Is It Just an ACL Tear?
Margaret Frens, Kinesiology
As the anterior cruciate ligament (ACL) tear continues to be one of the most predominant injuries within athletics, sports medicine specialists have become fixated on the ACL injury at hand, such that we may be forgetting an array of underlying pathologies, leading to the question, “Is It Just an ACL Tear”? This case study explores several concurrent injuries, as well as follows a collegiate athlete who experienced and ACL injury with an associated Osteochondral Defect (OCD). When the ACL tears, compression between the knee’s articulating surfaces generates a shearing force of the hyaline cartilage, exposing the underlying subchondral bone in 70% - 80% of ACL pathologies. These chondral defects have minimal healing potential due to the lack of vascularity, creating the risk for long term osteoarthritis. Various surgical procedures will be examined through subchondral drilling, abrasion arthroplasty, and in this case an induced microfracture with the goal to restore tissue by stimulating the metabolic healing process. The rehabilitation timeline will be explored in comparison with a general ACL protocol, along with the success rates. Through these shearing forces, meniscal tears coincide with approximately 85% of OCD pathologies and 60% - 70% of ACL tears, while rotational knee instabilities, more specifically a posterolateral instability prevails in about 72% of ACL injuries. Classifications of tears and specific rotational instabilities will be explored, as well as their treatment, rehabilitation, and outcomes. Whether it be an ACL tear, or another common pathology, we cannot assume every injury is the same. Every patient should be treated as a specific individual based on their symptoms rather than an injured body part.
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