Description

The anterior cruciate ligament, or ACL, is located in the center of the knee, along with the posterior cruciate ligament, or PCL. These ligaments wrap tightly around the femur and tibia to form the cruciate structure in the knee, which prevents the bones from moving forward or backward.

The cruciate ligaments provide stability and limit internal rotation of the tibia, prevent hyperextension of the knee, limit anterior displacement of the tibia during knee flexion.
ACL injuries are usually sports-related. However, spraining, straining or tearing of the ACL can be caused by repetitive physical stress, such as excessive pivoting or twisting of the knee.

Injury to the cruciate ligaments may not cause pain. Rather, the patient may hear a popping sound in the joint and the leg bends when attempting to sit orthostatically (standing).

Diagnostic

For diagnosis, the doctor performs several tests to check the position of different structures in the joint.
Magnetic resonance imaging (MRI) detects a complete ligament rupture, but arthroscopy may be the only investigation that can detect a partial meniscus tear.

Treatment

In general, for active people, anterior cruciate ligament reconstruction is opted for, a surgical treatment that will be followed by a recovery treatment.
Non-operative treatment is indicated for elderly and sedentary people
In active people (young or elderly), ACL deficiency increases the risk of instability, which can lead to meniscal tears, joint damage and subsequent degenerative changes
ACL reconstruction regains knee stability, rehabilitation is focused on gaining mobility and strength, thus maintaining stability.

1) For those who avoid surgical treatment and opt for physiokinetotherapy treatment with the following objectives:

Disappearance or relief of pain;
Prevent, disappear or relieve inflammation;
Maintaining or improving joint stability and mobility;
Maintaining or improving muscle strength and endurance;
Improving tissue trophicity and functionality;
Gaining a correct body attitude;
Readaptation to usual and professional gestures, and if the patient is elderly, resuming the usual daily activities (ADL- activity of daily living) and thus increasing the patient’s quality of life (QOL- quality of life).
Occupational therapy: you will wear knee orthoses for an indefinite period of time, periodically performing exercises to tone the lower memebrae muscles associated with sports such as swimming and cycling, which take the weight off the knee.
In situations of ligamentoplasty of the LIA the principles of recovery will be:

Principles of rehabilitation

– achieving full range of motion and reducing inflammation prior to surgery to avoid arthrofibrosis
– early loading and maintenance of range of motion, with emphasis on achieving full extension
– early initiation of quadriceps and hamstring activation
– efforts to control inflammation and pain to limit muscle inhibition and atrophy
– avoid early ex PRECOCECE open kinetic chain (OKL) that could shear or tear the immature graft (ligamentoplasty)
– conditioning of the entire lower limb
– neuromuscular and proprioceptive retraining
-functional training
-cardiovascular training In case of ligamentoplasty the recovery will start before the surgery, namely:

Pre-operative recovery:
– Ice and non-steroidal anti-inflammatory drugs to avoid reflex inhibition of the quadriceps.
– Closed kinetic chain exercises for the quadriceps to maintain muscle strength
– Mobility exercises in the knee joint
– Proprioceptive activities can also be started

Postoperative physiotherapy will start a few days after surgery, in a specialized physiotherapy center or at home under the supervision of a physiotherapist, at least during the first 3-4 weeks. The recovery of the muscles of the affected limb requires the most time and will be done gradually, with a muscle recovery taking up to six months.
We consider the recovery of the quadriceps muscle, which is the anterior thigh muscle and which is indispensable for a good function of the knee, as well as the hamstrings (posterior thigh muscles) and the calf muscles.
During the first weeks of physiotherapy, more emphasis will be put on restoring the mobility deficit in the operated knee, through passive mobilizations, passive-active and postural, but also on toning the muscles, through isometric exercises, without weight.

Example of isometric exercises:
1.Quadriceps contractions.
2.Sitting with the lower limbs extended, lift the affected limb with the tip pulled up.
3. Same ex. with 2-3 sec. holding the limb.

Gradually, in weeks 3-4 weeks, depending on the patient’s physical condition, the patient will start cycling (10-15 minutes). In the following weeks, isometric toning exercises, but using light weights, will be introduced. In weeks 14-16 the patient will try light running, without change of direction, with full recovery in weeks 20-24.

Example of exercises:
1. Partial knee bends on both legs
2. Standing on your toes .
3. Fandari usoare.

It can be associated with drug treatment, physiotherapy, thermotherapy, massage therapy.

Electrotherapy is used in different forms:

– interferential currents (CIF) of medium frequency;
– pulsed currents (TENS) – transcutaneous stimulation, non-traumatizing, combats acute and chronic pain;
– diadynamic currents – analgesic, hyperemittent, dynamogenic;

Ultrasound (in continuous or discontinuous field) with analgesic, myorelaxant and hyperemesis, in combination with other types of currents.
Magnetotherapy – Magnetic field – with indications in contracts
Laser therapy
Thermotherapy – Cryotherapy – ice applications
Local forms – cold compresses, local ice massage, cold packs, cooling spray;

Effects: vasoconstrictor, hemostatic, anti-inflammatory, analgesic-anesthetic.