2. A 28 years old male reported to hospital with vigorous
left knee pain associated with knee bending and weight
bearing as well as giving way of knee joint secondary due
to injury while playing a day back.
4. HISTORY TAKING
Chief complaints:-
• Patient experience pain while walking with
reduced movement, unable to do any daily
activities,difficulty in stair climbing and instability
at knee.
History of present illness:-
• Patient presented with knee pain at left side,
experiences pain while moving knee and not able
to bear weight on affected side.
• Popping sound is heared by patient while moving
knee.
5. Mechanism of injury - rotational
Mode of onset - sudden
Condition - worsen
History of past illness -
No relevant history.
Medical history -
Nothing relevant.
Surgical history -
No surgical history.
6. Personal history -
Takes alcohol occasionally.
Family history - Not significant
Pain assessment-
Site- knee
Side- left
Type- acute
Frequency- continuous pain since injury
Nature- dull aching
Pain aggravating factor- while walking, weight bearing on affected side
and movement associated with bending of knee.
Pain relieving factor- at rest and pain is relieved with medication.
Intensity- Visual Analog Scale (VAS) – 8/10.
7. Objective Assessment-
Observation: -
Sensorium- alert
General condition of patient- irritable
Body type- mesomorphic
Redness- present
Scars- no
Bony contour and alignment/deformity- normal
Bowing of legs- no
Wasting of muscles- present
Ambulatory status- ambulatory with assistive
device(walker)
Gait pattern- limping gait
8. Palpation-
Swelling - Yes
Tenderness- Grade III
Temperature variation- local warmth
Muscle spasm- Yes
Examination- as per nursing notes
Physical examination:-
Vital signs
Temperature- 97.2°F
Heart rate - 73 b/m
Blood pressure- 117/77 mm Hg
Respiratory rate- 17 b/m
Oxygen saturation- 92 %
10. Special test -
Anterior drawer test (+ve)
Lachman test (+ve)
Provisional diagnosis -
As per the examination and assessment of the patient the
provisional diagnosis is suspect of partial to complete
rupture ACL ligament tear
Differential diagnosis -
Fracture/ dislocation
Genu Recurvatum
11. Investigation -
X-ray- APview and lateral view
MRI (ACL rupture grade lll with tear of lateral miniscus)
Diagnosis -
ACL rupture grade lll with tear of lateral miniscus.
Surgical treatment -
Left ACL reconstruction - 01/02/2024.
12. Physiotherapy Management
Short- term goal -
• Reduce pain, swelling and stiffness.
• Provide brace from POD-0
• Provide patient education.
• Advice patients to sleep with brace in initial days.
Long -term goal -
• Attain full range of motion.
• Return to training.
• Do ADL's easily .
• Return to sports.
13. • To provide relief from pain and swelling, providing RICE protocol for
at least 10 to 15 minutes, twice daily.
• Weight wearing as decided by surgeon.
POD -0
• Patient kept under observation and monitoring.
• Application of knee brace
• Passive ATMs
• Patient/attendant is advised to give cryotherapy every 2hourly for
10-15 minutes.
POD -1:-
• Application of knee brace from POD -0
• Cryotherapy × every 2 hourly and after exercise therapy.
• Quadriceps isometric strengthening × 5sec hold× 5 repetition × 2
hourly.
Physiotherapy Treatment
14. • Long sitting, breathing exercises in long sitting, active toe movement
in long sitting× by 2hourly, passive SLR with assistance with knee
brace on upto 30°(manual assistant as per need)
• High sitting prohibited.
• Standing with knee brace on with walker along with bed side walking.
• Patient education about pillow positioning , turning in and out of
bed.
POD -2
• Cryotherapy every 2hourly for 10-15 minutes.
• Quadriceps isometric strengthening without brace× 5sec hold× 5
repetition × 2 hourly.
• Quadriceps dynamic strengthening in supine lying without
brace×5sec hold× 5repetition×2 hourly(manual assistant as per
needed).
• Corridor walking with brace with Walker under the supervision of
therapist.
15. POD -3
• Discontinue knee brace from POD -3, continue
cryotherapy, quadriceps isometric strengthening ×5sec
• Active SLR without knee brace without assistance upto
30°
• There should be no extension lag while doing SLR
• Corridor walking with brace with Walker under the
supervision of therapist.
• Toilet training under the supervision of therapist with
minimum knee bending, patient is advised to use bars
while sitting and standing from the toilet chair.
16. POD-4:- Day of discharge
• Treatment same as POD-3.
• Home physiotherapy program for minimum 40 days
has been advised to the patient.
• Patient is advised to follow the instructions as taught
by the consultant physiotherapist.
• Patient education has been provided by therapist for
discharge.
17. Patients Education
Do's Don'ts
Exercise regularly atleast thrice a
day.
Avoid over exertion and long
walking.
Corridor walking regularly. Don't heat or massage in /around
affected knee
Wear optimum foot wear
preferably sports shoes.
Don't use casual slippers while
walking outdoors.
Cryotherapy after exercises or
along 3hourly.
Avoid walking on rough , irregular
surfaces.
