Any injury to the lower limbs can substantially impair the patient, limiting their ability to walk without assistance and lead an active life. Knee injuries are particularly widespread among athletes engaged in high contact sports such as football, soccer, lacrosse, or rugby. One of the most common traumas in such sports is the rupture of the anterior cruciate ligament (ACL) that can be repaired with reconstructive surgery. This essay will discuss a patient with a repaired left ACL tear who experiences a deficit in the range of motion. It will also examine the epidemiology and mechanism of ACL injuries, the expected outcomes following reconstruction surgery, and potential post-operation complications.
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The patient is a 16-year-old male enrolled in high school. His height is 5’10,” and he weighs approximately 185 lbs. The patient recently underwent reconstruction surgery on his left ACL and is now experiencing problems with the range of motion of the joint. The flexion of the left knee is limited to 65 degrees, while the extension is at 105 degrees. There is a concern that the patient may develop arthrofibrosis following the surgery. Prior to the rapture, the client was a running back in his school gridiron football team and is overall very athletic, also taking part in several other sports. The patient has torn the ACL during his football practice after making an unfortunate landing after a jump. Despite the seriousness of the injury, the client wants to continue participating in athletic activities, even if not in a competitive capacity.
ACL Injuries Epidemiology and Mechanism
ACL tears in athletes engaged in contact sports are quite common. According to Kaeding et al. (2017), knee-related injuries in high school athletes constitute up to 60% of all sports-related surgeries in the United States. Several team sports put the players at a higher risk of sustaining a knee trauma. Thus, lacrosse and American football are associated with a 0,4% and 0.8% probability of at least one player suffering an ACL tear in a season (Kaeding et al., 2017). The overall chance of tearing an ACL in high school over the four years is between 5-10%, putting every young athlete at significant risk (Kaeding et al., 2017). Furthermore, returning to an active lifestyle after knee surgery is correlated with a high probability of retearing the ligament, suffering a second ACL trauma (Kaeding et al., 2017). Thus, it is imperative to ensure the patient has enough time to rest and rehabilitate after the surgery, recovering the full range of motion before taking part in any sports.
Most of the risk factors associated with ACL injuries in high school athletes are linked to lower limb mechanics. Research shows that hip and tibia rotations can impact the ligaments in the knee and contribute to a higher risk of injury. For example, reduced hip flexion during landing can lead to decreased flexion in the joint and ligament tear as the position of the leg contributes to more weight being put on it (Kaeding et al., 2017). Additionally, internal hip rotation combined with knee adduction can lead to valgus, whereas the rotation of the tibia towards the center of the body can increase the strain on the ACL and result in a sprain (Kaeding et al., 2017). In the patient’s case, the athlete landed after a jump with little flexion in the hips, leading to his left knee being almost completely straight with no flexion and his full weight being put on the left ACL. The patient was unable to recall the position of his left shinbone during landing. Overall, sustained injury is consistent with the standard ACL rapture mechanics.
ACL Reconstruction Surgery Outcomes and Potential Complications
ACL reconstruction surgery is conducted in cases of severe tears to the ligament. The surgery is primarily aimed at restoring “the normal anatomy and biomechanics of the knee joint” (Eckenrode et al., 2017, p. 315). ACL reconstruction procedure is always follow-up by a rehabilitation process that allows the patient to recover the range of motion. According to Cavanaugh and Powers (2017), the range of motion two weeks after surgery should reach up to 90 degrees. By week four after the treatment, the flexion of the knee should be at 120 degrees, with a full extension of 0 degrees (Cavanaugh & Powers, 2017). Although every patient’s recovery is different, failure to achieve 120 degrees flexion and full extension of the knee 4-6 weeks after the surgery was performed is a matter of concern. Specifically, the lack of full extension is concerning as full passive extension can be achieved in the first two weeks following the surgery (Cavanaugh & Powers, 2017). Overall, if the process of recovery after ACL reconstruction is characterized by an impaired range of motion, it indicates the patient developing post-surgery complications.
There are several potential outcomes after the ACL reconstruction surgery that need to be discussed. These complications include infection, the deficit to the range of motion and strength, and secondary knee injuries (Eckenrode et al., 2017). Infection following surgery is quite rare, with most patients experiencing issues with the range of motion. Deficits in the flexion and extension can lead to the client experiencing pain in the joint during movement, gait, and function (Eckenrode et al., 2017). Furthermore, unaddressed deficits in the range of motion can result in arthrofibrosis (Eckenrode et al., 2017). Arthrofibrosis can be defined as “a loss of 15 degrees extension or more, with or without flexion loss compared to the contralateral knee” (Rushdi et al., 2019, p. 34). The complication is quite common and develops due to the formation of excessive scar tissue forming around the ACL after the surgery (Ekhtiari et al., 2017). Other risk factors include prolonged immobilization of the knee joint and concomitant meniscal repair (Ekhtiari et al., 2017). Overall, ACL reconstruction surgery complications can be avoided with clear communication between the surgeon, the recovery team, and the patient.
In conclusion, various knee injuries, including ACL tears and raptures, are highly common in contact sports. Trauma to ACL can be sustained on landing with little hip and knee flexion or during sudden turns if the shinbone is internally rotated. ACL reconstruction surgery aims to restore the joint’s autonomy and function; however, it can result in several complications, including infection, deficits in the range of motion and strength. Failure to timely start physical therapy, simultaneous meniscal repair, and impaired flexion and extension following the operation can lead to the formation of excessive scar tissues and arthrofibrosis development. Overall, the patient needs to undergo restoration and begin post-surgery therapy as soon as possible to increase the chance of swift recovery.
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Cavanaugh, J. T., & Powers, M. (2017). ACL rehabilitation progression: where are we now?. Current reviews in musculoskeletal medicine, 10(3), 289-296.
Eckenrode, B. J., Carey, J. L., Sennett, B. J., & Zgonis, M. H. (2017). Prevention and management of post-operative complications following ACL reconstruction. Current reviews in musculoskeletal medicine, 10(3), 315-321.
Ekhtiari, S., Horner, N. S., Simunovic, N., Hirschmann, M. T., Ogilvie, R., Berardelli, R. L.,… & Ayeni, O. R. (2017). Arthrofibrosis after ACL reconstruction is best treated in a step-wise approach with early recognition and intervention: a systematic review. Knee Surgery, Sports Traumatology, Arthroscopy, 25(12), 3929-3937.
Kaeding, C. C., Léger-St-Jean, B., & Magnussen, R. A. (2017). Epidemiology and diagnosis of anterior cruciate ligament injuries. Clinics in Sports Medicine, 36(1), 1-8.
Rushdi, I., Sharifudin, S., & Shukur, A. (2019). Arthrofibrosis following anterior cruciate ligament reconstruction. Malaysian Orthopaedic Journal, 13(3), 34.