Anterior Cruciate Ligament Injury - Research Paper Example

ACL Injury ACL (anterior cruciate ligament) injury is a common knee injury that is quite predominant amongst athletes and persons that tend to engage in demanding physical activities. Such activities include those physical exercises that engage bipedal movements or exertion of pressure on the lower limbs. The activities vary from long distance running, sprints, jumping from heights, and playing games that require one to move and change positions quite randomly and repeatedly. In professional terms, ACL injury can be defined as musculoskeletal injury to the knee. The most common ACL injury tends to be associated with raptures and non-contact tears. There are other knee ligaments injuries but the most common injury associated with instability at the knee is ACL injury (Chaudhari, 2008). Perhaps this is because of the fact that ACL injury presents quite a number of ways through which it can suffer tears. Research has shown that the most common ACL injury occurs when the knee is bent exceedingly to the or to the sides more than it is used. Such scenarios are highly likely to occur amongst sports persons during trainings when they engage in activities aimed at making them flexible. In other instances, ACL injury may also occur when there is a direct pressure exerted on the thigh at a time when a person is standing on one leg (Tiidus, 2008). Studies have also revealed that ACL injury may also occur when a victim makes abrupt stop from a significantly highly speed, or attempts to make a sudden turn to the side while on a significantly high-speed motion. In all the above instances, one may observe that they all tend to exert pressure to the sides or on the ligaments at the back of the leg as had been noted. It is not a straightaway guarantee that any of such movements will result in ACL injury, but that they put a person at a highly risk of suffering from ACL injury. Therefore, there is a need to advise persons that take part in physical activities quite often on how what precautions to take during active periods of activities (Chaudhari et al., 2008). However, many physiotherapists and health professions have researched and proposed various ways for recovery and rehabilitation for detected cases of ACL injury. The thesis statement of this research shall be: Appropriate response to ACL injury should be case specific rather than universal approach for recovery and rehabilitation. This research shall assess various cases and analyze each depending on its magnitude. This is because prevalence of ACL injury has revealed that each case comes with its own uniqueness whereby some cases require surgery while others have shown that it is also possible for non-surgical responses (Myer et al., 2005). Methodology Since the sensitivity in the area of research is critical, it is practically impossible and inappropriate to anticipate ACL injury and conduct recovery and rehabilitation. The paper shall, therefore, focus on various clinical observations and researches that had been conducted. The research will assess various scholarly researches on and their findings on physical injuries that result from taking parts in sports. It will particularly focus on knee injuries and narrow down to ACL injury. The research will also attempt to analyze the recovery and rehabilitation methods that were used in the past and their applicability in the present society where technology has made a significant number of procedures easier that they were previously (Myer et al., 2005). ACL Injury Prevalence Statistics indicate that ACL injury is very common among athletes than on any other category of sports persons. Research has also shown that ACL injury prevalence is increasingly becoming common among sports persons in basketball and football. Such claims are also supported by findings from American Orthopedic Surgeons Society for Sports Medicine (AOSSSM). The AOSSM also highlights that over 145,000 ACL injury cases occur in the United States annually. Health care response for such cases is noted to cost up to $ 500, 000,000 every year, making it one of the injuries that is increasingly becoming expensive over time (Chaudhari, 2008). Most of the noted causes that have high prevalence are those that result from sports that have been categorized as high intensity sports. Injury from such high intensity sports have been noted to be mostly resulting from contact mechanism and non-contact mechanisms. Research indicates that prevalence from both mechanisms have almost equal chances of occurrence. However, prevalence of ACL injury resulting from contact mechanism is commonly associated with soccer, rugby, football, and basketball. On the other hand, prevalence of ACL injury resulting from non-contact mechanism is closely associated with sports such as athletics and other related games such as high jump and jumping hurdles. The other category that is not associated with any sports usually occurs from amongst children games though its prevalence is so insignificant that it is almost negligible (Tiidus, 2008). While prevalence is mostly common amongst persons active in sports, it has also been noted that ethnicity also plays a vital role in ACL injury. Some researchers have shown that persons of some ethnicities have been found to have higher incidences of ACL injury. In a report from the American Women’s National Basketball Association, it emerge that the prevalence of ACL injury was quite high from among white European-American players than from their Asian, African-American, and Hispanic counterparts. However, no genetic research has successfully explained such differences (Chaudhari, 2008). The findings in the report thus remain just a coincidence as far as ACL injury prevalence is concerned. Other reports have shown that prevalence of ACL injury remains equal for any persons taking part in active sports as a career or for the fun of it. Even so, a gendered analysis of prevalence of ACL injury supports the argument that the likelihood of prevalence of ACL injury among female subjects have up to three times as compared to prevalence in males. This is from the fact that women have a wider pelvis when compared to male (Tandogan, 2011). Other studies also postulate hormonal variations in females as a result menstruation usually induce changes in the tension of the muscles. Findings from the same study has found that prevalence of ACL injury is also sport specific with volleyball being noted to have the least prevalence for ACL injury. Prevalence of ACL injury was also noted in sports such as Alpine skiers but with insignificant comparisons to gender differences (Tiidus, 2008). In short, one may notice that although prevalence of ACL injury has emerged to be also affected by gender and ethnicity, the difference is so small that all the variables seemingly have equal chances of falling victims. It is emerging, however, that prevalence remain high amongst personalities taking part in sports in general as opposed to the common belief that only athletes have a high prevalence. Given the prevalence of ACL injury, it is therefore apparent that the chances of injuries are almost unavoidable since personal caution alone does not eliminate chances of injuries. Coaches and medics should therefore be prepared to respond to each case of ACL injury depending on its unique complications. They need to know the symptoms associated with ACL injury. Knowing such symptoms enable them to conduct confirmatory diagnosis and proceed with an appropriate recovery and rehabilitation procedures (Chaudhari, 2008). ACL Injury Detection, Recovery, and Rehabilitation Detection of ACL injury is quiet easy in many cases since victims can tell from the pains that they feel. ACL injures that result in rears are likely to take many forms. Victims have been noted to hear a “pop” sound upon landing just before the inability to support themselves from the side of the leg that had injury. Cases of both limbs suffering similar ACL injuries are almost nil since the injuries result from excess pressure on one leg. Meniscal tears are some of the most common of knee injuries. Findings have indicated that they tend to occur sometimes as lone lesions and in some cases as compound injuries (Myer et al., 2005). Qualified medical personnel usually conduct diagnosis of ACL injury. Such a medic may use the pivot-shift test, Lachman test, or the anterior drawer test. These are the most recommended clinical diagnosis of any suspected injuries related to ACL injury. Another emerging method that can be used to diagnose ACL injury also include MRI (magnetic resonance imaging) scan. Clinical examinations could also include having to observe swellings on the affected part. Victims are also noted to be experiencing excruciating pain in attempts to bend the knee. Other physical diagnosis that coaches and trainers should be on the lookout for includes buckling during movements of sometimes-even knees locking (Tiidus, 2008). As compound injuries, injuries to the meniscus may occur in association with other related injuries along the articular cartilage on the tibia plateau of the femoral condyles. For torn menisci, treatment used to be treated surgically. Such treatment was achieved through conducting a meniscectomy. Modern treatment does not approve of total meniscectomy owing to its increased of degenerative changes in the articular cartilage with incidences of up to 40%. Treatment of meniscal injuries, whether transverse, degenerative, or transverse, usually takes into consideration chronicity of the patient’s symptoms (Chaudhari, 2008). Even so, it is not easy to determine the contribution of meniscal tear to the amount of pain in the specific joint that has been injured. Many approaches that medics have adopted in response to such cases normally include removal of the torn and degenerated meniscus. Given that a torn ACL has been observed to be less likely to bar knee movement, some researches have supported the idea that there is the need for persons involved in such ACL injury to rest their knees and compress the knee as they await professional care. Such a conservative care is based on the fact that if it happens that as long as tears to the ACL remain unrepaired, they are highly likely to result to more damage in the cartilage in the knee region. This is because after the ACL has been torn after an injury, chances that the tibia and the femur would rub are very high. Depending of the severity of the injury, the ACL injury may or may not require surgical procedure (Tandogan, 2011). Surgical Procedures for Severe Tears Research has shown that sometimes an injury is so severe that it cannot heal on its independently. Under such circumstances, there is usually a need to consider surgery as a solution to the problem. It is vital to note that the circumstances that surgery becomes a necessity, the situation is usually such that there is no blood supply in the affected ligament. Because athletes and sports persons require take sharp turn, it becomes inevitable that surgical reconstruction has to be carried out so that that the victims may resume their lifestyles quiet safely without putting themselves at a risk (Myer, 2005). Even so, any surgery does not usually come immediately provided there is severe injury. Medically, it would be practically impossible for the procedure to go on in the event that there is swelling on the ligament area. It therefore follows that primary care is first conducted to reduce the swellings and assess any other possible related secondary complication as a result of the injury. Only then does surgery follow, normally some weeks from the initial ACL injury period. For reliable performance, the torn ACL is not usually repaired, but reconstructed. Medics identify other ligaments in the body and use them to reconstruct the broken ACL. For good results, several researches indicate that many surgeons prefer using patella tendon bone auto graft and hamstring auto graft. For immediate adaptation, one third of the central patella tendon is removed together with a small piece of bone (Chaudhari, 2008). Each method usually has its advantages although all of them guarantee success. Working with the patella tendon is advantageous given that it is approximately the same size as the ACL, therefore adapting to its new functions almost immediately. On the other hand, reconstructive surgery using hamstring auto graft offers advantage such as elimination of pain in the post-surgery period. Although the patella tendon bone method usually result is post-surgery pain owing to the removal of bone to allow attachment in the kneecap, many medics agree that it is the most reliable surgery that guarantees strength. The fact that there is bone-to-bone attachment makes it very string once the bones have attached and fused (Tiidus, 2008). Rehabilitation It is important to note that medical response for ACL injury does not end with surgery for severe cases and other cases that do not necessitate surgery. Patients have to be guided on appropriate recovery exercises. Competent physiotherapists under the guidance of qualified medical personnel have been observed to best conduct rehabilitation. Rehabilitation process usually starts with pain and swelling management as the patient tries to regain his/her normal movements (Myer, 2005). Progressive management will be carried on in the third and fourth weeks to enable knee-bending reflexes. Progressively, the patient should be guided to do additional exercises that are challenging such as regaining balance and later attempt locomotion between eighth week all the way to the tenth week. Physiotherapist should focus on other activities aimed at strengthening the joint and ligaments. They should take caution that all the activities are progressive to allow adaption and avoid any circumstance that may result in an injury before full recovery. Finally, the patient will gain full recovery and resume the normal activities. Medical personnel may do later follow-ups after the full recovery to analyze progress before finally confirming resumption of full recovery. It should be noted that the timeframe for rehabilitation should not be followed strictly, as some cases may respond quite slowly while other cases will just be normal (Chaudhari et al., 2008). Conclusion In conclusion, one should notice that although ACL injury result from largely similar causes, the nature or medical response that would be most suitable for each case may differ. Such differences are case specific depending on how the patients system adapts to the grafts. For non-surgical treatments, responses and recovery are also related to the post-surgical rehabilitation and may vary depending on the severity of the initial injury. It is therefore vital that medical personnel involved in treatment and rehabilitation of such cases be prepared to treat each case from its own perspective rather than generalizing recovery period. After analyzing causes of ACL injuries, its varying nature and treatment methods, this research confirms that appropriate response to ACL injury should be case specific rather than universal approach for recovery and rehabilitation (Myer, 2005). References Chaudhari A.M., Briant P.L., Bevill S.L., Koo S., Andriacchi T.P. (2008). Knee kinematics, cartilage morphology, and osteoarthritis after ACL injury. Medicine and Science in Sports and Exercise, 40(2):215-222. Myer G.D., Ford K. R., and Hewett T. E. (2005). The effects of gender on quadriceps muscle activation strategies during a manoeuvre that mimics a high ACL injury risk position. Journal of Electromyography and Kinesiology Volume 15, Issue 2, 181-189, April 2005. Tandogan R.N., Mann G., Verdonk, R., and Doral, M.N. (2011). Sports Injuries: Prevention, Diagnosis, Treatment and Rehabilitation. New York: Springer. Tiidus. P. (2008). Skeletal Muscle Damage and Repair: Mechanisms & Interventions. Champaign: Human Kinetics. Read More