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Abstract: The patient in this case is a 25-year-old young man who came to the clinic two days before the visit because he had knee pain and limited joint movement after falling without standing still while landing on the ground while playing basketball, which could not be relieved after resting, and came to the clinic because he had to participate in a basketball game. After evaluation, a rupture of the anterior cruciate ligament, also known as anterior cruciate ligament rupture, was considered. Through arthroscopy, an autologous tendon graft ACL reconstruction was performed, and after the surgery, the knee function was restored.
Basic information】Male, 25 years old
Disease Type】Anterior cruciate ligament rupture
Hospital】Hunan Provincial Brain Hospital
Consultation date】March 7, 2021
Treatment plan】Surgery (ACL reconstruction) + medication (Celecoxib capsules, Mizarin tablets)
Treatment period】2 weeks of hospitalization, 3 months of postoperative brace protection exercise, regular outpatient follow-up
Treatment effect] Knee pain and swelling were relieved, and function was restored.
I. Initial consultation
Today, a 25-year-old man came to the clinic. When he entered the clinic, it was obvious that he was a regular athlete, and by asking him about his medical history, we learned that the patient fell to the ground after playing basketball two days ago and did not stand still. After a day’s rest, he could not walk well. He came to the clinic because he was anxious about a basketball game at school. On examination, the patient was found to have limited knee flexion and extension activities, positive anterior knee drawer test and positive Raffman test.
Treatment
The patient was considered to have suffered a violent knee injury due to unstable landing during high-speed sports. The ACL injury as a common sports medicine disease, because it is not a fracture, the ligament nerves are not many, the patient will not find the problem in the first time, usually rest on their own after not relieved before coming to the doctor. The patient’s knee was examined, including frontal and lateral X-rays and MRI of the knee, which showed no signs of fracture, and the MRI showed significant edema of the ACL, walking inversions, and anastomosis of the femur and tibia, all suggesting a rupture of the ACL. The patient was treated surgically by taking an autologous tendon graft and reconstructing the ACL under arthroscopy, and after the surgery, oral celecoxib capsules were given to relieve inflammation and pain, and oral mydriatic tablets were given to reduce swelling.
III. Treatment effect
ACL rupture is a kind of sports medicine disease that occurs in young patients, mainly manifesting as limited knee movement with obvious pain. Active knee flexion activities. The stitches were removed 2 weeks after surgery and the patient went home and continued rehabilitation exercises. 1 month and 3 months after the follow-up, the patient complained of relief of knee pain and significant improvement in function. One month after surgery, the knee joint was flexed to 90 degrees, and weight-bearing exercises and rehabilitation exercises were feasible on the ground.
IV. Notes
We are glad that the patient’s anterior cruciate ligament rupture was repaired after active and effective treatment. After the patient is discharged from the hospital, it is recommended to wear an adjustable brace and gradually increase the range of motion during activities. In daily life, or during rehabilitation, the patella can be pushed by itself to prevent adhesions around the joint. In case of pain and swelling, it is recommended to elevate the affected limb at rest and to take oral heptaerythroside sodium tablets to reduce swelling. After discharge from the hospital, patients should rehabilitate themselves and follow the principle of gradual progress. They can choose quadriceps contraction exercise and ankle pump exercise to promote blood return and reduce swelling, in addition, knee extension and thigh lift can exercise the muscle strength around the knee joint. Patients are promptly reviewed in our department at 4, 8, and 12 weeks after surgery, and knee MRI is reviewed at 3 months after surgery to assess the ligament reconstruction and regeneration.
V. Personal insights
In young patients who present with symptoms of anterior cruciate ligament rupture, it needs to be differentiated from patellar fracture. Patellofemoral fracture has obvious anterior knee pressure pain and limited movement of the knee in extension, and X-rays can reveal patellofemoral fracture signs. In this case, no fracture signs were found on the front and side X-rays of the knee, so the diagnosis was anterior cruciate ligament rupture. Postoperative rehabilitation is very important for patients with ACL injuries. Patients should always be encouraged to strengthen the static exercise of the muscles around the knee to prevent stiffness of the joint. To avoid ACL injury during exercise, firstly, warm up sufficiently to move the muscles around the joint; secondly, exercise the strength of the core muscles to increase their stability. Do not rush to move immediately after the fall to prevent secondary injury aggravation, you can take the RICE treatment principles, that is, braking, ice, compression, elevation of the affected limb, can avoid further aggravation of the injury.