Adrian N. Pragacha BSN 3-1, RLE Grp.

Anterior Cruciate Ligament Injury (Blown Out Knee)

Introduction The anterior cruciate ligament (ACL) is probably the most commonly injured ligament of the knee. In most cases, the ligament is injured by people participating in athletic activity. As sports have become an increasingly important part of day-to-day life over the past few decades, the number of ACL injuries has steadily increased. Anatomy Ligaments are tough bands of tissue that connect the ends of bones together. The ACL is located in the center of the knee joint where it runs from the backside of the femur (thighbone) to connect to the front of the tibia (shinbone). The ACL runs through a special notch in the femur called the intercondylar notch and attaches to a special area of the tibia called the tibial spine. The ACL is the main controller of how far forward the tibia moves under the femur. If the tibia moves too far, the ACL can rupture. The ACL is also the first ligament that becomes tight when the knee is straightened. If the knee is forced past this point, or hyperextended, the ACL can also be torn.

Adrian N. Pragacha BSN 3-1, RLE Grp. 1

Causes
ACL injuries occur when an athlete rapidly decelerates, followed by a sharp or sudden change in direction (cutting). ACL failure has been linked to heavy or stiff-legged landing; as well as twisting or turning the knee while landing, especially when the knee is in the valgus (knockknee) position. Women in sports such as football, basketball, tennis and volleyball are significantly more prone to ACL injuries than men. The discrepancy has been attributed to differences between the sexes in anatomy, general muscular strength, reaction time of muscle contraction and coordination, and training techniques. The majority of ACL injuries occur in athletes landing flat on their heels. The latter directs the forces directly up the tibia into the knee, while the straight-knee position places the lateral femoral condyle on the back-slanted portion of the tibia. The resultant forward slide of the tibia relative to the femur is restrained primarily by the now-vulnerable ACL. Signs and Symptoms Sudden popping sound Swelling Instability of the knee Pain (moderate to severe)

Diagnostics X-ray MRI Arthroscopy

Surgical Management ACL Reconstruction Patellar Tendon graft procedure Hamstring graft Procedure Allograft procedure Synthetic grafts

Pharmacological Treatment: NSAIDS Opiod analgesics

Adrian N. Pragacha BSN 3-1, RLE Grp. 1

Nursing Management
Assess degree of mobility produced by injury or treatment and note patients perception of immobility. Administer analgesics as ordered. Encourage participation in divertional activities. Instruct patient in assisting in active or passive range of motion exercises of affected and unaffected extremities. Assist with or encourage self-care activities. Reposition periodically and encourage deep breathing exercises. Refer to therapist as needed.

Nursing Diagnosis Impaired physical mobility of the lower extremity related to knee injury. Acute pain related to status post surgery Impaired skin integrity related to surgical incision Knowledge deficit related to lack of information.

References: 1. 2. 3. 4. http://www.orthogate.org/patient-education/knee/anterior-cruciate-ligament-injuries.html http://en.wikipedia.org/wiki/Anterior_cruciate_ligament_injury http://www.scribd.com/doc/54824934/Anterior-Cruciate-Ligament http://emedicine.medscape.com/article/89442-treatment#aw2aab6b6b2