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 Table of Contents  
CASE REPORT
Year : 2020  |  Volume : 15  |  Issue : 1  |  Page : 132-133

Impact of fall on anterior cruciate ligament of 33-year-old male


1 Department of Community Health Physiotherapy, Ravi Nair Physiotherapy College, DMIMS (DU), Wardha, Maharashtra, India
2 Department of Neurophysiotherapy, Ravi Nair Physiotherapy College, DMIMS (DU), Wardha, Maharashtra, India

Date of Submission10-Dec-2019
Date of Decision10-Jan-2020
Date of Acceptance15-Jan-2019
Date of Web Publication13-Oct-2020

Correspondence Address:
Dr. Ashish Wasudeorao Bele
Department of Community Health Physiotherapy, Ravi Nair Physiotherapy College, DMIMS (DU), Sawangi (Meghe), Wardha - 442 004, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdmimsu.jdmimsu_184_19

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  Abstract 


Injury to anterior cruciate ligament (ACL) is very common, especially seen in the athletic population. It usually occurs as a result of fall. A 33-year-old male had a history of fall from bike which lead to full-thickness tear of ACL, partial thickness tear of PCL, Grade II injury of patello-femoral ligament, and moderate knee joint effusion of the right limb and had undergone arthroscopic ACL reconstruction of the right side. After arthroscopic ACL reconstruction, the patient presented with pain (7 on numerical pain rating scale), swelling and swelling at right knee joint and referred for physiotherapy.

Keywords: Anterior cruciate ligament tear, arthroscopic anterior cruciate ligament reconstruction, fall, knee


How to cite this article:
Bele AW, Qureshi MI, Dhankar S, Seth N. Impact of fall on anterior cruciate ligament of 33-year-old male. J Datta Meghe Inst Med Sci Univ 2020;15:132-3

How to cite this URL:
Bele AW, Qureshi MI, Dhankar S, Seth N. Impact of fall on anterior cruciate ligament of 33-year-old male. J Datta Meghe Inst Med Sci Univ [serial online] 2020 [cited 2020 Oct 28];15:132-3. Available from: http://www.journaldmims.com/text.asp?2020/15/1/132/297972




  Introduction Top


An anterior cruciate ligament (ACL) injury is a tear or sprain of the ACL injuries most commonly occur during sports that involve sudden stops or changes in direction, jumping and landing such as soccer, basketball, football, and downhill skiing.[1],[2]

Many people hear or feel a “pop” in the knee when an ACL injury occurs. Your knee may swell, feel unstable, and become too painful to bear weight. Depending on the severity of your ACL injury, the treatment may include rest and rehabilitation exercises to help you regain strength and stability or surgery to replace the torn ligament, followed by rehabilitation.[3]

A proper training program may help reduce the risk of an ACL injury. Signs and symptoms of an ACL injury usually include A loud “pop” or a “popping” sensation in the knee, severe pain and inability to continue activity, rapid swelling, loss of range of motion, a feeling of instability, or “giving way” with weight-bearing.[3]

Here, we present a case of 33-year-old male presented with chief complaints of pain and swelling over the right knee. Hence, the patient underwent various special tests and magnetic resonance imaging (MRI) which confirmed the ACL tear.


  Case Report Top


This case report was of a 33-year-old male with chief complaints of pain (10 on numerical pain rating scale) and swelling over the right knee. The patient had a history of fall from bike on a previous day sustaining injury to the right knee; complaints were sudden in onset, progressed for a short duration and then regressed. On performing special tests, the Lachman's test was positive depicting ACL tear and varus, valgus test was negative. As primary treatment, the patient was advised long knee brace application and limb elevation. During physical examination, the vital signs were stable, lungs and heart sounds were normal, on palpation right knee local tenderness over the tibial spine. The MRI of the right knee joint confirmed the full thickness tear of ACL, partial thickness tear of PCL, Grade II injury of patellofemoral ligament, moderate knee joint effusion, and X-ray of anteroposterior and lateral view confirmed the fracture of tibial spine right leg. Hence, he underwent arthroscopic ACL reconstruction of the right side, and the patient was advised for suture removal, to continue the long knee brace application and knee range of motion exercise.

After arthroscopic ACL reconstruction, the patient presented with pain (7 on numerical pain rating scale), swelling, and swelling at right knee joint [Figure 1] and [Figure 2].
Figure 1: Knee joint with swelling – Anterior view

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Figure 2: Knee joint with swelling and stiffness – Lateral view

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  Discussion Top


An ACL injury is the overstretching or tearing of the ACL ligament. A torn ACL is a common knee injury. On average, women are 2–8 times more at risk of ACL injuries than men. Teenagers also are getting ACL injuries at an increased rate, probably because more kids are involved in organized sports.[1]

Teenagers also are getting ACL injuries at an increased rate, probably because more kids are involved in organized sports. The primary sign of an ACL injury is a popping noise. This is often combined with pain and swelling. The patient experienced grinding feelings of your bones or kneecap. Another sign is not being able to put weight on your leg. People with a mild ACL injury might feel like their knee is unstable, or like it might “give out” when they are using it.[3]

ACL injuries often occur in sports or active environments. The participant in this case study showed a history of fall which caused ACL injury and had a history of pain and swelling.

In the injury of ACL, it can be a partial or full tear. In a partial tear, only part of the ligament is torn. A full or complete tear happens when the ligament is torn in two pieces. Usually, ACL tears happen in the middle of the ligament.[4] Sometimes, the ligament is pulled completely off the thigh bone. Other injuries can occur at the same time. These include other torn knee ligaments (primarily the medial collateral ligament, the ligament that gives your knee stability), a torn meniscus (knee cushion), or bone bruises. There is no clear evidence that the use of a knee brace prevents ACL injuries. There also is no proof that a knee braces help more during treatment or physical therapy.[5],[6]

There is a strong requirement of ACL reconstruction in full-thickness tear.[6],[7] The participant in this study underwent arthroscopic ACL reconstruction.


  Conclusion Top


This case study concluded that ACL injury should be suspected in cases of fall on knee joint, and the patient presenting with complaints of pain, sudden swelling over knee joint on fall. The ACL reconstruction was a choice of treatment in full-thickness ligament injury.

Declaration of patient consent

The authors certify that appropriate consent forms were obtained from the patient. In the consent form, the patient has given his consent for his images and other clinical information to be published in the journal. The patients understand that their personal information will not be disclosed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Butler DL, Noyes FR, Grood ES. Ligamentous restraints to anterior-posterior drawer in the human knee. A biomechanical study. J Bone Joint Surg Am 1980;62:259-70.  Back to cited text no. 1
    
2.
Kiapour AM, Wordeman SC, Paterno MV, Quatman CE, Levine JW, Goel VK, et al. Diagnostic value of knee arthrometry in the prediction of anterior cruciate ligament strain during landing. Am J Sports Med 2014;42:312-9.  Back to cited text no. 2
    
3.
Levine JW, Kiapour AM, Quatman CE, Wordeman SC, Goel VK, Hewett TE, et al. Clinically relevant injury patterns after an anterior cruciate ligament injury provide insight into injury mechanisms. Am J Sports Med 2013;41:385-95.  Back to cited text no. 3
    
4.
Chu CR, Beynnon BD, Buckwalter JA, Garrett WE Jr., Katz JN, Rodeo SA, et al. Closing the gap between bench and bedside research for early arthritis therapies (EARTH): Report from the AOSSM/NIH U-13 Post-Joint Injury Osteoarthritis Conference II. Am J Sports Med 2011;39:1569-78.  Back to cited text no. 4
    
5.
Quatman CE, Kiapour AM, Demetropoulos CK, Kiapour A, Wordeman SC, Levine JW, et al. Preferential loading of the ACL compared with the MCL during landing: A novel in sim approach yields the multiplanar mechanism of dynamic valgus during ACL injuries. Am J Sports Med 2014;42:177-86.  Back to cited text no. 5
    
6.
Hewett TE, Di Stasi SL, Myer GD. Current concepts for injury prevention in athletes after anterior cruciate ligament reconstruction. Am J Sports Med 2013;41:216-24.  Back to cited text no. 6
    
7.
Lohmander LS, Ostenberg A, Englund M, Roos H. High prevalence of knee osteoarthritis, pain, and functional limitations in female soccer players twelve years after anterior cruciate ligament injury. Arthritis Rheum 2004;50:3145-52.  Back to cited text no. 7
    


    Figures

  [Figure 1], [Figure 2]



 

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Abstract
Introduction
Case Report
Discussion
Conclusion
References
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