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Artise 1Lauren ArtiseMrs. Tillery5th period14 October 2011 ACL Tear Prevention The knee is an important joint to the body. The ACL, one of the four major ligaments inthe knee, is responsible for mobility and turning when dealing with strenuous activities (KneeAnatomy 2). When torn, this ligament requires surgery to repair. In addition to surgery, physicaltherapy has become an extremely effective way in helping patients recover from medicaldisabilities and surgeries such as ACL reconstruction (Moffat 1). Years after physical therapy was originated, the practice of physical therapy was broughtto the United States with the coming of the poliomyelitis epidemics from the 1800s to the 1950sand after the damages of World War I and World War II. Poliomyelitis was a disastrous viraldisease that took many lives, especially during the 1920s and 1930s. The most common way totreat this disease was to keep those infected in isolation with bed rest and eventually surgery.Marguerite Sanderson and Mary McMillan were the first to take part in the training of“reconstruction aides” and possessed the duty of caring for the soldiers and civilians wounded inthe war. During World War II, however, vast improvements were made in the medical care andsurgical strategies of those effected, which resulted in the increase of lives saved. The techniquesacquired for victims of poliomyelitis were then carried to the United States in 1940 by SisterElizabeth Kenny. Six years later, the Hospital Survey and Construction Act of 1946, also recognized as the“Hill Burton Act,” allowed an increase in the practice of physical therapy in hospitals. Physical
Artise 2therapists had to once again deal with the wounded as the Korean War sparked. In 1967,amendments to the Social Security Act encouraged more states to participate in the practice ofphysical therapy. As time passed, orthopedic physical therapy emerged and became an importantway for patients to recover from disabilities and injuries, such as ACL tears in the knee (Moffat1). For instance, the knee joint is the largest joint throughout the body, composed of bones,ligaments, and muscles. Being a vital part to body movement, knees are often one of the mostcommon areas of injuries during sports and athletic activity. The knee is comprised of fourdifferent bones, each of which is necessary for knee movement. The femur, or thigh bone,connects to the tibia, or shin bone, by the meniscus. The patella, or kneecap, is a guard thatprovides a protection to the ligaments inside the knee. The fibula, also known as theoutter shinbone, is blended in with the tibia to form the leg below the knee and above the foot. Most of theknee movement occurs between the femur, patella, and tibia. In addition, ligaments hold the responsibility of the knee’s stability. The knee has fourligaments, each with a specific purpose. The Medial Collateral Ligament (MCL), located on theinside of the knee, resists different forces that come from the outer surface of the knee, known asvalgus forces or knock-kneed, while the Lateral Collateral Ligament (LCL), running on theoutside of the knee, resists forces pushing from the inside of the knee, known as varus forces orbow legged (Varus of Valgus? 1).The Anterior Cruciate Ligament (ACL), one of the most vitalcomponents to the knee, travels from the back of the knee to the front and prevents the tibia frommoving forward. Twisting movements are the most common way to injure the ACL, in whichsurgery and rehabilitation are often necessary. The Posterior Cruciate Ligament (PCL) runs fromthe front of the tibia to the back of the femur and is also responsible for controlling the
Artise 3movement of the tibia and keeping the components of the knee in place. Together, these fourligaments make up the knee joint. Also involved in the knee joint, the menisci is composed of two crescent-shaped cartilagemenisci that rest on the medial, or inner, and lateral, or outer, sides of where the bottom of thefemur meets the top of the tibia.The meniscus acts as a shock absorber for the knee and preventsthe femur and tibia from rubbing against each other, which would cause pain andwearing of thebones. Finally, the knee joint is surrounded by the quadriceps and the hamstrings, which help themobility and stability of the knee. Four different muscles form together to create the quadricepsmuscle group that specializes in leg strength, knee extension due to quad contraction, and hipflexion. This group of muscles links together and attaches to the patella. The hamstrings, alsoknown as the secondary ACL, work to allow knee flexion, provide stability on each side of thejoint, and keep the tibia secure from moving forward or rotating to the side (Knee Anatomy 2).In addition, the calf muscles, made up of the gastrocnemius and soleus, are necessary in order tohave maximum strength and functionality in the knee and leg (Anatomy of the Calf Muscles 1). Consequently, it is not uncommon for someone to tear their ACL in sports or duringrecreational activity. In fact, 70% of all ACL injuries occur in a non-contact situation. Twistingmovements are the main cause of injury to this crucial ligament (Lowe 1).Although surgery isnot necessary in order to function in daily activities, it is needed in order to play any form ofsport or intramural activity, since the ACL controls the cutting, or sudden change in directionthat is often required during these games (ACL-surgery 1).
Artise 4 Unfortunately, it is proven that females are six times more likely to tear their ACL thantheir male counterparts. Several risk factors instigate ACL injuries. Anatomically, females have anarrower femoral notch, which impairs the movement of the ACL, and a larger Q- angle, inwhich wider hips force female knees to turn inwards, making them more susceptible to tearing.Biomechanically, females have weak hips and less developed muscle in the leg as well asincorrect techniques when landing. When females are undergoing their menstrual cycle, theirjoints tend to be more relaxed, creating a hormonal disadvantage against males.Environmentally, however, both females and males can suffer from weather conditions andconstant play that can cause growing stress on the knees. All these factors take a heavytollon theACL as well as the other ligaments within the knee (Lowe 1). In actuality, there are three different grades in which a person can tear an ACL. In agrade 1 sprain, the ACL is slightly damaged but still functional and does not require surgery torecover. A grade 2 sprain is a partial ACL tear, where surgery depends of the severity of the tear.A grade 3 is a complete ACL tear, where the ACL is no longer attached and where both surgeryand rehab are required (Anterior Cruciate Ligament Injuries 1). Scientifically, ACL reconstruction surgery is the process in which the ACL isreconstructed by use of an autograft or allograft. An autograft is harvested from the patient’s ownbody, usually from a tendon within the leg. Allografts are taken from cadavers and are used toact as the patient’s new ACL. Since the ACL is a ligament and not a tendon, the body undergoesthe process of ligamentization, where the tendon graft slowly changes itself into a ligament(Marumo 1).When performing surgery, surgeons either use the technique of open surgery orarthroscopic surgery. During open surgery, a large incision is cut on the front of the knee.However, with today’s technology, surgeons often perform arthroscopic surgery, which involves
Artise 5smaller incisions and use of a camera for viewing the inside of the knee. The arthroscopictechnique is more popular for both patients and surgeons because of the smaller scars left fromsurgery and the reduced risk factor (Anterior Cruciate Ligament (ACL) Surgery 1). After surgery, most surgeons require their patients to complete physical therapy beforebeing released to sports activities. Physical therapy allows patients to gain strength in the mainmuscle groups surrounding the knee, stability in the knee through balance exercises, stretching ofthe muscles, and teaches patients techniques to prevent ACL tears. In reality, physical therapy begins the day of surgery. Patients are required to spend hourseach day in a continuous passive motion (CPM) machine in order to keep flexion in the knee andavoid having the knee become immobile. In addition, patients are given a knee brace andcrutches as well as orders to complete physical therapy with a professional immediately aftersurgery (Admin 1). During physical therapy, therapists follow a general protocol combined with differentforms of exercises to complete with patients over the course of a couple months. In order to becleared in six months, the ACL has to be completely healed, the muscles around the knee have tobe strong enough to support and protect the knee, the patient needs to have balance to avoidanother tear, and the body has to be flexible in order to be able to stretch and twist easily duringextensive activity.Patients must be aware of the fact that it is vital for them to come back afterthey are cleared by the orthopedic surgeon so that they does not reinjure the knee by playing on itbefore the ACL and the rest of the knee has had maximum time to heal and become strong again. The purpose of physical therapy is to relieve the discomfort and pain of people of all ageswho suffer from conditions that limit their physical well being. The therapy process treats
Artise 6patients with medical disabilities and informs patients about ways to overcome and relievetension in areas of stress. The main goal of physical therapy is to return patients to maximumstrength and back to participating in demanding physical activities. Ultimately, the three keyobjectives of physical therapy are assessment of the patient and of the injury, rehabilitation of thearea suffering from a health condition, and education on ways to avoid further injuriesand growstronger in all aspects of physical health (Physical Therapy 1).
Artise 7 Works Cited“ACL-surgery.” PTC Physical Therapy, LLC. N.p., n.d. Web. 14 Nov. 2011. <http://www.my- physical-therapy-coach.com/surgery.html>.Admin. “Orthopedic Sports Medicine Corner: Guidelines for the 1st Week after ACL Reconstruction .”NISMAT. N.p., 8 Mar. 2007. Web. 14 Nov. 2011. <http://www.nismat.org//acl_postop>.“Anatomy of the Calf Muscles.” Better U Inc.N.p., n.d. Web. 14 Nov. 2011. <http://www.fitstep.com///.htm >.“Anterior Cruciate Ligament (ACL) Surgery.” WebMD. N.p., 14 May 2010. Web. 14 Nov. 2011. <http://www.webmd.com/to-z-guides/cruciate-ligament-acl-surgery>.“Anterior Cruciate Ligament Injuries.” American Academy of Orthopaedic Surgeons.N.p., Mar. 2009. Web. 14 Nov. 2011. <http://orthoinfo.aaos.org/.cfm?topic=a00549 >.“Knee Anatomy.” Sports Injury Clinic.N.p., n.d. Web. 14 Nov. 2011. <http://www.sportsinjuryclinic.net/rapist/.php>.Lowe, Walt, Dr. “ACL Risk Reduction.” Dr. Walt Lowe. N.p., n.d. Web. 14 Nov. 2011. <http://www.drwaltlowe.com/injury-risk-reduction/>.Marumo, Keishi. “The “Ligamentization” Process in Human Anterior Cruciate Ligament Reconstruction With Autogenous Patellar and Hamstring Tendons.” The American Journal of Sports Medicine.N.p., n.d. Web. 14 Nov. 2011. <http://ajs.sagepub.com////>.
Artise 8Moffat, Marilyn. “The History of Physical Therapy Practice in the United States.” Life and Health Library.N.p., n.d. Web. 17 Oct. 2011. <http://findarticles.com///_qa3969/_200301/_n9302437/>.