Ligamentous Injury
Treatment
Surgical repair of complete ACL tears involves reconstruction with use of autogenous or allogeneic grafts.
Common procedures:
Patellar Tendon grafting (autogenous)
Hamstring grafting (autogenous)
Cadaver (allogeneic)
The Knee Ligament Sprain Clinical Guidelines provide an overview of interventions commonly used post injury including:
· Continuous passive motion
· Knee bracing
· Early weight bearing
· Cryotherapy
· Therapeutic exercises
· Neuromuscular reeducation
· Neuromuscular electrical stimulation (NMES)
· Eccentric strengthening
Common procedures:
Patellar Tendon grafting (autogenous)
Hamstring grafting (autogenous)
Cadaver (allogeneic)
The Knee Ligament Sprain Clinical Guidelines provide an overview of interventions commonly used post injury including:
· Continuous passive motion
· Knee bracing
· Early weight bearing
· Cryotherapy
· Therapeutic exercises
· Neuromuscular reeducation
· Neuromuscular electrical stimulation (NMES)
· Eccentric strengthening
Prevention
Long-term studies have indicated that 41% to 75% of patients undergoing ACL reconstruction still develop osteoarthritis by fourteen years postoperatively; in addition the rate of graft failure is high, peaking at 20% to 25% in adolescent patients, resulting in knee instability as well as osteoarthritic progression. Although, many surgical procedures are done without complication the necessity for prevention is crucial to reduce the risk of subsequent impairments. The literature suggests an inability to recommend specific type of prevention program. Overall, literature advocates for neuromuscular training as a fundamental basis of prevention treatment to reduce knee sprains.
Education
Correct mechanics of landing during jumping activities has been an emphasis in educating younger athletes especially in females. The Knee Ligament Sprain Clinical Guidelines has divided risk factors into 4 categories of environment, anatomical, hormonal, and neuromuscular.
References
(1) Sadoghi P, von Keudell A, Vavken P. Effectiveness of anterior cruciate ligament injury prevention training programs. Journal Of Bone & Joint Surgery, American Volume. May 2, 2012;94(9):769-776.
(2) Logerstedt DS, Snyder-Mackler L, Ritter RC, Axe MJ, Godges JJ. Clinical Guidelines. Knee stability and movement coordination Impairment: Knee ligament sprains. JOSPT. 2010:40 (4).
(3) Linko E, Harilainen A, Malmivaara A, Seitsalo S. Surgical versus conservative
interventions for anterior cruciate ligament ruptures in adults. Cochrane Database
Syst Rev. 2005;2:CD001356.
(2) Logerstedt DS, Snyder-Mackler L, Ritter RC, Axe MJ, Godges JJ. Clinical Guidelines. Knee stability and movement coordination Impairment: Knee ligament sprains. JOSPT. 2010:40 (4).
(3) Linko E, Harilainen A, Malmivaara A, Seitsalo S. Surgical versus conservative
interventions for anterior cruciate ligament ruptures in adults. Cochrane Database
Syst Rev. 2005;2:CD001356.