The anterior cruciate ligament starts from the posteromedial aspect of the lateral condyle of the femur, continues anteriorly and medially, and attaches to the anterior part of the medial intercondylar protrusion of the tibia. Dense collagen fibers form the physiological structure of the cruciate ligament. A small part of the fascicles consists of elastic fibers. The primary function of the cruciate ligament is to provide stability by limiting the movement limits between the femur and tibia. It affects hyperextension. Secondly, it prevents rotations beyond anatomical-physiological limits and supports the lateral ligaments during varus-valgus stress.
The ACL may suffer partial or complete rupture as a result of chronic microtraumas or acute traumas. The main reason for injury is the straining of the joint and ligaments beyond their physiological stability limits. Sudden stops during fast running or falling on one leg from a high jump have an important place in the causes of rupture.
Anterior cruciate ligament combined tears;
With internal rotation-abduction of the femur on the fixed tibia of the flexed knee, It develops as a result of adduction, flexion and external rotation of the femur on the tibia. These types of injuries are caused by sudden rotation on the fixed leg and sudden changes of direction during running, unlike straight running. The location and severity of injury are determined by the severity and type of trauma. Anterior cruciate ligament injuries or ruptures are much more common than the posterior cruciate ligament.
Symptoms in the acute phase;
-
Pain
-
Swelling
-
Movement limitation
-
Serious sound, tearing and feeling of being wasted during trauma,
-
Difficulty walking and stepping
Apart from imaging methods, Lachman Test, Forward Drawer Test and Pivot Shift Test are physical tests that will give an idea about rupture. ACL tears can be divided into 3 stages. Stage 1: There is a stretch or small tear in the ligament. Stage 2: There is a partial tear in the ACL and the ligament length has increased due to strain.
If there is a partial tear in the anterior cruciate ligament and arthroscopic reconstruction surgery has been performed, the rehabilitation example may be as follows.
After anterior cruciate ligament surgery. We can summarize rehabilitation by dividing it into phases as follows:
.
In the early phase ( 0-2 weeks)
️Use of knee brace with physician's recommendation
️Pain and edema control
️Providing full passive knee extension
️Gradual knee flexion exercise (target 90 degrees)
️Providing QDC muscle control
️Independent walking exercises
️Ice application
️Elevation
️Qdc isometric exhaust.
️Bridge exhaust
️NMES
.
Phase-1(2-4 weeks)
️Full knee extension exercise
️Gradual increase in knee flexion will continue
️Continue with Qdc exercises
️Patellar mobilization
️soft hamstring stretching
️Prone suspension exercise
️Prone isometric knee flexion exercises
️Resisted DBK exercise
️Bridge exercise
️Clam exercises with theraban
️Leg press exercise.
️Hip muscle strengthening
️4-way muscle strengthening with Theraband
️Balance and proprioception exercise.
.
Phase-2 (5-8 weeks)
️Clam exercise in lateral plank position
️Qdc, hamstring and iliotibial band exercises
️Non-resistive stationary bike exercise
️Resistive hamstring strengthening exercises
️Resistive bridge exercise
️Four-way kicking exercises
️Squat and lunge exercise( at appropriate angles)
️Step exercises
️Balance and propriseption exercises (perturbation added)
️Walking exercises with Theraband
.
Phase -3
️Resistive open kinetic Qdc exercises
️balance and proprioception exercises
️Squat exercises (at appropriate angles)
️Theraband and resistive exercises with sandbags
️ Progress of Phase 2 exercises
️ Strengthening exercises
.
Phase -4 (3-6 months )
️Continue with balance, strengthening and proprioception exercises
️Relevant Sport-specific exercises
️Plyometric exercises
️Advanced running and agility exercises
p>
Read: 0
