Yet Another Patient With Lots Of Bruising

But this is not after a massage session......

Check out the bruising .....

.... but this is after her Anterior Cruciate Ligament (ACL) operation done 11 days ago .....with a hamstring graft.

And as written earlier, men don't get it  (men do get it, just not as often as women) and why women are more prone to ACL injuries.

No bruises in front.

Having seen lots of men and women who had an ACL reconstruction done, I must say this is one of the more serious bruising I've seen so far.

She definitely needs to get started on her rehab.

What To Do If Your Child Tears An ACL

What do you do if you child tears his or her anterior cruciate ligament (ACL)? Please have a read here.

*Picture by richseow - RI vs ACJC  'A' Division semi final match 2013.

You May Not Need That ACL Operation

Here is another follow up to our current trends in anterior cruciate ligament (ACL) reconstruction management which started a while ago. This one seems to be the best one yet, especially if you're considering whether to do the operation or not.

You may NOT need surgery after all. Please read on to find out more.

An article by Swedish physiotherapist/ researcher and colleagues (Frobell et al, 2010) made headlines when it was published back in 2010. Allow me to give you a little info on Frobell. While working as a physiotherapist back in 2001 rehabilitating ACL injuries and also assisting at ACL surgeries (to better understand the procedure), he was inspired to find out more. In one particular case, a patient's ruptured ACL had partially healed and attached to the posterior cruciate ligament or (PCL) and the knee was stable and did not require surgery. This led him to investigate further which brought about the following study.

The researchers reported that 60% of all ACL reconstructions could be avoided in favour of correct advanced rehabilitation. Their results made waves all over the world and were of course met with healthy skepticism (including yours truly). Many nay sayers said it could not be done. It was even agreed that their results will probably not hold up in the long term.

Surprise surprise, the same researchers have published a 5 year follow-up study that confirms the results from the earlier study. More importantly, the results also show that the risk of osteoarthritis and meniscus injuries (requiring surgery) is not higher than those treated with physiotherapy alone.

The patients also did not experience any difference in function, activity level, quality of life, pain, symptoms etc. The researchers reported that there wasn't any difference in any outcome between patients that were operated soon after injury, operated on later and those who did not have any operation at all.

Take home message from the researchers? Young, active patients with ACL injuries may be better off doing specialized rehabilitation initially rather than getting an ACL reconstruction.

Well, I guess the key here if you want to avoid surgery is specialized rehabilitation with experienced physiotherapists as mentioned by the researchers. Come talk to us if you have any questions, we have much experience with ACL injuries and we do aqua based rehabilitation as well.

The researchers are now starting their third part of the study, Knee ACL Non-operative treatment (KANON) whereby they follow-up on the patients 10 years after their ACL injury. I will be waiting for their results.

References

Frobell RB, Roos HP, Roemer FW et al (2013). Treatment For Acute Anterior Cruciate Ligament Tear: Five Year Outcome Of Randomised Trial. BMJ 346(Jan 24 1) :f232. DOI: 10.1136/bmj.f232.

Frobell RB, Roos EM, Roos HP et al (2010). A Randomised Trial Of Treatment For Acute Anterior Cruciate Ligament Tears. NEJM 363(4): 331-342. DOI:10.1056/NEJMoa0907797.

*Picture from flickr.com

Hamstring Strength & ACL Injury Risk In Women

*Picture by Lai Jun Wei/ Red Sports

More evidence on why women get it. Here's what researchers in the study below found in young women with regards to the relative strength of their quadriceps and hamstrings. The women who had significantly lower hamstring strength compared to their quadriceps strength were the ones who sustained the anterior cruciate ligament (ACL) tears.

The researchers matched the injury free athletes and the injured athletes as closely as possible in terms of height, weight, dominant limb side and sport to eliminate other factors and then compared their quadriceps and hamstring strength. In addition, a similar group of uninjured male athletes who acted as controls were matched to the injured female athletes as secondary control as well.

The results specifically show that the female athletes who tore their ACL's had weaker hamstring strength as compared to their male counterparts although quadriceps strength was not weaker. In direct contrasts, female athletes who did not tear their ACL's had decreased quadriceps strength and similar hamstring strength compared to matched male athletes.

The researchers concluded that excessive quadriceps strength in relation to hamstring strength is a significant risk factor for ACL injury in female athletes.

As we've said before research is now pointing towards gender and sport specific training and rehabilitation programs to prevent ACL injuries. Please contact us if you have any queries, we can help prevent ACL injuries. If you enjoyed this please also see this.
 

Reference

Meyer GD, Ford KR et al (2009). The Relationship of Hamstrings and Quadriceps Strength to Anterior Cruciate Ligament Injury in Female Athletes. Clinical J of Sports Medicine. 19(1) : 3-8

*Picture by Lai Jun Wei/ Red Sports

Aqua Based Rehabilitation After Knee Surgery

We've written about our Aqua Based Rehabilitation before in our other blog. Have a look at some of our pictures of our recent Aqua Based Rehabilitation (Deep Water Running) session taken yesterday. Check out one of our post-ACL reconstruction patients who can't swim but is able to run in water (with the flotation device of course). We have pregnant patients joining us for the classes as well.


We have classes twice weekly, please contact us if you are struggling with your rehab, or want to exercise pre and post pregnancy. 

Back To The 80's... Not!

In the 1980's, it was common for patients to have their ACL reconstruction within one week of the injury. These was because surgeons believed that this would prevent meniscal and articular cartilage damage. These patients also had lots of problems regaining full range of motion (ROM) partly due to arthrofibrosis (or scarring from bleeding, inflammation). These patients had a loss of knee extension (straightening) which was functionally worse than prior to their surgery. Even now, there are patients who tell us that they were advised to have the reconstruction as soon as possible. So what does the published studies say?

Results on studies for early versus later reconstruction are mixed, some report good results while others are poor. A major problem was the the studies were often retrospective (looking backwards) in nature, so there was so some bias and confounding factors.

To sum up, the time interval from your ACL injury to reconstruction is not as important as the condition of your knee at the time of injury. Prior to your operation, your knee should have full ROM with minimum or no swelling as compared to your uninjured side. Pain should be minimal and you must be mentally prepared for the ACL reconstruction, and more importantly the lengthy rehabilitation required after the operation. A good surgical technique is only as good as its rehabilitation.

Current Trends In Anterior Cruciate Ligament (ACL) Reconstruction Management

"A torn anterior cruciate ligament (ACL) is the beginning of the end" (Allan, 1974).

Fret not. Sports medicine and physiotherapy have come a long way since then.

The Physio Solutions Team will discuss some of the questions, controversies and evidence our patients, readers and friends may have with regards to having an ACL reconstruction.

In short, the ACL prevents anterior tibial translation, meaning if your foot and lower leg (shin bone or tibia) is fixed on the ground, it prevents the shin bone or tibia from moving forward excessively with respect to the thigh bone (or femur). It also limits excessive rotational movements in your knee.

First question will inevitably be "If I tear my ACL, do I need an ACL reconstruction?"

We will often ask our patients if their activities of daily living (ADL) are affected. If you cannot climb stairs, squat, run after the bus or have persistent giving way of your knee joint after injury then your ADL is definitely affected. Some people may be able to get away without a reconstruction if none of the discussed symptoms occur or structurally their knee joint may be sound.

We have seen some patients who do not do the operation and fare well. But they are few in numbers. Of course patient lifestyle factors such as present and future activity also play a part in decision making. In most cases, however, non operative management of the torn ACL usually leads to functionally unacceptable outcomes. Moreover, with many of our patient's increasing emphasis on sports, the majority of them will need a reconstruction especially those involved in sports that require changing directions, pivoting or jumping.

What choice of graft you choose in your reconstruction will and always be a subject of debate. Majority of operations done use either the bone-patella tendon bone (BPTB) or semitendinosus-gracilis (hamstrings) graft. Both have their pros and cons. We will discuss this in our next post. Stay tuned.