KNEE JOINT ACL REHAB

REPRESENT BY DR / MAHMOUD BAGAGO

ANATOMY

Ant View Flexion

-Part of Semimembranous Ms tendon.-One of the capsular ligaments.-Stabilizing structure for the knee's posterior part byPulls Forward and Inward .

-Y in shape - help LCL

Knee Flexors

Knee Extensors

-most of the rotation occurs when the knee is flexed.

–Biceps femoris–Sartorius

–Popliteus–Semimembranosus–Semitendinosus

BURSA

Ant-Suprapatellar-subcutaneous per patellar-subcutaneous (sup)infra patellar-deep infra patellar

Lat-Bet LCL and Biceps femoris-Bet LCL and cap popletius

Med-Bet MCL and Pes anserious-bet MCL and Cap , semit.

Post -Med gastro and cap-semim bursa-lat gastro and cap-popletus tendon and Tiba, fibula

prepatellar bursitis infrapatellar

Deep infra patSupra

Med gastro

MCL Bursa. Semimembranosus-Tibial Collateral Ligament Bursa

Pes Anserine

KNEE MECHANICSSagittal axis (flexion- Extension)

Frontal axis (varus-valgus rotation) 6-8 deg in extension

Transverse axis (internal-external rotation) 25-30 deg in flexion

I st 25 deg ROLLING

More 25 deg ROLL and Ant SlideUnlocking of ACL Taut

SCREW-HOME DURING KNEE EXTENSION IN LAST 20 DEG EXTENSION

LOCKING AND UNLOCKING OF KNEE

Locking:Additional 30° of knee extension caused by medial rotation of femur on the tibia.

Caused by longer articulating surface of the medial femoral condyle

Unlocking:Initial 30° of knee flexion

Caused by lateral rotation of femoral condyle on the tibia.

Done by popliteus muscle

ACL*laterally, and superiorly*ACL Consist Of ---- anteromedial band (AMB) Knee Flx get taut ---- posterolateral band (PLB) taut in full ext. named for their origins on the tibia.*Valgus knee acl get taut with flexion of knee*combined ACL injury when taut : - Flx + Med rot wind around PCL - flx + Lat ort strech over lat femoral condyle* role of ms -- Quadriceps and gastrocnimes ant trans.-- Hamastring and solus post force

ACL INJURY

WHEN TO SAY PT HAVE ACL!! ( SYMPTOMS )

*Pt say sound of POP * Knee felt out of place *swelling within first 24h*knee hyperextension*Hemarthrosis*3 types - Direct - Indirect -Non Contact (during deceleration and acceleration motions with excessive quadriceps contraction and reduced hamstrings co-contraction at or near full knee extension)

CLINICAL SPECIAL TESTS • Lachman test• Pivot shift test• Anterior drawer test• LELLI'S test

MRI KNEE

Cloud edema or hemorrhage by bone marrow of tibia and femur

ASSOCIATED INJURY

MCL Medical MenisciUnhappy triad ( ACL + MCL + MM or LM )Segond fracture

ACL avulsion tear segond #

MANAGEMENT

PT or surgical

• http://jisakos.bmj.com/content/early/2016/01/27/jisakos-2015-000013.abstract

• http://www.arthritis.org/living-with-arthritis/treatments/joint-surgery/types/knee/acl-tears-delay-surgery-physical-therapy.php

ACL RECONSTRUCTION