ACL Injury by

Focus Problem: ACL Injury

bboulger — 2023-08-31 00:25:39 UTC

ACL Injuries are a trending issue in society. Especially in the athletics world.

bboulger — 2023-08-31 00:34:36 UTC

white female athletes are at the highest risk

bboulger — 2023-08-31 00:37:45 UTC

Specifically, women between the age of 22-27

stephenluisgallegos — 2023-08-31 00:39:54 UTC

The Athlete/Athletic lifestyle is the easiest lifestyle to be vulnerable to ACL injuries.

bboulger — 2023-08-31 00:40:02 UTC

Tends to occur more during competition than compared to practice

ryangriggs2016 — 2023-08-31 00:41:20 UTC

What ethnicity is likely to suffer from ACL injury?

-Race and ethnicity have been linked to these types of injuries. Caucasians are the most susceptible amongst all ethnic groups. This is likely due to the size of their "intercondylar notches" which houses the stabilizing structures of the ACL.

Notable data is shown below:

Males:

African American: 18.0 mm
Caucasian:16.9 mm

Females:

African American: 15.5 mm
Caucasian: 14.1 mm.

References: https://fixknee.com/athletes-risk-acl-tears

bboulger — 2023-08-31 00:41:36 UTC

The leading sport in which ACL occurs is soccer

stephenluisgallegos — 2023-08-31 00:46:27 UTC

Basketball is the most common sports for ACL injuries in both men and women.

2023-08-31 00:47:21 UTC

-Suddenly slowing down and moving into another direction
-Landing awkwardly after a jump
-Stopping suddenly

Anterior Cruciate Ligament

bboulger — 2023-09-07 00:17:15 UTC

The anterior cruciate ligament is the main structure that is affected by this type of injury. Due to its importance of connecting your thigh bone also known as the femur to your tibia, the shinbone.

Incorrect landing from a high or long jump

bboulger — 2023-09-07 00:20:17 UTC

A common form of movement causing this injury is a particular landing with a significant amount of force from height and body weight.

Injuries often associated with an ACL tear

2023-09-07 00:22:20 UTC

ACL injuries can be associated with ruptures to the MCL (medial collateral ligament) or the menisci. There could also be pressure to the lateral condyle with a bone bruise or a chrondral lesion.

How does the ACL respond?

ryangriggs2016 — 2023-09-07 00:23:15 UTC

An ACL Tear can lead to several different issues. As already mentioned an ACL can be caused by sudden stops or changes in direction. But how does this injury cause the body to react?

-Popping noises
-Severe swelling and inflammation of the tendons
-Inability to put pressure or weight causing severe pain
-Limited or loss of ROM (Range of motion)

Loss of range of motion

bboulger — 2023-09-14 00:15:42 UTC

The normal flexibility of a joint is reduced.

Brace

stephenluisgallegos — 2023-09-14 00:16:09 UTC

Nonsurgical treatment such as a brace to protect from instability and physical therapy to strengthen the surrounding ligaments to provide greater stability.

Surgery

stephenluisgallegos — 2023-09-14 00:17:40 UTC

Surgical reconstruction of the ACL to restore the internal structures of the knee to enable maximal stability.

Ice

stephenluisgallegos — 2023-09-14 00:18:36 UTC

Ice can help with the inflammation after injuring the knee.

Hemarthrosis

bboulger — 2023-09-14 00:18:59 UTC

When this occurs, it causes bleeding into the knee joint

Inflammation

2023-09-14 00:19:08 UTC

When tearing or straining your ACL, the knee joint can immediately start swelling.

ACL Diagnosis: Lachman Test

ryangriggs2016 — 2023-09-14 00:20:03 UTC

The Lachman's test is a clinical exam technique used to evaluate patients with a suspected ACL tear. It identifies the integrity of the knee by assessing "single and sagittal plane instability."

Pain

2023-09-14 00:21:01 UTC

After an ACL injury, there will be a "popping" noise and one will feel pain on the outside and back of the knee.

MRI Diagnostic Test

ryangriggs2016 — 2023-09-14 00:26:35 UTC

An MRI is also another common way to diagnosis an ACL injury. MRI or "Magnetic resonance imaging" is a medical diagnostic technique to showcase the structural integrity of a given structure.

In this case, it can show the extent of the ACL injury but also show damage of other tissues and cartilage.

Chronic Inflammation

bboulger — 2023-09-21 00:28:20 UTC

The prolonged activation of the bodies attempts to heal itself doesn't work as efficiently in the immune system, there is decreased blood flow to the affected area and it negatively impact tissues and organs.

Osteoarthritis: How does it Affect People with ACL Injuries?

ryangriggs2016 — 2023-09-21 00:28:30 UTC

Osteoarthritis is a chronic condition and a degenerative bone disease. It is due to wear and tear within the joints and ligaments of the knee. For ACL injuries this is a highly prominent condition "10 to 20 years after injury." It is also diagnosed to roughly 50% of all people who have had an ACL injury.

Knee Locking

stephenluisgallegos — 2023-09-21 00:28:49 UTC

Caused by mechanical impediment to knee extension such as the stump of a ruptured anterior cruciate ligament (ACL).

Rate of Tears

2023-09-21 00:31:10 UTC

There are several studies that suggested that after tearing/straining the ACL, there is a higher rate of re-tearing. It could depend on the individual's exercise, age, or the surgery performed.

ACL Reconstruction Surgery

bboulger — 2023-09-28 00:34:24 UTC

This would be a long-term treatment that would be necessary for someone with an ACL injury, due to its effectiveness. With a success rate of 85%-90%, meaning most people who undergo surgery are able to return to the same level of function as they had before the injury. The cost can vary between $3,000 and $ 20,000 depending on the state, place of surgery, and insurance. It is usually covered by insurance if it is classified as a full tear in the ligament. If someone with a full tear does not seek surgery that could deal with further injury and pain in the future.

Brace

stephenluisgallegos — 2023-09-28 00:34:49 UTC

Brace to protect from instability and physical therapy to strengthen the surrounding ligaments to provide greater stability is a great long term treatment. A custom knee brace will range in price from $500 - $850 depending on the brand and any unique features or accessories being added onto your order. Most private health insurance companies and Medicare offer coverage for osteoarthritis knee braces based on medical necessity. Not using a brace before your knee joint is ready can impair healing. And neglecting to wear it when you are susceptible to an injury means that you could end up with knee damage.

Longterm treatment for ACL: Physical Therapy

ryangriggs2016 — 2023-09-28 00:39:16 UTC

Following an ACL tear, physical therapy is needed re-stabilize and strengthen the knee and its internal structure.

Once your deductible is met, "most private insurers will cover 80% of your physical therapy bill." Cases will also only be covered if deemed "medically necessary."

If insurance does not cover PT, these are the costs for rehab:

Initial evaluation visit: $150-200
Rehab across a 9-12 month span which approximates at 24 sessions: $2,880

Counseling

2023-09-28 00:41:43 UTC

The total cost for a counseling session can lead up to $60 to $250. Most insurance companies will not cover the cost if not medically needed. After a someone tears an ACL, they can fall into a state of depression and not be motivated to heal. Their mental health can play a big role in the way they seek any other type of therapy.

Counseling/Therapy

bboulger — 2023-10-03 19:33:06 UTC

Counseling or therapy with a mental health professional can help them through the hard recovery process to reduce anxiety and depression. A professional would need to conduct this kind of support.

Short term goals in therapy and counseling are typically ones in which the patient and therapist completes in a single session. Tackling one specific problem at a time is key to resolving the greater issue.

Long term objectives include resolving mental health problems like major depressive disorder, anxiety, anger, etc. Resolving these issues with the patient would in turn help them heal quicker and prevent physical hindrances from manifesting their mental health.

Credentials required for counseling and therapy also require a masters or doctorate and also licensed in the state they intend to practice.

Sports Psychologists

2023-10-04 02:12:53 UTC

Since athletes are most known to suffer from ACL injuries, they can be associated to have feelings of decreased athletic identity. Many athletes are encouraged to speak to a sports psychologist who is specifically trained to enhance a player's performance on the mental side.

An athlete might be doubting themselves and their physical capabilities of returning to the sport. This is a mental health issue since rehabilitation can lead to a full recovery.

Short term effect: "Kinesophobia" is a short term condition sports psychologists can treat. This is deliberating fear of engaging in movements and re-injuring the ACL. Sports psychologists can treat this shorter term issue if it is attacked early.

Long term effect: A chronic long term effect associated with ACL injuries is lack of confidence and stress management. Many athletes feel the pressure of coaches, parents, and teammates to re establish high expectations.

Credentials required for sports psychologists for most include a masters or doctorate in clinical counseling or sports psychology.

How Injury Affects Mental Health

ryangriggs2016 — 2023-10-04 19:19:48 UTC

Here is a video describing the effects of mental health on athlete injury.

Speech Therapy

2023-10-12 00:52:39 UTC

After suffering from a TBI, a patient can visit a speech language pathologists to regain the ability to speak and understand what others are saying. They could also help if they have suffered from issues with swallowing. A speech language pathologist works with children or adults who have trouble speaking or swallowing.

Sound/Music therapy

ryangriggs2016 — 2023-10-12 00:54:57 UTC

Music therapy is a new trending rehabilitation therapy. It can promote improvements in many areas of recovery, "including language production, cognitive functions, muscle control and coordination, and socioemotional regulation". Following a TBI this form of treatment works to engage different areas in the brain all at once.

This training can be performed by a licensed speech pathologist or other clinical professional who has specialized knowledge within this specific field.

Walking (occupational)

bboulger — 2023-10-19 00:28:59 UTC

Walking is a part of the "gait cycle" which is a term used by physical therapists to describe walking. It is used to rehabilitate and build up the body physically. The professional that would be necessary to prescribe this treatment would be a physical therapist as a treatment plan for ACL recovery. Details would include duration, speed and incline level. They would also work in a proper warm up, and cool down based on the recovery of the injury to the ACL.

Balancing/ROM exercises

ryangriggs2016 — 2023-10-19 00:33:27 UTC

A few rehabilitation treatments for ACL injuries include several balancing and range of motion exercises. These types of exercises target an issue called "dynamic knee stability". This is an issue that can cause instability and balance issues in everyday life activities.

Examples of balancing/ROM exercises include quad sets, heel slides, straight leg raises, prone hamstring curls, sitting calf stretch, etc.

Occupational therapists, athletic trainers and physical therapists deliver these treatments.

Increase sleep/rest

bboulger — 2023-10-26 00:46:02 UTC

Many studies have shown that increasing sleep can decrease the risk of re injury as well as speeding up the recovery process. It is noted that especially after ACL surgery, sleep is essential for the body to function during the rehabilitation and physiological process necessary for recovery. This also allows the body to keep the immune system strong as well as keeping the mind healthy in the event of mental health experiences a patient might experience.

Regular Exercise

stephenluisgallegos — 2023-10-26 00:46:49 UTC

After an ACL injury, your knee will not be stable, may be painful, and may have a limited range of motion. You may eventually develop osteoarthritis in the knee.
If you do exercises to strengthen your thigh muscles (quadriceps and hamstrings) and regain knee motion soon after an ACL injury, you will be better prepared for a rehab program or for surgery with a rehab program.
You should start slowly and gradually increase the intensity of the exercises. Do not push yourself to the point that you feel pain. Talk to your doctor about how to best progress through the exercises.

Quad sets, straight-leg raises, and heel slides are common exercises used after an ACL injury. As symptoms decrease and you are able to bear weight, side-lying leg lifts, glute sets, bridges, mini-squats, heel raises, and prone hamstring curls might be added.

Staying Accountable in Your Journey

ryangriggs2016 — 2023-10-26 00:47:10 UTC

Most of your recovery will require you to be accountable and continue exercises following an ACL injury. Many individuals may only engage in physical therapy with their specialist, but not engage in at home remedies. Recovery is ultimately up to you and it starts by having a positive mindset.

Dietary and Nutrition Changes

2023-10-26 00:49:11 UTC

Changing dietary and nutrition consumption can efficiently affect a person after suffering from a ACL injury. There are nutritions like vitamin D and calcium supplementation that help build more strength and keep them healthy. Also including more nutrient dense foods in the diet like proteins, fruit, carbohydrates can help rebuild that muscle. One can have difficulty making these changes because they may be unmotivated or upset with their injury. Although, it is best to see a dietitians and nutritionists to make a good plan.

Older Age People

ryangriggs2016 — 2023-11-02 00:47:33 UTC

Many older age adults are often at greater risk for ACL injury because of natural degeneration and wear over time. The fibers that compose the ligaments of the ACL lose organization and the elasticity diminishes with age.

Challenges:

Older age groups may struggle to fully recover from an ACL injury and in addition can suffer from far higher complication rates in surgery.

In addition, with age ligaments become poorly vascularized and unable to provide the nutrient needed for full recovery.

The recovery process can also occur at the end of the 8-12 month window and adults may not regain full ROM, stability, and also experience more future pain/arthritis.

Children

2023-11-02 00:47:53 UTC

Children have a greater risk of an ACL injury because of their need to be active or energetic. Any child can easily take a fall or land wrong and suffer an ACL injury. The child will be negatively impacted because with that injury they may have to cope with knee pain for the rest of their life. The child could also increase the risk of further injuries like meniscal tears or early onset osteoarthritis. When treating the injury, children may become bored and unmotivated to continue doing the exercises. They could also start being irresponsible and mess around which can make the injury worse.

Knee Brace

stephenluisgallegos — 2023-11-08 23:46:36 UTC

Based on the first reference, the study demonstrated that bracing had a significant effect on the gluteus minimus, rectus femoris, vastus medialis, vastus lateralis, gastrocnemius medialis, gastrocnemius lateralis, soleus, and tibialis anterior muscles. Thus, wearing a brace may help prevent ACL injuries by regulating muscle forces during single-leg landings. The gluteus maximus, vastus medius, and vastus medius muscle forces were significantly increased in participants who were wearing a brace during the single-leg landings from 30 cm to 45 cm. This implied that single-leg landings from a greater height may increase the risk of knee joint injury. Further research is required to determine the effects of various braces on specific maneuvers.

Based on the 2nd references test results The knee braces and sleeves worn by the participants in this study exhibited a decrease in flexion, abduction, and adduction movements, while no such reduction was observed in the knee joint shear force, internal rotation, or ACL force, which are part of the primary ACL injury mechanisms in athletes. Therefore, when considering only the mechanical aspects, it is considered that a sports knee brace, which could control the knee joint shear force and internal rotation, could be developed for preventing sports-related injuries or for rehabilitation purposes.

Some challenges with knee braces are athletes will not have the same flexion, abduction, and adduction movements without the brace meaning they are gonna move their legs to their fullest.

Reference:

The Effect of a Knee Brace on Muscle Forces during Single-Leg Landings at Two Heights

Wang, Yubin ; Liu, Haibin ; Wei, Huidong ; Wu, Chenxiao ; Yuan, Feijie

Switzerland: MDPI AG

https://search.lib.asu.edu/permalink/01ASU_INST/fdcm53/cdi_pubmed_primary_36901663

Effect of wearing a knee brace or sleeve on the knee joint and anterior cruciate ligament force during drop jumps: A clinical intervention study Jeheon Moona, Hyeyoung Kim b, Jusung Lee c, Siddhartha Bikram Panday

https://search.lib.asu.edu/permalink/01ASU_INST/fdcm53/cdi_elsevier_sciencedirect_doi_10_1016_j_knee_2018_07_017

Understanding Female Hormones (menstrual cycle)

bboulger — 2023-11-09 00:09:14 UTC

During the menstrual phase that females, go through there is a 40-50% decrease in collagen produced for the joints. Which increases the risk of injury by almost half for female athletes. The basal body temperature also fluctuates during this cycle. A preventative measure is for supporters such as coaches and athletic trainers who work with these athletes the closest to have awareness and basic knowledge about these hormone changes to look out for female athletes and prevent this injury.

MRI

bboulger — 2023-11-15 16:30:51 UTC

An MRI technology can be used to diagnose an ACL injury. An MRI does this by showing the patient signs of damage to the tissue and cartilage in the knee with its magnetic imaging. This is useful to know the extent of the injury to then take recovery precautions from there.

Electromyography (EMG) Biofeedback Devices

ryangriggs2016 — 2023-11-15 18:28:48 UTC

-This technology works to monitor and provide feedback on muscle activity. For ACL injuries, small electrodes are placed on the knee and are used to generate muscle contractions.

-Utilization of this technology can help individuals learn how to activate and control specific muscles more effectively. This is utilized specifically for treatment/recovery.

-In this case, EMG therapy can help individuals re-enhance knee extension/flexion.

BEAR (Bridge-enhanced Anterior Cruciate Ligament Repair)

ryangriggs2016 — 2023-11-15 18:50:48 UTC

-The BEAR implant is a new medical advancement designed for ACL healing.

-BEAR Implants are made out of collagen and work with your own blood to heal the torn ends of your ACL back together. During the procedure, the ACL surgeon adds your own blood to the implant and inserts it between the torn ends of the ACL. This process allows for self healing of the ACL.

Washercap

2023-11-15 19:47:54 UTC

The Washercap, a soft tissue fixation device, is used within a ligament or tendon reconstruction operation including an ACL surgery. The device helps treat the injury and replaces the original ACL with screws. It promotes a safer recovery and ensures proper graft osseointegration. The patient may experience pain from the placement of the screws or it could indicate a sign of failure from the surgery.

Proper Warm-up

2023-11-23 00:50:11 UTC

Before any conditioning or training, athletes are required to have a proper warm-up to help prevent muscle strains or stiff knees that could lead to an ACL tear. In the warm-up, the athletes could include exercises like reverse lunges, bridges, and straight/backward leg rises to help strengthen their muscles. There are also exercises that could improve landing or the sudden movements when playing. Without a warm-up, an athlete could receive cramps or sprains during their game/competition.

Amount of Exercise Needed Daily

ryangriggs2016 — 2023-11-23 00:50:29 UTC

While all ACL injuries can't be prevented, many are due to wear and tear on the body. Many athletes overwork their muscles making them highly susceptible for injury. With that being said, the National Institute of Health lists the optimal amount of exercise needed to be healthy while sustaining less injuries. These are the minimal requirements for both athletes and non athletes. However, nobody should exceed anywhere from 2-4 times this amount for optimal results.

-Minimum of 5 to 10 hours of moderate physical activity weekly.

-Minimum 2 hours and 30 minutes to 5 hours of vigorous physical activity weekly.