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