There are anterior and posterior cruciate ligaments in the knee joint, also known as cruciate ligaments. The anterior cruciate ligament starts from the front of the intercondylar bulge of the tibia and ends posteriorly, superiorly, and externally at the inner surface of the femoral epicondyle; the anterior cruciate ligament prevents the tibia from moving forward and rotating externally, and the cruciate ligament plays an important role in stabilizing the movement of the knee joint.
1. Etiology and classification
The cruciate ligament is deep and can only be damaged by strong violence. It is usually seen in traffic accidents and sports injuries. Violence causing knee hyperextension or hyperextension causes injury to the ACL of the knee. If external force is applied to the femur from anterior to posterior during knee flexion, or if external force strikes the upper tibia from posterior to anterior, it can cause rupture of the ACL.
Classification.
(1) A cruciate ligament injury can tear the bone at the point of origin and termination, resulting in an avulsion fracture.
(2) can also be injured in the body, the injury can be a partial rupture or complete rupture.
2.Clinical manifestations and diagnosis
There is a history of obvious trauma to the knee joint, and there may be a sense of tearing within the knee joint at the time of injury. After the injury, the knee joint is painful, obviously swollen, unstable and impaired in movement. Examination shows joint swelling, positive floating patella test; positive drawer test.
3.Reconstruction post-operative rehabilitation treatment plan
Early rehabilitation: eliminate swelling; relieve pain; maintain joint flexion mobility at 0~70 degrees; muscle contraction exercises (mainly ankle pump – forceful, slow, full-range flexion and extension of the ankle joint, which is important to promote circulation, subside swelling and prevent deep vein thrombosis; quadriceps isometric exercises -that is, thigh muscle tensing and relaxation, done as often as possible without increasing pain. Greater than 500 reps/day and N cord isometric exercises – the pillow on which the affected leg is pressed down hard to tense and relax the muscles of the posterior thigh. (Greater than 500 repetitions/day).
Initial rehabilitation: maintenance of joint mobility from 0 to 110 (3 weeks postoperatively, knee flexion exercises in a sitting position, holding the knee until you start to feel pain for 10 seconds, relaxing slightly for 5 seconds, then holding the knee again, repeatedly for 20 minutes, once a day); strengthening muscle strength exercises (straight leg raise); one third weight bearing on the affected limb.
Mid-term rehabilitation; maintenance of joint mobility from 0 to 120; strengthening muscle strength exercises (start static squatting exercises after 6 weeks); increasing proprioceptive exercises (start proprioceptive exercises such as stationary bicycle and balance machine after 8 weeks).
Post-rehabilitation: Full restoration of activities of daily living; strengthening of muscle strength exercises and joint stabilization (e.g. start knee loop exercises, jumping up and down exercises, lateral straddle exercises, swimming, etc.).
Return to sports rehabilitation: full recovery of sports or strenuous activities; strengthening of muscle strength and joint stability.
Adjunctive physical therapy.
(1) Continuous passive knee mobilization (CPM) therapy
(2) Unassisted passive joint movement
(3) Apparatus traction therapy
(4) Low frequency therapy
(5) Muscle strength exercises using equipment
(6) Ice packs and wax therapy
(7) Balance trainer exercises
4.Cautions.
(1) In addition to the braking protection of the operated limb, its body parts (such as upper limb, waist and abdomen, and healthy side leg) should be practiced as much as possible to ensure physical fitness, improve the overall level of circulation and metabolism, and promote the recovery of the operated local area.
(2) Early joint mobility (flexion and extension) exercises should be performed only once a day, aiming for an improvement in angle, and avoiding repeated flexion and extension for several times. If the flexion angle does not progress for a long time (more than 2 weeks), there is a possibility of joint adhesions, so we should pay great attention to this and insist on completing the exercises.
(3) Immediately after the mobility exercises, ice should be applied 2-3 times a day. The exercises should be completed according to the requirements of the rehabilitation program and should not exceed the prescribed angles or fail to reach the prescribed angles.