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Home » This is just a peer review for comprehension. Feel free to ask any questions.

This is just a peer review for comprehension. Feel free to ask any questions.

    This is just a peer review for comprehension. Feel free to ask any questions.
    My paper will go over the Anterior Cruciate Ligament (ACL). A few questions I structured my paper around are as follows:
    What is the ACL’s articulation?
    What sports are most prevalent to ACL injuries?
    Types of treatment for an ACL injury?
    Articulation
    The synovial joint connects three bones; the femur, tibia and patella. This joint has two articulations, the tibiofemoral joint and the patellofemoral joint. The four ligaments that help stabilize this complex hinge joint are; Anterior cruciate ligament (ACL), Posterior cruciate ligament (PCL), Medial collateral ligament (MCL) and the Lateral collateral ligament (LCL).
    I will be focusing on the Anterior Cruciate Ligament (ACL). However the ACL and Posterior Cruciate Ligament (PCL) attach the intercondylar area of the tibia to the condyles of the femur. The ACL sits in the joint capsule of the knee, where it prevents the tibia bone from sliding out in front of the femur bone. The ACL and PCL limit the anterior and posterior movement of the tibia and maintain the alignment of the femoral and tibial condyles. Injury occurs when the ligament is overstretched or tears, either the tear can be partial or a complete tear.
    Sport ACL Injuries
    Anterior cruciate ligament (ACL) injuries are increasingly common in the United States. This may be related to the increase in high school sports participation. In the USA alone, 250,000 individuals suffer an ACL rupture (complete tear) per year. ACL injuries are frequently caused by twisting an extended amount of weight that overloads the knee. Soccer, football and basketball players are more susceptible to ACL injuries due to the dynamic of the sport where the athletes are constantly cutting and pivoting different directions. Skiers are also susceptible due to the instability of singular skies causing a threesixty rotation of the knee if an accident were to occur. Oftentimes if there is an abrupt blow to the lateral side of the knee like a football tackle or a soccer slide tackle the ACL and Medial Collateral Ligament (MCL) both will be damaged. ACL tears often occur along with tears to the MCL and the shock-absorbing cartilage in the knee (Meniscus). Most ACL tears occur in the middle of the ligament, or the ligament is pulled off the femur bone. These injuries form a gap between the torn edges, and do not heal on their own and this type of tear would be considered a “complete tear” and that is also considered to be a “rupture”. In the next paragraph I will be addressing Anterior Cruciate Ligament Rupture (ACLR),
    Diagnosis and Treatment
    The diagnosis of ACL injuries involves a focused history and physical examination, which can provide a high index of suspicion. Several clinical tests can be used to detect an ACL rupture. The Lachman test is the most accurate clinical diagnostic test, with a pooled reported sensitivity of 85% and specificity of 94%. The anterior drawer test has high sensitivity and specificity for chronic ACL ruptures (92% sensitivity and 91% specificity), but lower accuracy for acute cases. When positive, the pivot shift test is a very clear indication of an ACL rupture (98% specificity). A negative test is, however, not sufficient to rule the injury out (24% sensitivity). Radio imaging is also popular, but the MRI is the gold standard for exactly seeing where the injury is.
    The three main treatment options for ACL rupture are (1) rehabilitation as first-line treatment followed by ACL reconstruction (ACLR) in patients, who develop functional instability, (2) ACLR and post-operative rehabilitation as the first-line treatment, and (3) pre-operative rehabilitation followed by ACLR and post-operative rehabilitation (Filbay, Grindem 2019). Long-term knee symptoms are common; only 42% of nonprofessional athletes return to competitive sport following ACLR and as many as 50% develop radiographic knee osteoarthritis within 10 years of ACLR. Knee injuries may lead to chronic painful arthritis that impairs walking. Total knee replacement surgery is rarely performed on young people, but is becoming increasingly common among elderly patients with severe arthritis due to old ACL injuries.
    Conclusion
    ACL injuries often include surrounding stabilizing ligaments, it’s very rare to see an injury that involves the singular ACL because of the four additional contributing ligaments that help stabilize the knee. There is a positive association with sports that involve cutting, pivoting or changing directions fast with ACL injuries. General recovery time is eight to nine months and I have found that most expectations from patients are unrealistic with a small anomaly of people that are able to return to competitive sports. Most ACL injuries and all ACLR need surgery, and the likelihood of a patient’s success rate is dependent on the post opt. recovery.

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