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An anterior cruciate ligament injury occurs when the anterior cruciate ligament (ACL) is either stretched, partially torn, or completely torn. [1] The most common injury is a complete tear. [ 1 ] Symptoms include pain, an audible cracking sound during injury, instability of the knee, and joint swelling . [ 1 ]
Most PLC injuries accompany an ACL or PCL tear, and can contribute to ACL or PCL reconstruction graft failure if not recognized and treated. [ 47 ] [ 48 ] A study by LaPrade et al. in 2007 showed the incidence of posterolateral knee injuries in patients presenting with acute knee injuries and hemarthrosis (blood in the knee joint) was 9.1%.
Typically there is a tear of the anterior cruciate ligament, posterior cruciate ligament, and either the medial collateral ligament or lateral collateral ligament. [3] If the ankle–brachial pressure index is less than 0.9, CT angiography is recommended to detect blood vessel injury. [3] Otherwise repeated physical exams may be sufficient. [2]
Anterior cruciate ligament tear seen on MRI. An anterior cruciate ligament injury results from excess tension on the ligament. This can come from a sudden stop or twisting motion of the knee. A few initial symptoms include swelling, knee instability, and pain. A popping sound or sensation may or may not be heard when the ACL first tears.
An increased amount of anterior tibial translation compared with the opposite limb or lack of a firm end-point may indicate either a sprain of the anteromedial bundle or complete tear of the ACL. [2] If the tibia pulls forward or backward more than normal, the test is considered positive.
A strain is a type of acute injury that occurs to the muscle or tendon. Similar to sprains, it can vary in severity, from a stretching of the muscle or tendon to a complete tear of the tendon from the muscle. Some of the most common places that strains occur are in the foot, back of the leg (hamstring), or back. [2]
Most ACL tears are a result of a non-contact mechanism such as a sudden change in a direction causing the knee to rotate inward. As the knee rotates inward, additional strain is placed on the ACL, since the femur and tibia, which are the two bones that articulate together forming the knee joint, move in opposite directions, causing the ACL to tear.
Originally described by Dr. Paul Segond in 1879 [6] [7] after a series of cadaveric experiments, the Segond fracture occurs in association with tears of the anterior cruciate ligament (ACL) (75–100%) and injury to the medial meniscus (66–75%), lateral capsular ligament (now known as the Anterolateral ligament, or ALL), as well as injury to the structures behind the knee.