Healthy Life: Anterior Cruciate Ligament Tear (777)

Healthy Life: Anterior Cruciate Ligament Tear

蘇鎮邦 (Christopher So)：
舒整物理治療師 (Manipulative Physiotherapist) 人類工程師 (Ergonomist)

Recently, I had a patient who had a skiing injury to his left knee. Preliminary assessment indicated anterior cruciate ligament tear. It is unfortunate that he stopped doing the exercises when he had 80% improvement. His physiotherapist did not emphasize that he had to continue the exercises until 100% recovery ocurred. Over the last 15 years, work and sporting activities caused minor strain in the knee. After he reached 40 year old, his knee degenerated more than normal. The reason is most likely that the normal daily activities become abnormal pressure on an already abnormal knee. His quadriceps medialis was atrophied and weak. His knee cap or patella has a lot of crepitation. When he played with his boys, he heard a click and then he could not walk properly because of sharp pain.

Diagram one shows the anatomy of the knee. The knee is composed of 3 joints with complicated structure and function. The femur and patella form the patellofemoral joint. The tibia and the femur form the tibiofemoral joint. The tibia and the fibula form the tibiofibula joint. Between the tibia and femur, there are the medial and lateral menisci performing a shock absorbing function, and the anterior and posterior cruciate ligaments for stabilising the knee, especially in forward, backward and twisting movements, assisted by the medial and lateral collateral ligaments. The medial meniscus blends with the fibres of the medial collateral ligament. Damage to one can involve the other.

Anterior cruciate ligament injuries are common among young people involved in vigorous sports or exercises. It happens when the foot is stuck down on the ground with violent upper body movement. The weight of the body plus the violent twisting movement will tear the ligament. If the knee is crushed by the weight of the other players, or run into by the knee of other players, tearing is almost inevitable. In this stage, I referred him to an orthopaedic surgeon for reconstruction of the ligament.

Diagram One