Unit 5:ACL Flashcards
What is the blood supply to the knee?
genicular branches of the popliteal artery ( a continuation of the superficial femoral artery ) - these branches are called lateral/medial/superior/inferior genicular.
Descending genicular artery - a branch of the circumflex femoral artery
Middle genicular artery - branch of popliteal posteriorly, supplys the synovial membrane and cruciate ligaments
Circumflex fibular - branch from posterior tibial
Recurrent branches - branch from the anterior tibial
What is the innervation of the knee?
The sciatic nerves splits into the common fibular nerve and the tibial nerve as it passess into the popliteal fossa.
The common fibular is located laterally and the tibial nerve is located medially.
How does an ACL linjury often present?
Sports injury - typically twisting landing such as football or skiing,
Pop sound at time of injury
Acute inflammation and pain
Decreased mobility
What happens in a knee examination?
Expose patient leg
Observations from all four angles - scars, injury, wasting,
Touch the knee - patella tap/swip for inflammation, feel for temperature difference, indicate inflammation or fluid accumulation
Passive movement
Active movement
Observe gait
Measure quadriceps muscles using a tape measure
What does an x-ray show of a knee ACL injury?
Removes other diagnoses such as fracture or necrosis of the bone.
ACL will have a reduced joint space
What does an MRI show of an knee ACL injury?
Often done in sagittal view
Will show disconnection of the ACL ligament and other connective tissue damage
What are the different types of ACLR surgery?
Autograft - from own quadriceps tendon
Allograft - from cadaveric calcaneal tendon
Synthetic graft
All of these are done arthroscopically, holes drilled into knee to attach the knee tendon which is secured by screws, new tissue will heal around strengthening it
Takes one to one and a half hours.
What are the outcomes of an ACLR surgery?
Restores knee function in 80% of cases
Lenghtne recovery time, particularly slow in the first 6 months
How do you qaulify for an ACLR surgery?
25-50% of patients will have reconstructive surgery.
Not given if: good range of motion, inactive lifestyle, other knee function is considered sufficient
Typically given three weeks after injury so that inflammation has resolved by ligament has not yet started to heal
Often require good range of mobility and strength of muscles in thigh, so may need physio before surgery.
How do you recover after an ACLR surgery?
2 works - support needed at home
4 - weeks on crutches and with brace - atrophy of muscles
8 weeks - sick leave from office based work
6 to 24 weeks - basic non twisting sports
38 weeks - return to competitive sport
Is there evidence that access to ACLR varies between groups of people? does this show inequality?
More common in males
More common in younger athletes - highest increase rate in teenagers
Higher income groups tend to pay for private surgery (£5000)
Black and hispanic groups have a greater delay before surgery and are offered fewer sessions with a physiotherapist.
What are the key factors influencing adherence to treatment?
Confidence - in treatment and doctor
Memory - recall information
Understanding - remembering what to do
Satisfaction - treatment is working
What are the risk factors for ACL injury?
Female - lower muscle mass, increased joint flexibility
Sports - football, skiing
Previous joint injury
Inadequate sport equipment e.g footware or ski bindings
Poor conditioning of muscles - leading to an increase risk of faulty movement patterns.
Age - most common between 15-45yrs old
What are the implication of an ACL injury of the lifecourse?
- increased risk of developing OA, 60 to 90% develop post-traumatic OA
- lifestyle factors, fear of reassuming exercise or physically unable
What are some of the pharmacological treatments for an ACL injury?
Pain killers and anti-inflammatory
NSAIDs - typically topical
May be given opioids after surgery
