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As a group we chose to study ACL injury's because we all know a friend or family member that has torn/injured their ACL. This is a very significant issue in elder development and teen sports. We would love to be able to understand this problem better as future healthcare workers.

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Who is most likely to experiance an ACL Injury?

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Who is most likely to experiance an ACL Injury?

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The Image above is a photo of Tom Brady tearing his ACL during a football game against the Kansas City Chiefs. Brady's ACL Injury was televised in 2008 during the first week of the NFL season. His injury occurred after being hit by Bernard Pollard during the game, causing him to leave the field. Brady didn't return for the season and spent his time in recovery. This situation is a representation of ACL Injuries that occur in sports, which we will be researching over the semester.

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Population: Which gender is most affected by an ACL injury?

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Population: Which gender is most affected by an ACL injury?

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Females are more likely to experience an ACL injury, especially during sports. Researchers have found that the anatomy of a woman's ankle has more ligament laxity, making women more likely to have sprains during sports, walking, and exercising. They differ from male act-related injuries due to their hormones and muscle activation

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Population: Which Age Group is Most Affected?

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Population: Which Age Group is Most Affected?

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An age group that is most affected are pre-teens entering into puberty. this is because the body is growing taller and heavier without much muscle mass increase. For females, because they enter puberty earlier, they are at a higher risk beginning at 12 years while for males it begins at 14 years old.

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Living as an athlete causes the progression of an ACL injury the most. It's seen in all sports mostly in football and basketball. Athletes put their body through a lot and the wear and tear eventually hits them. It's something people think males only experience, but ACL injury's are common among females as well. Younger athletes are often able to come back to their sport, but older athletes may have some more trouble and it may affect their future of the sport.

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Causes: What are the causes for ACL injuries?

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Causes: What are the causes for ACL injuries?

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ACL injuries are likely to be caused by different sports related activities, such as soccer, basketball, football, etc., and fitness. Specifically, activities that put stress on the knee including sudden stops, direct impacts, and a change in direction.

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Pathophysiology: Processes caused or affected by ACL Injuries.

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Pathophysiology: Processes caused or affected by ACL Injuries.

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Processes caused by ACL injuries are upbeat activities such as running, jumping, and even walking across all ages. A peer-reviewed article about an experiment at Kobe University in Japan found differences between the causes of ACL tears in teens compared to adults in their thirties. They found that because the teens ' bodies are still growing and have leftover tissue from their ACL, they are more prone to a tear, whereas a fully developed adult, less active than a teen, may be able to avoid strains, pulls, or tears in the ACL. These injuries may affect overall knee stability regardless of age.

Uefuji, Atsuo, et al. “Age-Related Differences in Anterior Cruciate Ligament Remnant Vascular-Derived Cells.” The American Journal of Sports Medicine, vol. 42, no. 6, 2014, pp. 1478–86, https://doi.org/10.1177/0363546514529092.

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Pathophysiology: The Tibia's Primary Atomic Structure

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Pathophysiology: The Tibia's Primary Atomic Structure

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The ACL, also known as the Anterior Cruciate Ligament, is A Vital ligament in the knee joint that connects the femur and tibia. When the ACL is torn, it is easier for the tibia to move forward, specifically in sudden or pivoting movements. Because the ACL is torn, it lacks an anterior restraint, which will cause further instability. This photo shows how the tibia often tears during actions like running.

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Pathophysiology: The Tibia's Primary Atomic Structure

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Pathophysiology: The Tibia's Primary Atomic Structure

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The knee comprises four prominent ligaments, which allow it to stabilize itself. The ACL is one of the most important, since it connects the femur to the tibia. The PCL, another ligament, connects the front of the femur to the tibia, keeping the tibia in its place. The MCL is another ligament along the side of the knee and keeps it from bending too far. Someone could tear more than one of these ligaments during a fall, causing more issues in the leg. This photo demonstrates this ligament the best.

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Pathophysiology: The Femur Primary Atomic Structure

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Pathophysiology: The Femur Primary Atomic Structure

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The femur plays a massive role in the human body, especially in the leg and ACL region. The femur sits above the shin bone, known as the tibia, and has small things attached to it called condyles. When an ACL tears, the tibia and femur become disconnected, disrupting that circular motion between the bones. This can give individuals the impression of giving up, so they must be connected. The picture above shows the femur and how it relates to the other bones.

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Pathophysiology: The Ligaments' Primary Atomic Structure 

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Pathophysiology: The Ligaments' Primary Atomic Structure 

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There are four major ligaments that function to connect the femur (thigh bone) and the tibia (shin bone). The first main one is the ACL itself, or the anterior cruciate ligament. The main function is to prevent the tibia from sliding too far in front of the femur. It provides stability to the knee, especially during heavy movements. The second major ligament is the PCL, or the posterior cruciate ligament. This works in the opposite way of the ACL, preventing the tibia from sliding too far backward/behind the femur. It also provides stability. The third major ligament is the MCL, or the medial collateral ligament. This ligament provides support to the inner knee while also resisting forces that push it inward. The last major ligament is the LCL, or the lateral collateral ligament. This ligament provides support to the outer knee while also resisting forces that push it outward. After an injury relating to any one of these ligaments, one could experience extreme pain, swelling, and instability that can lead to difficulty walking.

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One way that an ACL injury is diagnosed is through a physical exam referred to as the Lachman Test. This test involves a doctor checking for extensive forward movement of the tibia, or shin bone, in relation to the femur, the thigh bone. This exam may indicate a torn ACL.

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Diagnosis: Magnetic resonance imaging (MRI)

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Diagnosis: Magnetic resonance imaging (MRI)

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An MRI uses radio waves and a strong magnetic field to create images of both hard and soft images in the body. An MRI can show the extent of an ACL injury and signs of damage to other tissues in the knee, including the cartilage.

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Physical therapy can be a useful tool when someone has an ACL injury. This can reduce pain and swelling in the area. Restoring range of motion and building strength. This can be used after an ACL surgery or used alone if surgery is not necessary.

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In the event of an ACL tear, many individuals may have to consider undergoing surgery. Various patients chose to do ACK reconstruction surgery, where a torn ligament is replaced. Surgens use a graft tool, replicating the perivascular ligments' function and appearance. Post surgery, the people who got the surgery must walk on crutches for 6-12 months. Moreover, within a year, they should be fully recovered.

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There are multiple symptoms of an ACL injury. One that stands out instantly is limited movement or the loss of range of motion. This symptom is hard to ignore, and you won't be able to resume regular activity. It's best to seek medical attention as soon as possible to prevent the injury from getting worse.

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A telling sign that you may have an ACL injury is if you cannot bear weight on the leg/knee. This is because the ACL has lost structural integrity. Swelling may also be a factor when not being able to hold weight using your injured leg because it can inhibit total use of the leg.

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One symptom of an ACL injury is an immediate and audible popping sound at the time of the injury. This is often followed by swelling, loss of motion, and instability. Knee pain after the injury may be caused by ligament damage, bone bruising, swelling, cartilage injury, or even meniscus tears.

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Within the first few hours after an ACL Injury, individuals are likely to experience symptoms of swelling, especially around the knee. The internal bleeding is a result of the damaged blood ligaments from the torn blood vessels inside the knee. The knee will begin to enlarge, and rotations, bending, and any form of movement will be challenging. Swelling is an indicator of a ligament tear rather than a strain.

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Long Term Consequence: An Indvidual's performance in a sport may decrease.

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Long Term Consequence: An Indvidual's performance in a sport may decrease.

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Although many athletes are able to return to their sport after an ACL injury, research indicates a decline in performance and a shorter career length in their sport. Even after surgery, people still feel altered movement patterns. The injury can alter the brain's communication with the leg muscles, leading to a less efficient firing of the muscles. This results in reduced power and speed which is crucial for all athletes.

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Long Term Consequence: A decrease in knee function.

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Long Term Consequence: A decrease in knee function.

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An increased risk after injuring your ACL can be osteoarthritis. This causes a breakdown around the area and is accompanied with severe pain. The knee can also be unstable and lower quality of life.

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Long Term Consequence: Psychological Impact from injury.

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Long Term Consequence: Psychological Impact from injury.

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An ACL injury can impact people on a psychological level. Specifically, many of the athletes who suffer from this struggle with anxiety, depression, loss of self-identity, and fear of reinjury afterwards. This can delay rehabilitation needed to return to the sport that they love.

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Even though people still have insurance, there is still money coming out of pocket to cover all the medical fees. The cost of ACL surgery's can range up to ten thousand dollars, which can be a disaster for some people. There is a good chance that insurance cover's most of the cost, but it's still likely that you'll pay a couple thousand out of pocket. Rejecting treatment won't do any good, and it's likely to slow down recovery even more.

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Paying For Treatment: Mental Health services

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Paying For Treatment: Mental Health services

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A ton of athletes who lose the ability to play their sports from an ACL Injury, often fall into a deep depression. Many induvial play sports their entire lives so to one day face an injury where it could cause an end to that sport, may be very detrimental to their identify-causing them to seek mental health services like therapy which on average could cost up to $140-$300. If avoided, many induvial may turn on their friends and family and take anger out on the people they care about.

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One long-term treatment for an ACL injury is physical therapy (rehabilitation). The total expected cost for physical therapy is around $2,500-$10,000. Depending on the insurance that the patients provide, the total price could be much less once deductibles are met. The likelihood that the treatment would be covered by insurance is very high. If the person does not seek treatment because of the cost, it can lead to permanent loss of function or strength, increase the risk of other knee injuries, and higher medical costs because of other injuries that could occur.

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Individuals who have experienced ACL Injuries can utilize support groups by expressing their experiences, challenges, and coping strategies with each other. They are typically led by social workers, who reduce the feeling of isolation and improve mental recovery. Short-term-wise, it helps reduce the fear of moving and becoming active again. Long-term, it provides emotional support for them.

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Cognitive-behavioral therapy is used to help ACL-injured patients. It is a therapy that focuses on the relationship between thoughts and actions and helps stop fears of reinjury. Short-term-wise, this helps with goal setting and visualization. Long-term, it helps reduce the fear of reinjury because many of the people with this injury do fear injuring themselves again. A therapist would help the patient work through this.

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Speech, Hearing and Cognitive Rehabilitation

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Speech, Hearing and Cognitive Rehabilitation

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An ACL injury is a physical issue that tears a ligament in the knee. Because this kind of injury impacts the musculoskeletal system and not the brain/communication systems, there is no treatment needed for speech, hearing, and cognitive functions. Instead, recovery primarily focuses on physical therapy and trying to restore function and stability in the knee.

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PT: Restoring muscle strength and dynamic stability

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PT: Restoring muscle strength and dynamic stability

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The strengthening phase of physical therapy usually occurs arund 6-12 weeks either post-injury or post-surgery. The primary goals strength building PT are to regain strength in the quadriceps, hamstrings, and hip stabilizers; improve the ways that the muscles react to tensions involving the knee; enhance dynamic stability; and normalize gait patterns in the knee.

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Immediate treatment for an ACL tear includes R.I.C.E, which stands for rest, ice, compression, elevation. Long term treatments to reduce pain and swelling includes wearing a brace or using crutches for several weeks. Over-the-counter medications are often used by patients as well.

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A ton of individuals who have experienced an ACL Injury face a ton of struggles regarding the ability to use their knees. A PT, such as manual therapy and exercise, can help the ligaments in the knee regain strength that will allow the ACL ligament to support itsel

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During an ACL Injury, many people are put in a position where they are unable to use their knee to perform functions such as walking or running. The use and integration of crutches is a vital tool that is implemented to help with those activities. The lifestyle change typically lasts for a few months after surgery, physical therapy, and even exercise.

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Lifestyle Changes: slowing physical activity or stopping sports. 

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Lifestyle Changes: slowing physical activity or stopping sports. 

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When someone has an ACL injury they may have to be careful when exercising because that area is now more susceptible to injury. This also may make it unsafe for some individuals to continue to play an aggressive or intensive sport. This is often tough for athletes who really resonate with their sport, though may be vital to protect the ACL from another injury.

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After having a serious ACL injury and surgery many people have to add things in their home for stability. For example, a shower stability bar or rearranging furniture for easier movement. This can be a temporary change or for some people may be needed for a long period of time.

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Females are at a higher risk of tearing their ACL because of a mix in body structure, hormones, and movement patterns. One particular challenge that this population may face when getting care for an ACL injury is the risk of re-injury. Their body structures, again, play a role in the likelihood of this happening again. Furthermore, they may need to participate in more training during their rehabilitation.

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Teens are very prone to ACL Injuries because of how active they are. With combination of their constant acticy and moveing dancing and jumping, they often fall or stabrian or injure themselves which causes them to get an acl tear in their ligamrns. A challange they ace is not beign able to participate in sports, ot their lives or their events.

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AI-powered knee braces for ACL management which fall into two main categories: preventative braces that use airbags to stop injuries in real-time and rehabilitation braces with sensors that track recovery and guide physical therapy. Preventative braces uses sensors to monitor knee activity and sense when the joint is at a "breaking point. While rehabilitation braces collects data for the patient to give healthcare providers feedback in real time.

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One way to reduce the risk of an ACL injury is to do proper warm-ups and stretching. Dynamic stretching and other mobility exercises before activities prepare muscles and ligaments, which reduces the likelihood of injury. A challenge that may be encountered when trying to enact this is a lack of knowledge or technique. Some could be warming up incorrectly, which reduces the effectiveness of the activity, or they may lack the resources to get the proper techniques.

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MRI's are used to diagnose all kinds of injuries and conditions. Specifically in the ACL, MRI's determine the severity of the tear in the knee by creating detailed image's of the knee's soft tissue. MRI's are also capable of determining damage to other ligaments and cartilage outside of the main ligament. The results help doctors determine the best course of treatment for the patient.

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A type of technology used in ACL Injuries is in Arthroscopic surgery. This surgery involves placing cameras and surgical tools into the knee to help patients reconstruct their ACL ligaments without experiencing longer recovery times and more significant scars. The size of these cameras is approximately the width of a pencil, and typically three are used in this process. The only risk it poses is infection, but that can be treated through proper cleanings

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Public Health Measures: Enforcement of Rules/Regulations and Use of Proper Equipment

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Public Health Measures: Enforcement of Rules/Regulations and Use of Proper Equipment

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One public health intervention designed to reduce the prevalence of the risk of ACL injuries is the enforcement of rules and regulations. In sports, safety regulations can include restricting certain types of tackles and penalizing dangerous contact between players. A challenge that can come with this is people not adhering to the rules and doing what they want. Another public health intervention designed to reduce the risk of these injuries is the use of proper equipment. In many sports, athletes are required to use appropriate supportive footwear or bracing to minimize the risk of injury. A challenge that can come with this is that people ignore the safety recommendations.

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Public Health Measures: Proper Form and Core Strength 

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Public Health Measures: Proper Form and Core Strength 

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Some specific programs by the public are designed for coaches to learn from, and ensure that their athletes are playing safely. Proper form, for example, ensures that the hip and knee are aligned correctly during activity which reduces stress on the ligaments. Core workouts improve the overall stability of the athletes body. Some challenges that may come with this is athlete motivation, and how they disciplined they are.