The ACL provides primary stability to the knee by limiting anterior tibial translation. It has an average tensile strength of 2160 N. An ACL tear is commonly seen in sports involving sudden stops and changes in direction. Clinical exams like the Lachman and anterior drawer tests can indicate an ACL tear. MRI is the gold standard for diagnosis. Treatment options include conservative management or arthroscopic reconstruction using grafts like hamstring tendons. Post-op rehabilitation is crucial and athletes may return to sports around 6-9 months following surgery.

1. ACL TEAR
Dr. M.A.ROSHAN ZAMEER
1st Year,Pg

2. • Stability of knee.
• Anatomy of the ACL.
• Functions of ACL.
• Risk Factors to ACL tear.
• Clinical picture.
• Examinations.
• Investigations.
• Treatment.
• complications

3. Stability of knee

4. Anatomy
• The ACL is composed of densely organized,
fibrous collagenous connective tissue that
attaches the femur to the tibia.
• 2 groups:
• -Antromedia band
• -Postrolateral band

5. Attachment
On the Femur, the ACL is attached to:
a fossa on the posteromedial edge of the
lateral femoral condyle.

6. On the Tibia, the ACL is inserted to:
a fossa that is anterior to the anterior
tibialspine
Attachment

7. Function of ACL
• primary (85%) restraint to limit anterior
translation of the tibia.
• secondary restraint to tibial rotation and
varus/valgus angulation at full extension.
• The average tensile strength for the ACL is
2160 N.

8. Biomechanics
• Primary- Anterior translation of tibia
• Secondary – internal rotation of tibia

9. BIOMECHANICS

10. Mechanism of Injury
• Contact :
• Non contact:
Rapid deceleration
Jumping
Cutting

11. • Contact and high-energy traumatic injuries:
• -often are associated with other ligamentous
and meniscal injuries.

12. SYMPTOMS
• Acute :
• h/o injury
• Knee popped out and reduced
• Not able to getup and walk immediately
• Within hours knee swells
• Chronic :
• Giving way &instabiity

13. SIGNS
• Knee effusion (haemarthrosis) – A/C cases
• Quadriceps wasting – chronic cases
• Lachman test – most sensitive test
• Anterior drawer test
• Pivot shift test

14. Investigations
• Imaging Studies:
• Plain radiographs. Usually -ve
• Arthrograms. replaced by MRI
• MRI
* Gold standard
* 90-98% sensitivity.
* identify bone bruising.

15. MRI

16. TREATMENT
• Conservative
• Surgical
• Acute Phase
• Recovery Phase
• Maintenance Phase

17. Non operative
• who are willing to make lifestyle changes and
avoid the activities that cause recurrent
instability.
• Aggressive rehabilitation program and
counseling about activity level.
• functional knee brace - is controversial and
has not been shown to reduce the incidence
of reinjury significantly if a patient returns to
highlevel sports.

18. Arthroscopic Reconstruction
• Indications
• Atheletes - jumping, pivoting, cutting
• Recurrent episodes of giving way, recurrent effusions.
• Children
• Persistant anterior knee pain
• Associated Meniscal or collateral ligament injuries

19. Timing of surgery
• No swelling
• Full range of knee motion
• 3 weeks

20. Graft options
• Autografts
• Allografts
• synthetic

21. Autografts
– Hamstrings –
semitendinosus &
gracilis
– Bone patellar tendon
bone
– Quadriceps

22. Technique of Reconstruction
• Diagnostic arthroscopy

23. • Address meniscal pathology
• Clear the remanent of ACL

24. Graft harvesting and preparation

25. Tibial tunnel

26. Femoral tunnel

27. Femoral tunnel

28. Passing the graft

29. • Fixation of graft

30. Post op x ray

31. Recovery Phase
• Physical Therapy:
• Therapy protocols divided into the following 4 categories:
• Phase I: preoperative period when the goal is to maintain
full ROM.
• Phase II (0-2 wk): The goal is to achieve full extension,
maintain quadriceps control, minimize swelling, and
achieve flexion to 90o.
• Phase III (3-5 wk): Maintain full extension and increase
flexion up to full ROM.
• Phase IV (6 wk): Increase strength and agility, progressive
return to sports.
• Return to all sports without activity may take 6-9 months

32. Maintenance Phase
• Physical Therapy
• Once quadricepsstrengthreaches 65%of the
opposite leg, sports-specific activities may be
performed
• The athlete may return to activity when the
quadricepsstrengthhas reached 80%>>>
• Re-growth to takes time, it may be need
>>>>5-8 weeks3-4 month
• 6 months

33. complications
• Stiffness / loss of motion
• Loss of fixation
• Infection
• Graft site complications – patella fracture,
numbness over lateral aspect of leg
• DVT
• Recurrent instability

34. Summary
• ACL is one of the ligament that stabilize the knee.
• ACL tear is a popular injury in high risk sports.
• History & clinical examination is the most
important tools in diagnosis.
• MRI is the gold standard in diagnosis.
• The goal of surgery is to stabilize the knee.
• Success rate of ACL reconstruction is up to 95 %.
• Physiotherapy is an important factor in
treatment.

35. reference
• Campbell’s

36. Thank u