T&O: ACL PCL Tear Flashcards
Outline the physiology of the ACL
ACL = primary restraint to limit anterior translation of the tibia (relative to the femur) and contributing to knee rotational stability (particularly internal)
Outline the aetiology of an ACL tear.
History of twisting the knee whilst weight-bearing
Majority occur without contact and result from landing from a jump
What are the symptoms of an ACL tear?
Rapid joint swelling = ligament is highly vascular
Significant pain
Instability = leg giving away
How would you investigate an ACL tear?
Lachmans test = knee in 30 degrees of flexion, one hand stabilising the femur, pulling the tibia forward to assess the amount of anterior movement to the tibia
Anterior draw test = knee in 90 degrees of flexion, thumbs on the joint line and their index fingers on the hamstring posteriorly, force is applied anteriorly to demonstrate tibial excursion
X-ray = AP, lateral
MRI = gold standard
How would an ACL tear be managed?
RICE = rest, ice, compression, elevation
Conservative = rehabilitation, strength training of the quadriceps to stabilise the knee, the patient can often fully weight bear and a canvas knee splint can be applied for comfort
Surgical = use of a tendon or an artificial graft, this will always follow a period of ‘prehabilitation’, whereby the patient will engage with a physiotherapist for a period of months prior to the surgery
What are the complications of an ACL tear?
Post-traumatic osteoarthritis
50% of ACL tears will also have a meniscal tear, with the lateral meniscus the more commonly affected.
Outline details of a PCL tear.
Primary restraint to posterior tibial translation and works to prevent hyperflexion of the knee
Aetiology = high-energy trauma, such as a direct blow to the proximal tibia during an RTA, or less commonly in low-energy trauma when there is hyperflexion of the knee with a plantar-flexed foot
Posterior knee pain
MRI
Knee brace and physiotherapy
Surgery = insertion of graft
