Differences
This shows you the differences between two versions of the page.
| Both sides previous revision Previous revision Next revision | Previous revision | ||
|
group_5_presentation_3_-_acl_injuries [2016/11/24 14:39] jogendm |
group_5_presentation_3_-_acl_injuries [2018/01/25 15:18] (current) |
||
|---|---|---|---|
| Line 32: | Line 32: | ||
| ====== Symptoms ====== | ====== Symptoms ====== | ||
| - | MS symptoms vary from person to person (Multiple Sclerosis Clinical Presentation, 2016). | + | Symptoms of a severe and acute ACL injury include: |
| - | MS Symptoms include: | + | • Feeling or hearing a "pop" in the knee at the time of injury. |
| - | * Sensory loss | + | • Sudden instability in the knee. This may happen after a jump or change in direction or after a direct blow to the side of the knee. |
| - | * Walking difficulty | + | |
| - | * Spasticity | + | |
| - | * Bladder, bowel, and sexual dysfunction | + | |
| - | * Tremors | + | |
| - | * Optic neuritis | + | |
| - | * Heat intolerance | + | |
| - | * Fatigue | + | |
| - | * Pain | + | |
| - | * Cognitive difficulties | + | |
| - | * Constipation | + | |
| - | <HTML> | + | • Pain on the outside and back of the knee. |
| - | <br> | + | |
| - | </HTML> | + | |
| - | ====== Diagnosis ====== | + | • Knee swelling within the first few hours of the injury. This may be a sign of bleeding inside the joint. Swelling that occurs suddenly is usually a sign of a serious knee injury. |
| - | <style float-right> | + | • Limited knee movement because of swelling and/or pain. |
| - | {{:ms-mri_t1_535x314-01.jpg|}} | + | |
| - | **Figure 1**: A T1-weighted MRI demonstrating permanent lesions in a MS patient. The dark spots | + | Following an acute injury, the patient will almost always have to stop whatever activity they are doing, however, they may still be able to walk. |
| - | in the scan are the lesions. (Source: Spinms, 2016) | + | If the ACL injury is chronic (long-lasting and recurrent), the knee buckles or gives out, sometimes with pain and swelling. This occurs more frequently over time. It is important to note that not everyone with an ACL injury develops a chronic ACL deficiency. |
| - | </style> | + | <HTML> |
| + | <br> | ||
| + | </HTML> | ||
| + | ====== Diagnosis ====== | ||
| - | <style justify> | + | For the clinical examination of a suspected ACL injury, the pivot-shift test, anterior drawer test and Lachman test are used. |
| - | The diagnosis of Multiple Sclerosis (MS) can be detected through MRI, lumbar puncture and electroencephalography. MS is difficult to diagnose due to the multiple symptoms associated with the disease, which can vary from person to person. Magnetic resonance imaging (MRI) can be used to reveal areas of lesions. However, MRI has disadvantages as it lacks specificity and many conditions have similar conditions of MS and as a result many false positives occur. It has been determined that 90% of MS patients will display an abnormal MRI scan and thus MRI should be the first diagnostic tool to be used. However, 5% of individuals show no sign of lesions in the brain while using MRI (Rolak, 2003). | + | |
| + | The Lachman test is known by most authorities as the most reliable and sensitive test, and usually a better alternative to the anterior drawer test. The ACL can also be detected using a magnetic resonance imaging scan (MRI scan). | ||
| - | When there are abnormalities in the cerebrospinal fluid, it can be used to diagnose MS. In the Cerebral spinal fluid (CSF), the white blood cell and spinal fluid proteins are slightly elevated. An elevated Immunoglobin G level in CSF is the most significant in detecting MS. The Immunoglobin G reflects an autoimmune activation and appears as oligoclonal bands on the electrophoresis performed on the CSF. Oligoclonal bands indicate the presence of immunoglobins, which indicate inflammation in the central nervous system. The oligoclonal bands vary from MS patient, but 90% of MS patients present these bands. A limitation to this method is other diseases produce these bands as well and can lead to misdiagnosis. To obtain the CSF it requires undergoing lumbar puncture, which many patients are unsure of doing (Rolak, 2003). | + | Even though clinical examination if done by a professional can be accurate, the diagnosis is usually confirmed by MRI scan, which has significantly narrowed the need for diagnostic arthroscopy and which has a greater accuracy than clinical examination. It may also show a graphic of other structures which may have been involved in the injury, such as a meniscus, or collateral ligament, or posterolateral corner of the knee joint. |
| - | + | ||
| - | Another method that could be used is evoked potential, which is used to measure conduction rates in the CNS pathway though the recording of electroencephalographic response to sensory stimulation. Slow conduction rates indicate inflammation and demyelination, presenting an MS lesion (Rolak, 2003). | + | |
| - | + | ||
| - | + | ||
| - | **Prognosis and progression** | + | |
| - | + | ||
| - | There are four different patterns of MS, | + | |
| - | + | ||
| - | * Clinically Isolated Syndrome (CIS) | + | |
| - | * Relapsing and remitting (RRMS) | + | |
| - | * Secondary progressive (SPMS) | + | |
| - | * Primary progressive (PPMS) | + | |
| - | + | ||
| - | Clinically Isolated Syndrome refers to a first episode where there is inflammatory demyelination in the CNS. It is not yet considered MS, but could become MS if further activity occurs. In the relapse and remitting stage this indicates good health followed by an immediate change in symptoms. Secondary progressive MS occurs after the relapse and remitting stage. At this point there are more symptoms that are progressively getting worse. Primary progressive MS is the steady development of symptoms that will eventually become worse as the diseases progresses. RRMS, SPMS, and PPMS can be active or not active depending on if there is evidence of relapse or disease activity present (Hedley, 2012). | + | |
| - | </style> | + | |
| <HTML> | <HTML> | ||
| Line 223: | Line 198: | ||
| **__Nonsurgical Treatment:__** | **__Nonsurgical Treatment:__** | ||
| - | Torn ACL are not able to healed without surgery, however surgery may not always be a viable option for elderly patients or patients with low activity levels. In this situation, non-surgical treatment methods would be more beneficial. These methods are only recommended if the overall stability of the knee is intact. Some of these non-surgical treatment methods can include(UCSF,2016): | + | Torn ACL are not able to healed without surgery, however surgery may not always be a viable option for elderly patients or patients with low activity levels. In this situation, non-surgical treatment methods would be more beneficial. These methods are only recommended if the overall stability of the knee is intact. Some of these non-surgical treatment methods can include (UCSF, 2016): |
| **Use of Knee Braces:** This can be recommended by your doctor. Knee braces help support and protect the knee and the ACL from further damage. Furthermore, crutches may be implemented to transfer your weight away from your injured knee. This further protects and prevents more damage. | **Use of Knee Braces:** This can be recommended by your doctor. Knee braces help support and protect the knee and the ACL from further damage. Furthermore, crutches may be implemented to transfer your weight away from your injured knee. This further protects and prevents more damage. | ||
| Line 236: | Line 211: | ||
| </style> | </style> | ||
| - | **Physical Therapy:** This is usually recommended by doctors when swelling and inflammation of the knee go down. This program involves a series of exercises that will help improve function of the knee joint and strength surrounding muscles. Some of these exercises focus on training the Gluteus Maximus and Gluteus Medius in non-weight scenarios, followed by weight bearing scenarios. This helps to improve the control of the hip movements. In addition, exercises that focus on strengthening the Quadriceps muscles are also implemented. This is because this helps with improved bending of the knee. These exercises are also being implemented in ACL prevention programmes (Physioroom,2016). | + | **Physical Therapy:** This is usually recommended by doctors when swelling and inflammation of the knee go down. This program involves a series of exercises that will help improve function of the knee joint and strength surrounding muscles. Some of these exercises focus on training the Gluteus Maximus and Gluteus Medius in non-weight scenarios, followed by weight bearing scenarios. This helps to improve the control of the hip movements. In addition, exercises that focus on strengthening the Quadriceps muscles are also implemented. This is because this helps with improved bending of the knee. These exercises are also being implemented in ACL prevention programmes (Physioroom, 2016). |
| **ACL Reconstructive Surgery:** | **ACL Reconstructive Surgery:** | ||
| Line 258: | Line 233: | ||
| </style> | </style> | ||
| - | Tissue grafts can be retrieved from many sources. Some of these sources can include(Krans,2016): | + | Tissue grafts can be retrieved from many sources. Some of these sources can include (Krans, 2016): |
| * Patellar tendon: Graft can be taken from the tendon that attaches from the bottom of the patella to your tibia. | * Patellar tendon: Graft can be taken from the tendon that attaches from the bottom of the patella to your tibia. | ||
| * Hamstring: The graft can be taken from the tendon that connects the hamstring muscle to back of the knee. | * Hamstring: The graft can be taken from the tendon that connects the hamstring muscle to back of the knee. | ||
| Line 267: | Line 242: | ||
| **Allografts: Risks and Benefits:** | **Allografts: Risks and Benefits:** | ||
| - | An allograft is when a tissue graft is retrieved from a member of the same species but are not genetically identical to the recipient. The increased in the development of new techniques and research are one of the main reasons for the rise in the use of allografts in surgery. Some of the advantages of using allografts are very beneficial in cases requiring multiple ligament reconstruction surgeries and they have a very low rate of donor morbidity. However, this type of tissue graft does have some disadvantages. Primarily, this method is very costly and takes a longer time to treat and prepare for the procedure. Furthermore, the sterilization process involves radiation, which can potentially alter the biomechanical properties of the graft. Most importantly, this type of tissue graft has been associated with elongation and rupturing after surgery. A study was conducted on 120 young active adults that were cadets at the U.S. Military Academy at West Point. This study observed that an allograft ACL surgery was approximately 7 times more likely to fail compared to an autograft ACL reconstruction(Mayo Clinic,2016). | + | An allograft is when a tissue graft is retrieved from a member of the same species but are not genetically identical to the recipient. The increased in the development of new techniques and research are one of the main reasons for the rise in the use of allografts in surgery. Some of the advantages of using allografts are very beneficial in cases requiring multiple ligament reconstruction surgeries and they have a very low rate of donor morbidity. However, this type of tissue graft does have some disadvantages. Primarily, this method is very costly and takes a longer time to treat and prepare for the procedure. Furthermore, the sterilization process involves radiation, which can potentially alter the biomechanical properties of the graft. Most importantly, this type of tissue graft has been associated with elongation and rupturing after surgery. A study was conducted on 120 young active adults that were cadets at the U.S. Military Academy at West Point. This study observed that an allograft ACL surgery was approximately 7 times more likely to fail compared to an autograft ACL reconstruction (Mayo Clinic, 2016). |
| <style float-left> | <style float-left> | ||
| Line 279: | Line 254: | ||
| **Autografts: Risks and Benefits:** | **Autografts: Risks and Benefits:** | ||
| - | An autograft is when a tissue graft is retrieved from one part of the recipient’s body and placed in another part. Some common autograft sites can include patellar, hamstring and quadriceps tendons. Some of the associated advantages with this type of graft are minimal contamination, disease transmission and less structural alteration due to not irradiating the graft. The disadvantage associated with this type of graft is there is an increased post-surgery pain and recent research has indicated that if the hamstring tendon is used as a graft and the diameter is less than 8 millimetres, then there is increased risk of failure of the graft(Mayo Clinic,2016). | + | An autograft is when a tissue graft is retrieved from one part of the recipient’s body and placed in another part. Some common autograft sites can include patellar, hamstring and quadriceps tendons. Some of the associated advantages with this type of graft are minimal contamination, disease transmission and less structural alteration due to not irradiating the graft. The disadvantage associated with this type of graft is there is an increased post-surgery pain and recent research has indicated that if the hamstring tendon is used as a graft and the diameter is less than 8 millimetres, then there is increased risk of failure of the graft (Mayo Clinic, 2016). |
| <style float-right> | <style float-right> | ||
| Line 292: | Line 267: | ||
| **How to Prepare for ACL reconstruction:** | **How to Prepare for ACL reconstruction:** | ||
| - | Throughout this whole process, you will always be meeting with various health practitioners to help prepare you for this procedure. Before the surgery, the doctor and surgeon will discuss treatment options as well advising on medical and personal decisions required. Also, using medical imaging techniques several knee examinations occur before and after the surgery. During the day of the surgery, it is recommended you fast for 12 hours and refrain from aspirin and other blood thinning medications, as this may cause complications during the surgery. It is also recommended to have someone else with you so they can support you and help with post-surgery instructions to follow. The most important advice would be to ask questions and for advice from your health practitioner, as this may reduce some of the burden associated with the procedure(Krans,2016). | + | Throughout this whole process, you will always be meeting with various health practitioners to help prepare you for this procedure. Before the surgery, the doctor and surgeon will discuss treatment options as well advising on medical and personal decisions required. Also, using medical imaging techniques several knee examinations occur before and after the surgery. During the day of the surgery, it is recommended you fast for 12 hours and refrain from aspirin and other blood thinning medications, as this may cause complications during the surgery. It is also recommended to have someone else with you so they can support you and help with post-surgery instructions to follow. The most important advice would be to ask questions and for advice from your health practitioner, as this may reduce some of the burden associated with the procedure (Krans, 2016). |
| **How ACL Reconstruction is Performed:** | **How ACL Reconstruction is Performed:** | ||
| - | This procedure involves the use of intravenous (IV) lines, which are used to administer and inject medication as well as sedatives. Next, the allograft or autograft is prepared to be implanted into the knee. The tendon is prepared with bone plugs, which can anchor the tendon to the knee. Next, an incision is made into the front of the knee to allow for a thin tube that can allow for a fiber optic camera and surgical tools to pass through. Furthermore, the surgeon will remove the torn ACL and remove debris from the area. The surgeon will then drill small holes into your tibia and femur so the bone plugs can be attached with posts, screws, staples, or washers. After, the attachment of the new ligament, the surgeon will assess the knee’s motion and will ensure that the graft is secure. In addition, after the knee is assessed, the surgeons will suture the wound up. They will then place a brace on your knee to stabilize it. This procedure length can vary as there are many various techniques and versions of this procedure. It all depends on the various factors involved (Krans,2016). | + | This procedure involves the use of intravenous (IV) lines, which are used to administer and inject medication as well as sedatives. Next, the allograft or autograft is prepared to be implanted into the knee. The tendon is prepared with bone plugs, which can anchor the tendon to the knee. Next, an incision is made into the front of the knee to allow for a thin tube that can allow for a fiber optic camera and surgical tools to pass through. Furthermore, the surgeon will remove the torn ACL and remove debris from the area. The surgeon will then drill small holes into your tibia and femur so the bone plugs can be attached with posts, screws, staples, or washers. After, the attachment of the new ligament, the surgeon will assess the knee’s motion and will ensure that the graft is secure. In addition, after the knee is assessed, the surgeons will suture the wound up. They will then place a brace on your knee to stabilize it. This procedure length can vary as there are many various techniques and versions of this procedure. It all depends on the various factors involved (Krans, 2016). |
| **Risks of ACL Reconstruction:** | **Risks of ACL Reconstruction:** | ||
| Line 304: | Line 279: | ||
| - Loss of Knee motion | - Loss of Knee motion | ||
| - Rejection of tissue graft, causing inflammation | - Rejection of tissue graft, causing inflammation | ||
| - | There are other risks that are also associated with this procedure. If someone is a young growing child, they can have potential growth plate injuries, preventing the growth of their bones in affected areas. One way to prevent this is that doctors advise children to wait until they are older to have this procedure. Although there are risks associated with this procedure, this procedure has been labelled a gold standard solution to persistent knee injuries. This procedure has approximately 82 to 90% success rate(Krans,2016). | + | There are other risks that are also associated with this procedure. If someone is a young growing child, they can have potential growth plate injuries, preventing the growth of their bones in affected areas. One way to prevent this is that doctors advise children to wait until they are older to have this procedure. Although there are risks associated with this procedure, this procedure has been labelled a gold standard solution to persistent knee injuries. This procedure has approximately 82 to 90% success rate (Krans, 2016). |
| **Post ACL Reconstruction:** | **Post ACL Reconstruction:** | ||
| - | The road to recovery from surgery involves rehabilitation. Also, to deal with some of the other symptoms such as excessive pain, pain suppression medications are prescribed. Furthermore, to prevent infections to the wound, it is suggested that you clean the wound and keep it clean. In addition, to alleviate pain and reduce inflammation to the knee, it is recommended that you ice this area, as advised by the doctor. After a few weeks, the patient should be able to regain range of motion in the knee. Athletes typically return to full fitness within 6 to 12 months. Finally, this is all followed by physical therapy and rehabilitation, which is very vital to the success of recovering(Krans,2016). | + | The road to recovery from surgery involves rehabilitation. Also, to deal with some of the other symptoms such as excessive pain, pain suppression medications are prescribed. Furthermore, to prevent infections to the wound, it is suggested that you clean the wound and keep it clean. In addition, to alleviate pain and reduce inflammation to the knee, it is recommended that you ice this area, as advised by the doctor. After a few weeks, the patient should be able to regain range of motion in the knee. Athletes typically return to full fitness within 6 to 12 months. Finally, this is all followed by physical therapy and rehabilitation, which is very vital to the success of recovering (Krans, 2016). |
| <style float-left> | <style float-left> | ||
