Research Paper on "Anterior Cruciate Ligament, or ACL"

Home > Topics > Disease & Injury My Account

Research Paper 7 pages (2193 words) Sources: 7

[EXCERPT] . . . .

anterior cruciate ligament, or ACL, is one of four ligaments that connect the bones of the knee joint providing roughly 90% of the knee's stability (Health Information Publications, 2011). The ACL is one of the most important of the four ligaments and is often injured during athletic activities although it causes of ACL injury can be from non-athletic activities (Health Information Publications, 2011).

In order to better understand the ACL functions, injury causes, prevention of further or future injury, and the techniques used in surgically repairing a torn ACL, a brief discussion of the anatomy of the knee is both helpful and useful. The knee is a hinge joint and is the meeting place for the femur, tibia, and patella (Netter, 2011). Cartilage provides a smooth layer, which provides somewhat of a cushion for these bones such that the bones may smoothly glide over one another (Netter, 2011). Four ligaments, including the ACL firmly hold the knee together while still allowing range of motion (Netter, 2011). The ACL is located within the knee joint along with the posterior cruciate ligament, or PCL (Netter, 2011). The ACL and PCL form a cross (cruciate is Latin for cross hence the name cruciate) in the center of the knee and play a role in controlling forward (anterior) and backward (posterior) knee motions as well as rotation (Health Information Publications, 2011). The other two ligaments that hold the knee in place are the medial collateral ligament (MCL), which is located on the outside of the inner knee, and the lateral collateral ligament (LCL), which is located on the outside of the outer knee. One other ligament that is very important is the patellar (knee cap) ligament, which connects the pa

Continue scrolling to

download full paper ⤓

tella to the upper portion of the tibia. In ACL reconstruction, physicians will often use a portion of the patellar ligament (Health Information Publications, 2011).

Menisci are crescent shaped structures located either side of the knee and made up of a type of cartilage. Each meniscus acts as a shock absorber to help bear the weight loading between the weight bearing ends of bones in the knee. When the ACL is torn, it is very common for the menisci to tear as well (Bahr & Krosshaug, 2005).

Ligaments help stabilize the knee joint, menisci act as shock absorbers, and muscles aid in movement control, therefore, muscles play an integral role in keeping the ligaments healthy, and aiding in controlling weight loading of the joint (Ageberg, Thombe, Neeter, Gravare Silbernagel, & Roos, 2008). The most important muscles involved are the quadriceps, which are involved in knee extension, and the hamstrings, which are involved in knee flexion (hamstrings).

The quadriceps comprise of a groups of four muscles called the rectus femoris, vastus lateralis, vastus intermedius, and vastus medialis. The hamstrings comprise of a group of three muscles called the biceps femoris, which has two muscle heads known as the long and short head, the semitendinosus, and semimembranosus. The long and short head of the biceps femoris wrap together as the outer hamstring and merge as a tendon with insertion below the knee joint. The semitendinosus and a tendon from the semimembranosus wrap together along with the garacilis (groin) muscle to form the inner hamstring. Tendons, like ligaments, are made up of very tough tissue. Tendons connect muscle to bone, while ligaments connect bone over bone. Hamstring tendons are also used in ACL repair and reconstruction (Health Information Publications, 2011).

II. The FREQUENCY, SEVERITY, and CAUSE of ACL INJURY

Regular physical activity is important for a number of reasons in order to maintain a healthy lifestyle and for long-term health (Bahr & Krosshaug, 2005). Along with physical activity comes the risk of injury, in particular soft, musculoskeletal injuries (Bahr & Krosshaug, 2005). Knee and ankle injuries tend to be the most common injury and amongst those injuries, ACL ruptures and tears are a serious concern, perhaps even the most severe (Bahr & Krosshaug, 2005). Specifically regarding the knee, over 11.2 million people visit their healthcare provider because of injury (Healthcare Information Publications, 2011). Of those 11.2 million knee injuries roughly 100,000 are specific to ACL injuries occur every year, even though in the general population, ACL injuries tend to be fairly low (Grindstaff, Hammill, Tuzson, & Hertel, 2006). Of those 100,000 injury cases, around 50,000 are surgical ACL reconstructions (Health Inofrmation Publications, 2011). Even still, the injury consequences in terms of surgery, rehabilitation, and time lost from activity are just as serious as in an elite, or recreational athlete (Grindstaff et al., 2006). The surgical costs alone are around $17,000 per case not including the subsequent medical costs such as physical therapy, and future complications that often arise such as osteoarthritis (Grindstaff et al., 2006). Determining risk factors for injury can greatly aid in prevention, and scientific research studies are an effective method of determining the frequency, risks, and cause of ACL injury.

The precise etiology and mechanisms of ACL injury aren't entirely known, however, there are generalizations as to what causes and ACL to tear (Bahr & Krosshaug, 2005).

The ACL usually tears when specific knee movements place intense strain on the ACL (Health Information Publications, 2011). Examples of these movements include hyperextension of the knee especially if the knee is extended 10 degrees further than its normally extended position as this forces the lower leg abnormally forward in relation to the upper leg, or femur (Health Information Publications, 2011). Pivoting motions are also common causes of ACL tears, such as excessive inward rotation of the lower leg (Health Information Publications, 2011). Either of these two types of ACL injury can be through contact, or non-contact force although most ACL injuries occur during non-contact athletic sports (Yeager, 2010). One of the specific movements that can lead to inward rotation or hyperextension is planting and cutting whereby the foot is firmly planted on the ground followed by the leg of that foot and body simultaneously turning (pivoting) as in making a fast cut and then changing directions (Yeager, 2010). Football is an example of this. Another specific injury causing movement is a straight-knee landing, which can result when a person strikes their foot against the ground with a straight knee, which can occur in sports such as gymnastics the foot strikes the ground with the knee straight (Yeager, 2010). Movements such as a one-step-stop landing with a hyperextended knee can cause injury and result in a sudden stop with a hyperextended leg with additional force placed upon hyperextension (Yeager, 2010). An example of this is a baseball player sliding into base such that the leg abruptly stops while in an over-straightened position (Yeager, 2010). Lastly, ACL injuries can result from a rapid deceleration movement followed by planting the foot, then pivoting the knee, an example being the movements a soccer player performs during a game (Yeager, 2010). Non-athletic causes of ACL injury usually result from wear and tear on the knee causing small tears that progress further, car and motorcycle accidents, contact injuries to the knee (Health Information publications, 2011). Injury severity depends on the direction and force of injury, knee position at time of injury as well as other factors that may predispose an individual to injury, sport, etc.

Other factors that may cause, or even predispose, a person to ACL injury are, as already mentioned, a frequent topic of scientific research studies. Research has, and is, often focused on intrinsic factors such as anatomical (e.g., pelvic tilt, ACL geometry, pronation of the foot, etc.), hormonal, and neuromuscular reasons. One of the main anatomical reasons for increased susceptibility to ACL rupture is the quadriceps (Q) angle as it can alter the alignment of the lower leg in relation to the upper leg altering the kinematics of the knee (Posthumus, 2009). Specifically, the Q. angle refers to the anatomical, geometric relationship between the center of the patella to the hip, and the center of the patella to the tibia (Posthumus, 2009). This is believed to influence the pelvic angle, hip rotation, tibial rotation, patella and foot position, and there are inherent gender differences between males and females with regards to the Q. angle (Posthumus, 2009). Studies have shown that ACL injury is much higher in female athletes compared to male athletes (Grindstaff et al., 2006). Possible contributing factors are the Q. angle, which affects, as mentioned previously, the anatomical structure therefore placing females at greater risk (Posthumus, 2009). Hormonal changes due to menstruation, muscle activation ratios, joint laxity, and styles / techniques of athletic play, also may play a role in placing females at greater risk for ACL injury (Grinstaff et al., 2006).

There are some research studies that have investigated a genetic component to ACL injuries though the data is limited (Posthumus, 2009). Studies have been attempting to identify specific hereditary markers that predispose a person to ACL ruptures, as well as what role they may play in the development of these injuries, with some success (Posthumus, 2009). Research has recently identified a specific binding… READ MORE

Download Full Paper

Write a New Paper for Me

Quoted Instructions for "Anterior Cruciate Ligament, or ACL" Assignment:

“

This is a research paper on the ACL. I have a start on the paper, but it will need revised and reformated. I would like to add 7 pages to the current paper. Below is the guidelines for the paper. I will also like 7 additional references for the paper. It paper should be in apa format.

1-2 page introducing the topic (1-2)

2-4 pages frequency, severity, and cause of injury (3-6)

7-8 pages caring and preventing injury (10-14)

2 pages summarizing, providing thesis, and best applications (12-15)

Introduction

Anatomy and Biomechanics

The anterior cruciate ligament (ACL) is an important structure in the knee. It originates on the lateral femoral condyle and inserts into the tibial plateau medial to the anterior horn of the lateral meniscus (Evans, Chew, & Stanish, 2006). The femoral attachment is on the lateral wall of the inter-condylar notch posteriorly. The tibial attachment is on the anterior part of the tibial plateau near the tibial spines. The ACL has an anteromedial band that is tighter in flexion and a posterolateral band that is tighter in extension (Bonci, 1999). During anterior tibial loading, the ACL plays an important role in limiting anterior tibial translation (Sakane, Livesay, Fox, Rudy, Runco, & Woo, 1999). The primary function of the ACL is to provide knee stability, primarily against anterior translation of the tibia on the femur, proprioception at the knee, and knee hyperextension.

Common Mechanisms of Injury

An anterior cruciate ligament (ACL) injury can vary in three grades: partial sprains (grade one or two) to a complete tear (grade three). If other structures in the knee are damaged as well, the injury is described as being *****combined***** rather than *****isolated***** when only the ACL is damaged. Complete ligament ruptures, especially those involving the ACL, are often associated with other ligamentous injuries, leading to the clinical complaint of knee instability (Smith, Rosenlund, Aune, MacLean, & Hillis, 2004). Combined tears usually occur with damage to one or many of the following knee anatomical structures: the menisci, the articular cartilage, the collateral ligaments, and/or the joint capsule (Bonci, 1999).

Athletes are more likely to injure the ACL and other structures in games versus practice, and contact injuries are more frequent than noncontact injuries (Dick, Ferrara, Agel, Courson, Marshall, Hanley, & Reifsteck, 2007). The most common mechanism of injury is a plant and cut or *****flexion-valgus-external rotation movement***** (Evans, Chew, & Stanish, 2006). In other words, the foot plants with slight knee flexion, then on attempting to turn outward the tibia externally rotates while the femur internally rotates and with slight valgus can cause enough force to tear an ACL, and probably other knee anatomical structures. For a complete and/or partial tear, the patient will immediately be unable to bear any weight on the injured leg and could have possibly heard a pop or snap. Other common mechanisms of injury for an ACL injury include direct trauma, sudden stops, and jumping. Each sports mechanism of injury will differ with the required movements of the knee.

Predisposing Factors

There are many different predisposing factors that can target a patient for an anterior cruciate ligament (ACL). Intrinsic factors are internal elements that include age, gender, previous injury, and body composition, etc., whereas extrinsic factors are external elements such as shoe traction, playing field, and environment. Some athletes may come to preseason poorly conditioned, thus, the stress of the high-intensity, high-load preseason training may result in an excess of injuries (Hootman, Dick, & Agel, 2007). Also, preseason practices often include multiple practices a day limiting recovery time. Preseason practices also may have less skilled or *****walk-on***** persons trying out for the sport; and such individuals may be more susceptible to injury (Hootman, Dick, & Agel, 2007). Unfortunately for females, they have a four-to-six increased risk for ACL injury compared to males in the same sport/playing level due to the hormonal levels (i.e. release of hormones during menstrual cycle), biomechanical differences (i.e. increased Q angle), and lack of neuromuscular development after puberty (Bonci, 1999).

Preventative Techniques

Testing for Injuries

There are many different types of tests that test the stability of the anterior cruciate ligament (ACL). Common tests performed by orthopedists in determining an ACL injury are the Lachman test, anterior drawer, pivot shift test, and Slocum drawer. The Lachman test provides the best overall positive and negative likelihood ratios, whereas the pivot shift test solely has a high positive likelihood ratio, and the anterior drawer test is mediocre in both categories (Ostrowski, 2006). If absolute displacement found during the anterior drawer test is larger than that in the Lachman test, this may indicate a combined ACL+MCL injury (Smith, Rosenlund, Aune, MacLean, & Hillis, 2004).

Options for Repair

Following a rupture of the anterior cruciate ligament, there are different methods available to re-establish the stability of the knee joint (Gorschewsky, Klakow, PÃ¼tz, Mahn, & Neumann, 2007). In the instance of a partial ACL injury, the individual may opt for conservative treatment that focuses on muscle strengthening, proprioceptive training, and protective bracing (Evans, Chew, & Stanish, 2006). The modern orthopedic surgeon has a variety of techniques and materials that may be applied to specific clinical situations. Many different graft sources and types of fixation exist (Mahirogullari, Oguz, & Ozkan, 2006). The two most common grafts used in ACL reconstruction are the bone-patellar tendon-bone (BPTB) and semitendinosus-gracilis autografts (Denti, Lo Vetere, Bandi, & Volpi, 2006). Different forms of the grafts are categorized as autograft (individual*****s own tissue), allograft (tissue from donor), or synthetic (man made). Today, both the BTPB and semitendinosus-gracilis grafts are used about equally often; deciding which graft is right for the ACL reconstruction depends on the time since injury, amount of laxity, relevant medical history, and postoperative occupation (Denti, Lo Vetere, Bandi, & Volpi, 2006). The BPTB graft is used for many reasons that include: 1. show better stability and a lower failure rate with patellar tendon grafts; 2. has a twenty precent greater chance to return to preinjury activity levels; and 3. patients with BPTB grafts were more likely to have normal Lachman, normal pivot-shift, and less loss of flexion (Maletis, Cameron, Tengan, & Burchette, 2007). A common complaint with the bone-patellar tendon-bone graft is anterior knee pain and quadriceps muscle weakness due to the removal of a portion of the patellar tendon. The hamstring graft is beneficial for individuals who have mild to moderate knee laxity, anterior knee dysfunction, and who want to avoid a recurrence of postoperative pain in the hamstring area. An observation distinguished by individuals with the hamstring graft was the higher incidence of anterior knee laxity (Mahirogullari, Oguz, & Ozkan, 2006). Anatomic reconstructions of ACL with double bundle gracilis and semitendonosus tendons graft, reproducing AM and PL bundles, have been introduced to offer a better biomechanical outcome, especially during rotatory loads (Monaco, Labianca, Conteduca, De Carli, & Ferretti, 2007).

Rehabilitation

Prior to surgery, starting a preoperative rehabilitation program can greatly increase the individual*****s healing time. Exercises would include swelling reduction, hyperextension exercises, and gait training (Arnold, & Shelbourne 2000). In the first weeks of rehabilitation, after anterior cruciate ligament (ACL) surgery, pain control, reduction of swelling, regaining range of motion, and strengthening the quadriceps muscle group are the major goals. Allowing the individual to regain range of motion immediately postoperatively will eliminate the need for any other surgeries to regain range of motion. Once pain has subsided, additional exercises can be implemented to work on regaining complete range of motion, teaching proper gait, and muscle strengthening of all affected muscle groups. It is important not to progress too quickly because stress on the new graft can cause irritation and improper healing. Closed kinetic chained exercises are initiated first because they are considered *****safe,***** and stress is focused on many joints and can help control any possible irritation of the new graft (Fitzgerald, 1997). The progression of exercises should begin with range of motion and strengthening of muscles and eventually end with the individual able to complete sport specific drills without pain or swelling.

Return to Play

After a rehabilitation program, which targeted range of motion and muscle strengthening, certain sport specific drills can be done to determine if the individual is ready to return to normal physical activity. With an accelerated rehabilitation program, positive motivation, and near absence of functional limitations, an individual can return to sport sooner and be more satisfied. An individual competing with functional problems increases the risk of secondary injury, accelerated deterioration of knee function, and progressive osteoarthritis (Smith, Rosenlund, Aune, MacLean, & Hillis, 2004). Functional knee braces have also become popular for protection of the graft during rehabilitation after anterior cruciate ligament reconstruction and provide support when the individual returns to play. The brace is designed to minimize internal and external rotation and anterior and posterior translation of the tibia. It is important for each physical therapist to individually assess each patient and be able to recognize when the individual is best suited to return to play.

Conclusion

References

Arnold, T., & Shelbourne, K. (2000). A perioperative rehabilitation program for anterior cruciate ligament surgery. . The Physician and Sportsmedicine , 28(1)

Bonci, C.M. (1999). Assessment and evaluation of predisposing factors to anterior cruciate ligament injury. . Journal of Athletic Training, 34(2), 155-164.

Denti, M., Lo Vetere, D., Bandi, M., & Volpi, P. (2006). Comparative evaluation of knee stability following reconstruction of the anterior cruciate ligament with the bone-patellar tendon-bone and the double semitendinosus-gracilis methods: 1- and 2-year prospective study. Knee Surgery, Sports Traumatology, Arthroscopy , 14(7), 637-640.

Dick, R., Ferrara, M., Agel, J., Courson, R., Marshall, S., Hanley, M., & Reifsteck, F. (2007). Descriptive epidemiology of collegiate men*****'s football injuries: National Collegiate Athletic Association Injury Surveillance System. Journal of Athletic Training, 42(2), 221-233.

Evans, N.A., Chew, H.F., & Stanish, W.D. (2006). The natural history and tailored treatment of ACL injury. The Physician and Sportsmedicine , 29(9)

Fitzgerald, G. (1997). Open versus closed kinetic chain exercises: issues in rehabilitation after anterior cruciate ligament reconstructive surgery. . Physical Therapy, 77(12), 1747-1754.

Gorschewsky, O., Klakow, A., PÃ¼tz, A, Mahn, H., & Neumann, W. (2007). Clinical comparison of the autologous quadriceps tendon (bqt) and the autologous patella tendon (bptb) for the reconstruction of the anterior cruciate ligament. Knee Surgery, Sports Traumatology, Arthroscopy , 15(11), 1284-1292.

Hewett , T. (2009). Prevention of non-contact acl injuries in women: use of the core of evidence to clip the wings of a *****black swan*****. Current Sports Medicine Reports , 8(5), 219-221

Hootman , J., Dick, R, & Agel, J. (2007). Epidemiology of collegiate injuries for 15 sports: summary and recommendations for injury prevention initiatives. Journal of Athletic Training, 42(2), 311-319.

Mahirogullari, M., Oguz, Y., & Ozkan, H. (2006). Reconstruction of the anterior cruciate ligament using bone-patellar tendon-bone graft with double biodegradable femoral pin fixation. Knee Surgery, Sports Traumatology, Arthroscopy , 14(7), 646-653.

Maletis, G., Cameron, S., Tengan, J., & Burchette, R. (2007). A prospective randomized study of anterior cruciate ligament reconstruction: a comparison of patellar tendon and quadruple-strand semitendinosus/gracilis tendons fixed with bioabsorbable interference screws. . The American Journal of Sports Medicine, 35(3), 384-394.

Monaco, E., Labianca, L., Conteduca, F., De Carli, A., & Ferretti, A. (2007). Double bundle or single bundle plus extraarticular tenodesis in acl reconstruction? : a caos study. Knee Surgery, Sports Traumatology, Arthroscopy , 15(10), 1168-1174.

Ostrowski , J.A. (2006). Accuracy of 3 diagnostic tests for anterior cruciate ligament tears. Journal of Athletic Training, 41(1), 120-121.

Myer, G.D., Ford, K.R., Brent, J.L. & Hewett, T.E. (2007). Differential neuromuscular training effects on ACL injury risk factors in *****high-risk***** versus *****low-risk***** athletes. BMC Musculoskeletal Disorders, 39(8), doi:10.1186/1471-2474-8-39

Sakane, M., Livesay, G., Fox, R., Rudy, T., Runco, T., & Woo. S. (1999). Relative contribution of the acl, mcl, and bony contact to the anterior stability of the knee. Knee Surgery, Sports Traumatology, Arthroscopy , 7(2), 93-97.

Shah, V.M., Andrews, J.R., Fleisig, G.S., McMichael C.S., & Lemak, L.J. (2010). Return to play after anterior cruciate ligament reconstruction in national football league athletes. The American Journal of Sports Medicine, 38(11), 2233-2239.

Smith, F., Rosenlund, E., Aune, A., MacLean, J., & Hillis, S. (2004). Subjective functional assessments and the return to competitive sport after anterior cruciate ligament reconstruction. . British Journal of Sports Medicine , 38(3), 279-284.

Woodford-Rodgers, B., Cypert, L., and Denegar, C. (1994). Risk factors for anterior cruciate ligament injury in high school and college athletes. Journal of Athletic Training, 29(4), 343-346.

Yu, B., and Garrett, W. (2007). Mechanisms of non-contact ACL injuries. British Journal of Sports Medicine, 41(suppl I), i47-i51.

How to Reference "Anterior Cruciate Ligament, or ACL" Research Paper in a Bibliography

“Anterior Cruciate Ligament, or ACL.” A1-TermPaper.com, 2011, https://www.a1-termpaper.com/topics/essay/anterior-cruciate-ligament-acl/9264. Accessed 6 Jul 2024.

Anterior Cruciate Ligament, or ACL (2011). Retrieved from https://www.a1-termpaper.com/topics/essay/anterior-cruciate-ligament-acl/9264

A1-TermPaper.com. (2011). Anterior Cruciate Ligament, or ACL. [online] Available at: https://www.a1-termpaper.com/topics/essay/anterior-cruciate-ligament-acl/9264 [Accessed 6 Jul, 2024].

”Anterior Cruciate Ligament, or ACL” 2011. A1-TermPaper.com. https://www.a1-termpaper.com/topics/essay/anterior-cruciate-ligament-acl/9264.

”Anterior Cruciate Ligament, or ACL” A1-TermPaper.com, Last modified 2024. https://www.a1-termpaper.com/topics/essay/anterior-cruciate-ligament-acl/9264.

[1] ”Anterior Cruciate Ligament, or ACL”, A1-TermPaper.com, 2011. [Online]. Available: https://www.a1-termpaper.com/topics/essay/anterior-cruciate-ligament-acl/9264. [Accessed: 6-Jul-2024].

1. Anterior Cruciate Ligament, or ACL [Internet]. A1-TermPaper.com. 2011 [cited 6 July 2024]. Available from: https://www.a1-termpaper.com/topics/essay/anterior-cruciate-ligament-acl/9264

1. Anterior Cruciate Ligament, or ACL. A1-TermPaper.com. https://www.a1-termpaper.com/topics/essay/anterior-cruciate-ligament-acl/9264. Published 2011. Accessed July 6, 2024.

Related Research Papers: