Referenced based case study of ACL tear with proper treatment plan.

??????????????CASE STUDY

A 26-year-old patient came to the clinic with a complaint of, ACL and meniscocapsular separation with a medial meniscal ramp lesion while playing football six months ago. The patient had no past medical condition.

History of pain:

???????????????????????????The patient reported that he had a good full range of motion in the knee and was able to bend his knee but he had pain only when climbing the stairs. On a pain scale from 1-10, the level of pain is 4.

Clinical Test:

????????????????????????The Lachman test is the most sensitive test to determine ACL injury/tear with 77.7% sensitivity.

Treatment Plan:

????????????????????????????Strengthening Exercises: ?

·???????Single-leg hop test:

????????????????????????????????????????????This exercise, is recommended for the strengthening of knee muscles after an ACL injury. (https://www.jospt.org/doi/abs/10.2519/jospt.2010.3)

Internal Cues:

???Ask the patient to jump as far as possible on a single leg without losing balance and landing firmly. The distance is measured from the start line to the heel of the landing leg.

External Cues:

????????????????????????The goal is to have a less than 10% difference, in hop distance between the injured limb and the uninjured limb.

Muscles involved:

Quadriceps muscles contract eccentrically during this exercise.

Is this exercise Close chain or open kinetic chain?

As the distal part is fixed so that It is a Closed Kinetic Chain exercise.

Progression with weight lifting:

??????????????????????????????????????????????Weight-bearing is not possible in the hop test so we can use a countermovement jump to hop from cone to cone as a progression of this exercise.

How to perform the exercise in a pool:

·??????Step 1: Stand in the pool in chest-high water.

·???????Step 2: Take your right foot off the ground and place the bottom of your foot on the water log (noodle)

·???????Step 3: Hold your right leg at a 90-degree angle.

·???????Step 4: Hold this position for the desired amount of time and then sit.

?Stability Exercises:

Dynamic knee stability exercises:

??????????????????????????????????????????????????Dynamic knee stability exercises are considered best for stability after an ACL injury. Dynamic stability exercises include lateral step-down exercises.

( https://journals.lww.com/acsm-essr/Fulltext/2003/10000/Dynamic_Knee_Stability_After_Anterior_Cruciate.00007.aspx )

Internal Cues:

?????????????????????????Stand with the leg you want to work on up on the step. Then put your hand on the hips. Now, ask the patient to pull up the toes of the other leg then the patient will ask to sit on an invisible chair until heal touches the ground and then come back up and don't let your right leg move side to side.

External Cues:

????????????????????????Perform the exercise slowly. Keep you right leg stable.

Muscle involved:

·???????The Muscles involved are the quadriceps and glutei muscles.

Is this exercise Close chain or open kinetic chain?

·???????Lateral step exercises are close-chain exercises cause the distal part of the joint is fixed.??

Progression with weights:

·???????We can progress the exercise by giving weight to patients in their hands such as dumbbells. Ask them to perform the same exercise again.

??????????????????????????????????????????

? ??Mobility Exercises:

Passive knee extension:

?????????????????????????????????????????Performing passive knee extension exercises at the early stage will help in ensuring mobility. Full ROM is maintained passively: 4-5 time; stretching exercise, should be done regularly.

( https://www.researchgate.net/profile/Waqar-Naqvi/publication/343556623_Impact_of_Physiotherapy_rehabilitation_program_on_postoperative_ACL_tear_patient_on_prognosis_leading_to_maintain_consistency_in_sport/links/62d4de6266bd1654d66ed196/Impact-of-Physiotherapy-rehabilitation-program-on-postoperative-ACL-tear-patient-on-prognosis-leading-to-maintain-consistency-in-sport.pdf )

Internal Cues:

?????????????????????????The patient asked to sit on one chair and place her heel on the seat of the other. Relax your leg and let your knee straighten.

External Cues:

????????????????????????Rest in this position for 1-2 minutes several times a day. This exercise also stretches out your hamstrings.

Muscles Involved:

????????????????????????????????Iliotibial band (ITB) and tensor fascia Latae (TFL) plays an important role in knee extension.

Close chain or open chain?

?????????????????????????????????????????????Knee extension is an open-chain exercise.

Progression with weights:

?????????????????????????????????????????????????Knee extension exercises can be progressed by using belts against the knee joint and then performing the same exercise as explained above.

?????????????????????????????????

?????Post-op Considerations:

·??????Take proper medications.

·??????Keep your wound clean and dry.

·??????Limit joint movement.

·???????Elevation of the leg above the heart level to prevent post-op complications such as swelling and edema

·??????Don’t put a pillow behind the knees because it will limit the motion of the knees. ?????

The outcome of the session:

??????????????????????????????????????????These exercises will help in the fast recovery from ACL restriction. Exercise will improve blood flow, and decrease pain and inflammation. Strengthening exercises will help increase strength and movement and helps the patient to return to desired activities and can perform activities of daily living (ADLs). Strengthening exercises will enable your muscles to work properly and effectively. Similarly, mobility exercises will help in getting the full range of motion in muscles and joints. It also decrease joint pain, and reduces the risk of injury. Stability exercises will help in maintaining balance and proprioception after an ACL tear. It helps the patients to walk on different surfaces such as smooth or rough surfaces and induce independence in performing different task.

Progression of Exercise:

????????????????????????????????????????Exercises; can be progressed by increasing weight (dumbbells) and by applying resistance (with belts). Each exercise has a different way of progression then other so we will access the joint anatomy before the progression of any exercise. When we achieve our primary goals, then we will go towards the progression of the exercise so that the patient will be able to perform his daily living task and not depend on others for his routine work.?