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Ligament Injuries Essay Research Paper The volleyball

Ligament Injuries Essay, Research Paper


The volleyball match has been going


on for over an hour. Both teams have been trading


points and side-outs. The ball is set high outside so


that the big outside hitter can put the ball away.


She comes in hard, plants, leaps into the air and


smashes the ball down the line in a twisting motion.


As she lands on her right leg, a POP is heard and


down she goes. What has just happened is


occurring more and more often in athletics, the


athlete has just torn the anterior cruciate ligament


(ACL). In this paper I will describe ACL, how it


is injured and diagnosed, how it be repaired and


what is being done to prevent ACL injuries. The


Anterior Cruciate Ligament (ACL) is one of the


two cruciate ligaments of the knee, the other being


the Posterior Cruciate Ligament (PCL). These


ligaments are the stabilizers of the knee. The ACL


is a strip of fibery tissue, which is located deep


inside the knee joint. It runs from the posterior


side of the femur (thigh bone) to the anterior side


of the tibia (shin bone) deep inside of the knee.


The ligament is a broad, thick cord the size of a


person’s index finger. It has long collagen strands


woven together in a fashion that permits forces of


up to 500 pounds to be exerted. The function of


the ACL is to prevent the tibia from moving in


front of the knee and femur. The ACL also


prevents hyperextension (or extreme stretching of


the knee backward) and helps to prevent rotation


of the tibia. The amount of knee ligament injuries


have been on the rise in recent years. Over the last


15 years, ankle sprains have decreased by 86%


and tibia fractures by 88%, but knee ligament


injuries have increased by 172%. The injury


usually occurs in either a slow twisting fall, a


sudden hyperextension, or a sudden hyperflexion


as when landing from jumping. When the injury


occurs the athlete usually hears a "pop" and they


will have immediate swelling of the knee. When


the person tries to put weight on the leg it will feel


like the knee isn’t underneath the athlete. With


most injuries the type of movement will help to


determine the injury: "I twisted to the right." etc.


When ACL injuries occur there is a "popping"


sound at the time of injury and swelling within six


hours. An experienced clinician can diagnose an


ACL tear with relative accuracy by a manual


examination. X-ray examination and Magnetic


Resonance Imaging (MRI) is also used in


diagnosing ACL injuries. The knee joint will be


instable and the athlete will have joint pain on the


inner (medial) side of the knee. Doctors or trainers


can use three different types of physical


examinations: Lachman’s test, Anterior drawer test


and Pivot shift test of MacIntosh. Lachman’s test


is performed by having the athlete lie on his/her


back, then passively flexing the knee of the athlete


to between 20 degrees and 30 degrees. Make


sure that the hamstring is relaxed or it can produce


a false test result. Holding the lower part of the


athlete’s thigh in one hand and the upper part of


the athlete’s calf in the other, slowly pull the tibia


forward. Increased looseness in the knee joint is


indicative of an ACL injury. During the Anterior


drawer test the athlete lies on his/her back with the


knee bent to 90 degrees and the foot resting on


the table. Stabilizing the foot either by sitting on it


or having someone else hold it down, the doctor


will place his/her hands around the upper part of


the calf with thumbs on the end of the thigh bone


(tibal condyles), slowly appling pressure on the


posterior side of the proximal tibia. Any looseness


in the joint could indicate ACL injury. The Pivot


shift test of MacIntosh is done by having the


athlete lay on his/her back. The foot of the injured


side is lifted with the leg straight and the foot


turned inward. Pressure is applied to the outside


of the knee while the knee joint is slowly bent. An


ACL injury is detected if the tibia moves out of


joint at 30-40 degrees or if a clunk is felt. One


should note that this test can be very painful for the


athlete. When an athlete has injured his/her ACL


the initial

treatment involves splinting the knee, ice


treatment to help reduce swelling, elevation of the


joint (just above the heart) and administration of


anti-inflammatory drugs. The athlete also needs to


limit physical activity. A non-athletic person can


live with the injury using rehabilitation and bracing.


When the ACL is injured the guide wire of the


knee is gone, creating instability. Without the


stabilizing actions of the ligament, there is


increased wear on the top of the tibia, meniscal


cartilages tear and the articular cartilage erodes.


The erosion will result in degenerative arthritis with


grinding and pain when climbing stairs, running or


jumping. But for the active athletic person ACL


reconstruction surgery is the only solution. Repair


of the ACL by surgery can be done by open or


arthroscopic techniques. Recent advances in


surgical techniques have made ACL repair much


more predictable and less traumatic to the athlete.


Techniques in arthroscopic surgery now allow


surgeons to reconstruct the ligament through


smaller incisions and several smaller "stab wounds"


leaving less scarring. Techniques involve using the


athlete’s torn ligament strands and incorporating


them into a primary repair of the ligament usually


backed up by a portion of the athlete’s patellar


tendon. The patellar tendon’s middle one-third is


used with a block of bone from the patella and


from the tibia. The graft is then passed through


two tunnels drilled into the tibia and the femur. The


boney portions of the graft are anchored using


specially designed screws, giving a solid fix to the


graft. The graft recreates the ACL and allows


early motion and weight bearing. One problem


knee injuries have is that ligaments and cartilage


have little blood supply (vascularization). This


means that they take longer to heal. Athletes can


expect to return to competition nine to twelve


months after surgery. The repair of ACL injuries


has a relatively high success rate. Approximately


1-2% of people will have some degree of


dissatisfaction with their surgery. The leading


causes of dissatisfaction are: arthrofibrosis (scar


tissue), deep venous trombosis (blood clots in leg


veins), poor knee motion, infection and injury to


the patella. How can athletes prevent ACL


injuries? Like most injuries they are not always


preventable. Certain things can be done to help


prevent the risk of injury. Strengthening the


muscles around the knee that act as shock


absorbers and joint stabilizers is of key


importance. Strong thigh muscles will help keep


the knee in position. Doing half squats or using a


leg machine will work the thigh muscles. Running


hills and stairs will strengthen both quadriceps and


hamstrings. Riding a bicycle three times a week


either indoors or outdoors will help. Make sure


that the seat is high enough to avoid excessive


knee bending. Water aerobics is also a great way


to strengthen joints without a lot of stress. A knee


bend resistive exercise program done by The


United States Ski Team has resulted in an 80%


decline in serious knee injuries. The program uses


a single stance one-third knee bend going from 30


to 80 degrees at a steady rate for three minutes,


working up to five minutes on each leg. Sport


band (elastic cord) can be used to increase


resistance when initial levels are achieved. The


anterior cruciate ligament is the main guide to knee


stabilization. Fortunately injuries to the ACL are


now much more treatable and athletes are


returning to performance at a greater rate. All


athletes need to be aware of the risk of ACL


injuries but they also need to know if it does


happen, it’s not the end of their athletic career.


BIBLIOGRAPHY Anterior Cruciate Ligament


(ACL) Injury.


http://www.familyinternet.com/peds/scr/001074cc.htm


The Knee


http://www.mednet.qc.ca/mednet/anglais/hermes_a/knee/knee_15.html


Knee Injuries The Anterior Cruciate Ligament


http://www.medseek.com/portfolios/reference/gallz.html


Healther Knees, Please! – AHFMR May/June


Article


http://www.worldweb.com/ahfmr/may/knees.html


ANTERIOR CRUCIATE LIGAMENT


INJURIES BY DAN KUKLOCK

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