Unit 5 Case 1

Question 1

What is Unit 5 case 1 about?

Answer 1

A 32-year-old gardener fell heavily while skiing in poor visibility, where she felt sudden severe pain in her knee and a ‘pop’. An x-ray and then an MRI scan was ordered revealing a torn anterior cruciate ligament (ACL), requiring ACL reconstructive surgery.

Question 2

What does the ‘pop’ sound represent in this case?

Answer 2

The tearing the anterior cruciate ligament

Question 3

What is the normal healing time for ligament injuries?

Answer 3

10-12 weeks

Question 4

What is the normal healing time for muscle and why is there a difference?

Answer 4

2-4 weeks
-muscle is the fastest healing tissue as it has a more rich blood supply, providing it with the nutrients and oxygen it needs to heal

Question 5

What are the different grades of ligament injury?

Answer 5

Grade 1- mild sprain, no swelling
Grade 2- small tear, significant swelling
Grade 3- complete tear, unstable, requires surgery to repair

Question 6

For rehabilitation of ligament injuries, why is motion exercises good?

Answer 6

Promotes circulation, so more blood can get the damaged site. To provide it with the nutrients and oxygen it needs to heal faster

Question 7

What is the main difference between a tendon and a ligament?

Answer 7

Tendons connect skeletal muscles to bones, allowing the movement of the bone
Ligaments are a fibrous connective tissue that connects bone to bone, serving to hold the structures together and keep them stable

Question 8

What happens if a ligament does not repair/heal properly?

Answer 8

Ligaments can lose their ability to retain their original shape when stretched or elongated past a certain point for a prolonged period of time
-When this occurs the ligament becomes lax (loose) and cannot properly support the joint. Leading to instability, pain, and eventual osteoarthritis of the joint

Question 9

What is knee instability?

Answer 9

Knee instability is the sensation of the knee twisting or moving from side to side when doing basic activities

Question 10

What is the ACL?

Answer 10

The anterior cruciate ligament (ACL) is a band of dense connective tissue which courses from the femur to the tibia

Question 11

What is the function of the ACL?

Answer 11

Provides stability in the knee joint. Provides approx 85% of the total restraining force of anterior translation. And prevents excessive tibial medial and lateral rotation.

Question 12

What are the symptoms of an ACL injury?

Answer 12

• A loud ‘pop’ or ‘popping’ sensation in your knee
• Severe pain and inability to continue the activity
• Rapid swelling
• Loss of range of motion
• A feeling of instability or ‘giving way’ with weight-bearing

Question 13

What happens if you leave a torn ACL untreated?

Answer 13

It leaves the knee very unstable, other structures in the knee try in vain to provide stability. This causes a stretch in those structures and increased instability and then associated cartilage tears. This can cause an increased rate of osteoarthritis.

Question 14

What causes the pain in an ACL tear?

Answer 14

The ACL actually itself has no pain nerve endings so the torn ligament may not hurt. Pain often comes from injury to other structures in the knee that occurs when the ACL tears and the knee shifts

Question 15

What causes the swelling in an ACL tear?

Answer 15

Swelling of the knee may be a sign of bleeding inside the knee joint. Or a build-up of excess fluid in or around the knee joint. Swelling that occurs suddenly is usually a sign of serious knee injury

Question 16

What is knee effusion?

Answer 16

Knee effusion is the swelling of a knee due to accumulation of excess fluid in or around your knee joint.
-Effusion refers to the accumulation of fluid in an anatomical space

Question 17

What age range is most likely to develop ACL tears?

Answer 17

Between the ages of 15 and 45, mostly due to the more active lifestyle and higher participation in sports

Question 18

In what sports do most ACL injuries occur?

Answer 18

Sports that involve sudden stops or changes in direction, jumping, and landing. Such as football, basketball, downhill skiing.

Question 19

What is the common mechanism of injury for a tear in the ACL?

Answer 19

Where an athlete suddenly turns to the opposite side of the planted knee and injuries it. As the athlete turns and pivots the ligaments tears. In basketball, it is usually a result of hyperextension and internal rotation of the tibia on the femur

Question 20

What are the common tests for knee instability?

Answer 20

The anterior drawer test

The Lachman test

Question 21

What is the anterior drawer test and how is it done?

Answer 21

A test used in the initial clinical assessment of a suspected rupture of cruciate ligaments in the knee.

• Patient lays in supine position and knees flexed to 45 degrees
• Grab the knee with the thumbs in front of the knee and the fingers behind the knee
• Pull the shin bone forward
• If it slides more on the injured knee than the healthy knee, this is a sign of an ACL injury

Question 22

What is the Lachman’s test and how is it performed?

Answer 22

The Lachman’s test is a movement test to identify the integrity of the ACL

• Patient lays in the supine position with the injured knee in 20-30 degrees flexion
• Examiner places one hand behind the tibia and the other on the patient’s thigh (with the thumb on the tibial tuberosity)
• Pull the tibia anteriorly, and intact ACL prevents forward movement and has a ‘firm end feel’
• A torn ACL allows for anterior translation and has a ‘soft end feel’

Question 23

What is arthroscopic surgery?

Answer 23

A type of minimally evasive keyhole surgery used on joints (commonly the knee, ankle, shoulder, elbow, wrists and hip).
-A procedure for diagnosing and treating joint problems

Question 24

How is an arthroscopic surgery done?

Answer 24

An arthroscopic camera and light source (fibre optic cable) are used to see the joint.
A small incision is made to insert the instruments and then the surgeon guides them to complete the repair

Question 25

What is the benefit of arthroscopic surgery?

Answer 25

No large incisions so it speeds up recovery time as not as much soft tissue/wound healing

Question 26

What is ACL reconstructive surgery?

Answer 26

Surgery that is done to repair the torn ACL. It involves using a graft of new tissue, which is added to whatever remains of the torn ligament to repair it.

Question 27

How is ACL reconstructive surgery done?

Answer 27

The surgeon makes a small incision for the arthroscopic instrument and then drills a tunnel through the tibia and femur. The graft is threaded through the tunnel so it crosses the tear and fixes it in place with screws/staples. Need enough tension on the graft that it allows full range of motion. Then the incision is closed

Question 28

How does MRI work?

Answer 28

• MRI’s employ powerful magnets which produce a strong magnetic field that forces protons in the body to align with that field
• A radiofrequency is pulsed through the patient, causing the protons to be stimulated and spin out of equilibrium, against the pull of the magnetic field.
• When the radiofrequency is turned off, the sensors detect to the energy released as the protons realign with the magnetic field, and the speed that they realign.
• These magnetic properties allow physicians to tell the difference between types of tissue

Question 29

How are good quality, bright MRI images produced?

Answer 29

To obtain an MRI image, a patient is placed inside a large magnet and must remain very still to not blur the image.

• A contrast agent (often containing the element Gadolinium) may be given to a patient intravenously before or during the procedure
• This increases the speed at which protons realign with the magnetic field. The faster the protons realign, the brighter the image.

Question 30

What is a patellar tendon autograft?

Answer 30

hhhh