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Cognitive behavioral therapy is a treatment that focuses on addressing negative thoughts and behaviors. This therapy would work on addressing things like to kinesiophobia (fear of re-injury) and working on overcoming negative thoughts and behaviors developed from an ACL tear. The type of professionals that would be required to deliver cognitive behavioral therapy would include licensed psychologists, psychiatrists, clinical social workers, and licensed professional counselors or therapists.

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What are some of the causes of tearing your ACL? 

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What are some of the causes of tearing your ACL? 

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Certain genetic factors and anatomical differences can make it more likely for you to tear your ACL. Different collagen genes responsible for building ligaments could affect the structure. As well as having different bone structure of the bones that make up your knee or having more laxity in your knee joint.

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Athletes are more likely to experience ACL tears due to playing high impact sports. These sports require movements that cause them to stop abruptly, change direction, or jump quickly. With that said, athletes are at much greater risk for ACL tears.

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We chose the ACL tear because it is a very common injury with in athletes, so much so that one of our group members personally experienced this injury. An ACL tear is a tear of the anterior cruciate ligament which prevents the anterior translation of the tibia, in other words prevents the shin bone form going to far forward.

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Women:

Reasons being their anatomical factors like wider hips and smaller knees. Along with weaker hamstrings than men and less core engagement. It even comes down to the different hormones in women's bodies compared to men's.

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What are some of the causes of tearing your ACL? 

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What are some of the causes of tearing your ACL? 

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Common MOI's for tearing an ACL can be sudden stops, sharp changes in directions, planting and twisting in the knee, and direct blows to the knee. The most common is a non-contact pivoting motion in sports such as basketball, and gymnastics. In more contact sports such as football and soccer an ACL tear can come form a direct blow from the front or anterior side. I personally have torn my ACL in gymnastics by landing a flip and twisting in my knee as I landed.

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What are some of the causes of tearing ACL?

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What are some of the causes of tearing ACL?

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Overuse and a constant stress can cause a built up of micro-damage and fatigue on the ligaments that will eventually result in an ACL tear. Factors that can contribute to this overuse are overtraining, high-impact sports, anatomy, and not incorporating days of rest in a routine. As mentioned before, women's anatomy, which consists in wider hips and smaller knees is a large factor in how common ACL tears are in females rather than males.

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When the ACL is torn it primarily effects the two shin bones, and thigh bone. The shin bones being the tibia and the fibula. The tibia is the bigger bone of your shin on the medial part of your leg, while the fibula is the skinnier bone on the lateral side. The thigh bone is called the femur. These bones are effected because the primary function of the ACL is to prevent the forward translation of the tibia bone, preventing it from sliding to far forward relative with the femur.

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Since an ACL tear is extremely traumatic to the knee it can affect other ligaments like the MCL, LCL, and PCL within the knee. The ACL tear doesn't directly affect the other ligaments but it is the compensation and trauma of the injury that can lead to other tears, strains, or stretches of the ligaments surrounding the ACL.

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Movement is heavily affected by ACL tears. After tearing an ACL, people experience knee instability which can result in various negative effects because people typically experience the sensation of their knee giving away. This can cause people to be afraid to participate in physical activities, and people who aren’t afraid may experience difficulty pivoting, twisting, jumping etc.

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During the menstrual cycle, there is a sudden peak in estrogen. This peak of estrogen can affect the ligaments, slowing down their collagen production, making them less flexible, weakening the ligaments, and affecting joint stability. All these affects of high levels of estrogen make women more likely to experience ALC injuries.

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After tearing your ACL there is a increased risk of developing osteoarthritis. Osteoarthritis is a joint disease where the cartilage that cushions the knee wears down over time and can lead to knee pain, and instability.

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The tearing of an ACL can cause people to experience depression, loneliness, and frustration. Athletes who tear their ACL can't come back to their sport right away which can cause frustration and depression. People also experience a long recovery process with physical therapy which is very challenging and can lead people to feel alone in their progress.

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When the ACL is injured it puts a lot of pressure on the rest of your knee. This can lead to further injury of other structures in the knee like the meniscus and the other ligaments. You are also more likely to re-tear your ACL once it has already been tore.

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Quality of life may be changed drastically with very little and limited amount of physical activity. Non-weighted and low-impact sports and exercises with the advise of a doctor or sports medicine specialist are recommended.

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MRI's are commonly used to confirm ACL tears as it can provide detailed imaging of soft issues and the ACL.

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At the time of the injury, it is very common to hear a "pop" sound or feeling a sensation of something popping in the knee.

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For a grade 1 ACL tear the most common treatment method is a nonsurgical approach. A common treatment is RICE- Rest, ice, compression, and elevation. This paired with anti inflammatory medications for pain management. For grade 1 tears approaching a grade 2 it is common for treatment to include wearing a knee brace and physical therapy for restored range of motion and strength.

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At the time of the injury, directly after the popping sensation, there will be a rapid and sudden rush of sharp pain in the center of the knee.

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When going to a clinic, doctors might ask you about your symptoms and will conduct a physical examination. This examination involves looking for swelling of the knee, instability, and range of motion. The doctor can perform an anterior drawer test which involves pulling the tibia forward while the knee is bent to assess your injury.

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The ACL connects your thigh bone to your shin bones. So if the ligament is torn it is no longer able to do its job which is what causes instability because the ligament is not properly holding everything in place.

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For a full/complete tear (grade 3) the treatment is surgical reconstruction, as ligaments can not heal on there own. For reconstitution they go in and remove the torn ligament then put in a replacement. To replace it there is a few options they can take from a cadaver or take from your own body in places like the quad tendon, or patellar tendon. Following the surgery there is around a 9 month to one year full recovery time involving intensive physical therapy.

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Generally within a few hours of the injury occurring the knee will become very swollen. Areas around the ACL become very inflamed.

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The cost of surgery can vary significantly depending on whether or not that patient has insurance. On average expenses range from $12,000 up to $23,000. In most cases it is very likely that insurance will cover at least a portion of the expenses if not the entirety of the cost. If someone with this injury were to choose not to get surgery they will most likely experience continued knee instability, have a higher risk of osteoarthritis, increased pain and swelling, along with many other complications.

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psychosocial interventions post ACL tear

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psychosocial interventions post ACL tear

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The psychosocial interventions for an ACL tear focus in improving an athletes mental readiness and psychological coping. Such as goal setting, positive self talk, relaxation and guided imagery, and cognitive-behavioral therapy. For things such as goal setting and positive self talk you could go to a therapist.

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psychosocial interventions post ACL tear

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Psychological therapy can range from $100 to $250 per session without insurance. On a scale from 1-5, the likelihood that psychological therapy is fully covered by insurance is a 3. Insurance may cover some of the therapy, but it might not be the full cost. Long-term consequences if a person doesn't seek psychological therapy because of the cost are anxiety, depression, and reduced likelihood of returning to sports.

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After an ACL tear, extensive physical therapy may be needed to fully restore knee function, stability, and strength. This process can take a long time and can be divided into different phases. Each session can cost around $75-$150 per session. This form of treatment is very likely to be covered by insurances. Some long term consequences of refusing this treatment may be permanent knee instability, risking further damage of meniscal and cartilage, and an increased risk of knee osteoarthritis.

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Speech, hearing, and cognitive rehabilitation treatments aren’t needed for people who have ACL tears. ACL tears are physical injuries to a ligament in the knee joint, so it doesn’t directly affect parts in the nervous system that affect speech, hearing, or cognitive abilities. Treatments are more focused on treating the physical injury and changes in mental health.

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Pain and Swelling Management and Regaining Range of Motion

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Pain and Swelling Management and Regaining Range of Motion

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Physical therapy can help an ACL patient relieve pain, swelling, and restoring range of motion. Some techniques that can be used are the RICE method (rest, ice, compression, and elevation) and gentle exercises such as gently bending and straightening the knee. These methods can be used to treat the pain and limited range of motion that an ACL tear can cause. A physical therapist would be required to deliver this type of treatment.

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Regaining Balance and Stability and Injury Prevention

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Regaining Balance and Stability and Injury Prevention

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Occupational therapy is a treatment that helps people with physical, mental, or developmental challenges perform daily activities to improve independence and quality of life. In this case, it can focus on regaining balance and stability of the knee and educating patients on injury prevention. These treatments can help in the long term with ACL tears because they will allow for people to be more comfortable with their stability and prevent them from further injury. A licensed occupational therapist would be required to deliver these treatments

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Maintaining a proper diet and nutrition is very important for overall recovery. After any surgery it is important to focus on eating healthy foods that can help to make your exercise build muscle. Especially after a big surgery such as ACL. On a scale of 1-10 I feel this would be like a 7-8 to make these changes based on the person weather or not you ate healthy pre surgery or didn't will make it easier or more difficult to make those changes. A dietitian could help to guide you in the right direction of eating healthier.

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After an ACL tear the person is going to need to change their daily habits and movements to allow for healing. Due to the tear in the knee the person is going to have to learn how to bend at the hips rather than the knees to not put stress on the knee. They are going to have to be extremely mindful not to make any sudden movements but instead make controlled turns and pivots. On a scale from 1-10 I feel this would be a 8-9 to make these changes because the person is going to be in pain and have no option but to do this. A physical therapist could help someone with an ACL tear by making them do these movements to create muscle memory.

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Women athletes are affected by ACL tears because of anatomical factors such as wider hips and smaller knees. They also have weaker hamstrings and hormone factors that play a role. Some challenges that women athletes may experience when getting care for an ACL tear are psychological disorders like fear of reinjury and depression. They might also end up having a generalized treatment plan that isn't optimal for them due to a lack of gender specific research.

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Young athletes are affected by ACL tears because they are more likely to be involved in high impact sports. Growth spurts can also lead to rapid changes in height, hormone compositions, and body composition. Some challenges that young athletes may experience when getting care for an ACL tear are mental health issues such as PTSD, loss of identify, and social isolation.

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Warming up properly is going to help get the blood circulating throughout your body which will help your muscles/body loosen up that way they are not so tight making it less prone to injury. A possible challenge that could be encountered with this prevention measure is not having enough time. If someone is in a hurry or did not have enough time to warm up before a game then that would be a problem. and they will be more prone to get hurt.

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This can look like safe landings after jumps, proper techniques within the game, or to avoid certain movements. Educating athletes on the proper techniques will help keep themselves safer along with other athletes in the game. A challenge that could be encountered with this preventative measure is that it is possible not all coaches will be fully educated on these proper techniques which makes it hard to pass them on to your athletes.

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Doctors are able to use MRIs and ultrasounds to view the knee ligaments and soft tissue that surrounds it. This allows them to view the severity of the tear and in some case even with identifying other possible injuries that occurred because of the ACL tear. Unfortunately, some negative aspects of using technologies like an MRI and ultrasound is that smaller tears or partial tears can be misdiagnosed. An additional negative aspect of using an MRI scan is that it is more expensive.

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BEAR (bridge-enhanced ACL restoration) is a procedure where bioengineered scaffold is inserted into the blood and in between the torn ACL to stimulate the natural healing properties of the body. PRP (platelet-rich plasma) is a type of biological treatment where the patients own blood platelets in a high concentration are injected into the ACL tear location and release growth factors, allowing the tear to heal.A negative aspect of using PRP is that they are usually used for smaller tears and don't always offer the adequate long term effects. A negative aspect of BEAR is that this treatment had a high risk of failure and there is also complications that include infection, knee pain, and even limited range of motion.

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One public health measure taken to help prevent or control ACL tears is implementing programs that have multi-component training. Multi-component training combines strength, balance, agility, and plyometric training. One challenge with implementing this public health measure is resistance to change as some athletes or management may resist new training methods or the changes they require.

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Another public health measure taken to help prevent or control ACL tears is providing education on prevention. This education is given to coaches and athletes to encourage them  to work together to identify improper form and implement injury prevention strategies. A challenge with implementing this public health measure is lack of time because programs are often viewed as time-consuming and difficult to integrate into regular practice schedules which leads to low compliance.