Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
{"
Fadi&Hassan&&Hull&York&Medical&School"
Anatomy"
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Function"
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Proprioception"
What&is&ACL?"
Rapid&deceleration&or&rotational&injury"
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! ! !
Mechanism&of&injury"
Unhappy&triad&or&ODonoghue&triad"
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Associated&injuries"
Injury&grading"
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Epidemiology"
Clinical&features"
Examination"
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Haemarthrosis&within&hours&and&joint&line&tenderness." Lachman&test&"
$
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Anterior&drawer&test"
$
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Pivot&shift&test&"
$ $
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Valgus&and&varus&deformities"
Examination"
MRI"
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XUray"
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Signs&of&ACL&deciency&like&tibial&spines&peaking&or& intercondylar¬ch&narrowing."
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Avulsion&fractures&of&lateral&tibial&plateau"
Arthroscopy"
Investigations"
Menisectomy" Treating&impingements&(ACL&stump&removal)"
Management&&Non&operative"
! !
PreUOperatively&"
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Protect&knee&stability&as&well&as&meniscal&and&articular& surfaces"
Repair/reinforcement&is&possible&if&the&ligament&is¬& ruptured&completely."
Management&&Operative"
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Quick&examination&is&done&when&the&patient&is&anaesthetized.&" The&operation&is&done&through&arthroscopic&incisions&(incision&for& arthroscopy&is&made,&as&well&as&other&portals&for&instruments)." The&torn&ligament&is&removed&from&the&knee.&" Damaged&surfaces&are&often&trimmed&or&shaved&o." Tunnels&drilled&into&the&femur&and&tibia&at&the&original&ACL& aRachment&sites." Hamstring&autografts&are&made&with&semitendinosus&tendon&either& alone&or&accompanied&by&gracilis&tendon&(4&strand&hamstring&graft,& 25cm&long)." Tendon&segments&are&folded,&braided&together&to&form&a&quadruple& thickness&strand&" A&long&needle&is&passed&through&the&tunnel&and&out&through&the& skin.&" The&sutures&are&then&placed&through&the&eye&of&the&needle&and&the& graft&is&pulled&into&position&up&through&the&tibial&tunnel&and&then& up&into&the&femoral&tunnel" The&ends&are&then&xated&on&the&opposite&sides&of&the&two&bones."
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Test&again&to&conrm&knee&stability&and&graft&strength."
There&are&variety&of&xation&devices&like&interference&screws,&buRons& and&post&xation&devices."
Management&&Operative"
Management&&Operative"
The&graft&is&then&threaded&through&drilled&holes& in&the&tibia&and&femur"
Management&&Operative"
Types&of&grafts"
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Autografts:&using&bone&or&tissue&harvested&from& the&patients&body"
$
Graft&obtained&from&an&accessory&hamstring&or&part& of&the&patellar&tendon."
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Allografts:&Using&bone&or&tissue&from&a&donor/ cadaver."
$
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Synthetic&grafts"
Graft&choices"
Choice"
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$
Placement&>&Type" Type"
%
Autograft&is&preferred&"
Allograft&is&used&when&Autografts&are&hard&to&obtain.&"
%
Longer&recovery&(further&damage)"
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Site"
$ $
Irradiation&&does&it&weaken&the&graft?"
There&isnnt&an&ideal&place" BoneUPatellar&tendonUBone&(BTB)"
% %
Hamstring"
% %
Candidates:&Young,&high&demand&athletes" Advantages:&Strength&(bone&to&bone),&knee&stability,&rapid&healing,& early&rehab." Disadvantages:&knee&pain&when&lunging,&Patellar&fractures" Advantages:&less&anterior&knee&pain,&less&stiness,&smaller& incisions." Disadvantages:&problems&with&xation&slippage&and&stretching&out& over&time.&As&well&as&slower&recovery." Suitable&to&those&who&failed&ACL&reconstruction" Graft&taken&from&the&middle&third&of&the&tendon&and&a&bone&plug& from&the&upper&patellar&end." Also&suitable&for&taller&and&heavier&patients"
Quadriceps&tendon"
% %
Graft&choices"
Placement&of&the&graft"
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Femur"
$
%
Too&anterior"
Too&posterior"
%
Other&complications"
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Complications"
Fibrosis&if&the&operation&is&done&in&the&rst&4&weeks&after& rupture&while&the&knee&is&still&inamed&and&has&poor&ROM" Graft&failure" Fixation&failure&(widening&of&tunnel)" Loss&of&motion" ReUoperation" Patellar&fractures" Infections" Bleeding&and&numbness" Blood&clots"
It&takes&6&weeks&for&graft&true&healing&(&graft&aRachment&to&bone)"
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! !
Rehabilitation"
Using&knee&brace&can&reduce&the&chance&of&reUinjury."
Collagen&tissue&in&graft&works&as&scaold&and&new&collagen&tissue&is&laid& down,&this&procedure&usually&takes&6&months."
Grin&LY,&Armstrong&A,&DeMaio&M.&The&female&athlete.&In:& DeLee&JC,&Drez&D&Jr,&Miller&MD,&eds.&DeLee$and$Drezs$ Orthopaedic$Sports$Medicine.&3rd&ed.&Philadelphia,&Pa:&Saunders& Elsevier;&2009:chap&10." Honkamp&NJ,&Shen&W,&Okeke&N,&FerreRi&M,&Fu&FH.&Anterior& cruciate&ligament&injuries:&1.&Anterior&cruciate&ligament& injuries&in&the&adult.&In:&DeLee&JC,&Drez&D&Jr,&Miller&MD,&eds.& DeLee$and$Drezs$Orthopaedic$Sports$Medicine.&3rd&ed.& Philadelphia,&Pa:&Saunders&Elsevier;&2009:chap&23,§ion&D." Cimino&F,&Volk&BS,&SeRer&D.&Anterior&cruciate&ligament&injury:& diagnosis,&management,&and&prevention.&Am$Fam$Physician.& 2010;82:917U922." American&Academy&of&orthopaedic&surgeons.&(2009).&ACL$ Injury:$Does$It$Require$Surgery?.&Available:&hRp:// orthoinfo.aaos.org/topic.cfm?topic=a00297.&Last&accessed&7th& Feb&2013."
References"
Rosenberg,&Thomas&D.&vMethod&for&ACL& reconstruction.v&U.S.&Patent&5,139,520,&issued&August&18,& 1992." The&Daily&Mail,&(2011),&Vidic$ACL$injury&[ONLINE].& Available&at:&hRp://i.dailymail.co.uk/i/pix/2011/12/08/ articleU0U0F18683B00000578U97_468x286.jpg&[Accessed& 07&February&13]." Physio1st,&(2011),&Vidic$ACL$injury&[ONLINE].&Available& at:&hRp://www.physio1st.co.uk/wpUcontent/uploads/ 2012/02/ C_71_article_1467511_image_list_image_list_item_0_im age.jpg&[Accessed&07&February&13]." citifmonline,&(2011),&Vidic$ACL$injury&[ONLINE].& Available&at:&hRp://kitnes.net/ 1_188398/300..1.1207507.jpg&[Accessed&07&February&13]."
References"