average meniscus and that is known as a blown knee when you tear every one of the three. These mix wounds are connected with a higher commonness of radiographic osteoarthritis at 10-15 years, yet these patients demonstrate no distinctions in capacity contrasted with those with an detached ACL damage. The patient with an ACL break usually report a sudden sharp torment and precariousness amid rotating or a fast alter of course, or on effect, for example, a fall or handle. They additionally have heard or felt a thump as the joint separates or a snap of the muscle. On the off chance that there is intra articular muscle harm, the patient will report swelling (because of haemarthrosis). They might likewise give lost extent or development because of the torment and a sentiment unsteadiness on the weight bearing knee. The GP will watch, inspect the knee, screen and upgrade on swelling and emission. The foremost drawer tests the adaptability of the front ligament, Lachman test and the turn shift test are most normally used to test the strength of the knee joint. The level of crack or vicinity of different wounds can be affirmed by X-ray. Different ways while inspecting the patient in the event that they give atypically or abnormal amounts of torment are bone wound, microfractures, post-corner harm and tibial level breaks. All patients with suspected ACL wounds ought to see a physiotherapist inside of the initial two
With an ever increasing number of people becoming involved with athletic activities, there is an increasing number of injuries occurring which can be devastating for the individual. Most of the injuries that affect athletes occur in one of four structures in the human body: bones, muscles, tendons, or ligaments. Because ligaments attach bone to bone and play a major part in providing stability for joints, the major stabilizing ligament in the knee, the anterior cruciate ligament (ACL), assists in performing everyday actions of the human body including sitting, standing, walking, running, dancing, and participating in other sports. The injury that specifically affects this ligament is very serious and always
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)
The ACL (anterior cruciate ligament) prevents anterior forward movement of the tibia off of the femur, as well as hyperextension of the knee. It provides stability to the joint and allows for a dynamic motion. It also helps the bending of the knee sideways toward the body.
In the sports world the word ACL brings absolute horror and cringe with it. That’s because when an ACL tears it can be one of the most painful experiences an athlete can have, especially with the surgeries and recovery it brings with it. Along with that, the ACL is in the deep part of the middle of the knee, so most of the time when you damage your ACL you most likely have damaged something else. Women especially have to worry about the overall health of their knees as they have a 4.8% greater chance of tearing their ACL than men (Musgrave). ACL tears are one of the worst injuries in the sports world and in order to recover to full health it takes time, patience, and a hard-work ethic.
The ACL’s main function is to stabilize the knee and to provide proprioceptive feedback to the brain. The ACL stabilizes the ligaments of the knee during dynamic movement by keeping the tibia from sliding forward relative to the femur; while also restricting excessive knee extension, and preventing twisting of the knee inwards and outwards (Amis & Dawkins as cited in Dharamsi & Labella, 2013, p. 12; Silvers, 2009, p.81). The ACL acts to protect the cartilaginous shock absorbers of the knee, which are the menisci, from damage that may result from playing sports (Dharamsi & Labella, 2013 p.
There are wavy bundles of collagen fibers found in human anterior cruciate ligament (ACL) that are arranged in different directions. Fibroblasts are extended with short cytoplasmic processes and branches. The elastic system is comprised of both oxytalan and elastic fibers. The ACL is very different from other tendons and ligaments, with varied orientation of the bundles and complex structural organization. Thus, it provides a structure able to resist tensile strains and multi axial stresses enforced upon it.
A torn ACL is one of the most serious and common knee injuries. Many aspects play a role in the treatment and rehabilitation of this injury. This paper will discuss the anatomy of the knee, describe a torn ACL, and the rehabilitation.
Mc Lean (2005). Vulnerable position for ACL injury is knee in flexion, valgus and internally rotated, with foot planted. It happens while side cutting, players, internally rotates the tibia with knee flexed, valgus and suddenly changes the direction with planted foot. ACL undergoes tensile force to prevent the valgus, rotational force, and ground reaction force that acts on medial aspect of the knee due to valgum that leads to injury.
Rotation at the knee can only occur when the joint is in flexion. Medial, or internal, rotation is a slight “turning in” of the tibia, and the muscles that accomplish this are the semitendinosus, semimembranosus, and popliteus with assistance from the gracilis and sartorius. To slightly turn the tibia outward is called lateral (external) rotation, and the muscle that is solely responsible for this is the biceps femoris.
The knee joint consists of four ligaments, two intra-capsular which are the ACL and the PCL and two extra-capsular ligaments including the MCL and LCL. The ACL is an extremely strong stabiliser which prevents anterior displacement of the knee. The ACL is a ligament and therefore connects one bone to another, the femur with the tibia. The ACLs origin is from the anterior intercondylar eminence of the tibia (home,2017) and the fibres pass upwards, backward and laterally inserting into the lateral condyle of the femur.
The ACL is the most common knee ligament to get injured. The ACL injury causes from taking a hard hit on