Talk:Anterior cruciate ligament injury

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External bracing

I don't believe this statement is accurate: "External bracing is recommended for athletes in contact and collision sports for a period of time after reconstruction. It is important however to realize that this type of prevention is given by a 'surgeon to surgeon' basis; all surgeons will prescribe a brace and crutches for post surgery recovery total usage time is one month"

As my doctor told me, and as I found on the web (although I'm not going to research it right now), braces are mostly useless because the graft is far stronger than the brace itself.--69.86.74.38 (talk) 06:02, 13 August 2008 (UTC)

Merge with Anterior Cruciate Ligament and ACL Reconstruction?

This page could be combined with the article Anterior cruiate ligament and Anterior cruiate ligament reconstruction under the name "Anterior Cruciate Ligament."

I oppose the merger between the anatomical term and the name of the condition, but I would support the merger between the name of the condition and the name of the surgery. --Arcadian 08:08, 4 October 2006 (UTC)

There already is an ACL reconstruction section of the ACL injury page and the ACL reconstruction article should just replace that section.

I know CATZ is doing some research with USC to discover why there are differences in the number of ACL injuries betweeen boys and girls. http://pt.usc.edu/ACLprojectprevent/ Tucker2000 (talk) 20:14, 24 October 2008 (UTC)

Possible expansion to this article

Hello. I have been working on expanding information on the anterior cruciate ligament article. Particularly, I have expanding a section dedicated to explaining reasons women are more susceptible to ACL injury. I see that this article also briefly touches on a few of these factors. Now, I think it may be more appropriate to add this additional information in this article, instead. If anyone would like to work with me on expanding this section or has any other suggestions or ideas, please let me know. Eng 314 (talk) 03:57, 29 February 2008 (UTC)

Adding content for Project Anatomy Talk Page (for discussion)

I am a student from Cal Poly Pomona and we are involved in a project that is adding information to pages involving musculoskeletal injuries. I wanted to add the following information to the page. Please feel free review and leave any comments.

My group's project will be on the injury to the ACL. We will attempt to add to and revise any of the information already available in the current wikipedia article. This includes general information, causes, prevention, and treatment. The ACL is a vital ligament for proper movement. the anterior cruciate ligament (ACL) receives the most injuries then the other ligaments. Injuries of the ACL range from mild such as small tears to severe when the ligament is completely torn. There are many ways the ACL can be torn the most prevalent is when the knee is bent too much toward the back and when it goes too far to the side. Tears in the anterior cruciate ligament usually take place when the knee receives direct impact while the leg is in a stable position. Torn ACL’s are most of the time related to high impact sports or when the knee is forced to make sharp changes in movement and during abrupt stops from high speed. These types of injuries are prevalent in soccer, high jump, basketball, and football. Research has shown that women involved in sports are more likely to have ACL injuries then males. ACL tears can also happen among older individuals from a slip and fall and they are seen mostly in people over forty due to wear and tear of the ligaments. An ACL tear can be determined by the an individual if a popping sound is heard after impact, swelling after a couple of hours, severe pain when bending the knee, and when the knee buckles or locks during movement.

A torn ACL is less likely to control the movements of the knee. When tears to the ACL is not repaired it can sometimes cause damage to the cartilage inside the knee because with the torn ACL the tibia and femur bone are more likely to rub against each other. Immediately after the tear of the ACL, the person should rest it, ice it ever fifteen to twenty minutes, produce compression on the knee, and then elevate above the heart; this process helps decrease the swelling and reduce the pain. The form of treatment is determined based on the severity of the tear on the ligament. Small tears in the ACL may just require several months of rehab in order to strengthen the surrounding muscles, the hamstring and the quadriceps, so that these muscles can compensate for the torn ligament.

If the tare is severe, surgery may be necessary because the ACL can not heal independently because there is a lack of blood supply going to this ligament. Surgery is usually required among athletes because the ACL is needed in order to perform sharp movements safely and with stability. The surgery of the ACL is usually done several weak after the injury in order to allow the swelling and inflammation to go down. During surgery the ACL is not repaired instead, it is reconstructed using other ligaments in the body. There are three different types of ACL surgery. The first type is the patella tendon-bone auto graft is when the surgeon takes a piece of the patella tendon and uses it to reconstruct the new ACL tendon. The second type is hamstring tendon auto graft this is when the surgeon uses two tendons from the back of the knee and doubles them to become the new ACL tendon. The third type is when tissue is taken from a cadaver to for the new ACL. Patella tendon-bone auto graft and hamstring auto graft are the most common and preferred because it produce the best results. After the surgery, rehabilitation is required in order to strengthen the surrounding muscles and stabilize the joint. kjnavalta (talk) 17:10, 5 April 2010 (UTC)

References

Editorial Comments

A section is needed on epidemiology – incidence rates, etc. How often do these occur? In men or women is it more common?

Injury Types, Conservative Treatments sections need citations, and formal language. Scholarchanter (talk) 00:57, 1 June 2010 (UTC)

ACL Injury wikiproject Anatomy

The anterior cruciate ligament (ACL) receives the most injuries then the other ligaments. Injuries of the ACL range from mild such as small tears to severe when the ligament is completely torn. There are many ways the ACL can be torn the most prevalent is when the knee is bent too much toward the back and when it goes too far to the side. Tears in the anterior cruciate ligament usually take place when the knee receives direct impact while the leg is in a stable position. Torn ACL’s are most of the time related to high impact sports or when the knee is forced to make sharp changes in movement and during abrupt stops from high speed. These types of injuries are prevalent in soccer, high jump, basketball, and football. Research has shown that women involved in sports are more likely to have ACL injuries then males. ACL tears can also happen among older individuals from a slip and fall and they are seen mostly in people over forty due to wear and tear of the ligaments. An ACL tear can be determined by the an individual if a popping sound is heard after impact, swelling after a couple of hours, severe pain when bending the knee, and when the knee buckles or locks during movement.

A torn ACL is less likely to control the movements of the knee. When tears to the ACL is not repaired it can sometimes cause damage to the cartilage inside the knee because with the torn ACL the tibia and femur bone are more likely to rub against each other. Immediately after the tear of the ACL, the person should rest it, ice it ever fifteen to twenty minutes, produce compression on the knee, and then elevate above the heart; this process helps decrease the swelling and reduce the pain. The form of treatment is determined based on the severity of the tear on the ligament. Small tears in the ACL may just require several months of rehab in order to strengthen the surrounding muscles, the hamstring and the quadriceps, so that these muscles can compensate for the torn ligament.

If the tare is severe, surgery may be necessary because the ACL can not heal independently because there is a lack of blood supply going to this ligament. Surgery is usually required among athletes because the ACL is needed in order to perform sharp movements safely and with stability. The surgery of the ACL is usually done several weeks after the injury in order to allow the swelling and inflammation to go down. During surgery the ACL is not repaired instead, it is reconstructed using other ligaments in the body. There are three different types of ACL surgery. The first type is the patella tendon-bone auto graft is when the surgeon takes a piece of the patella tendon and uses it to reconstruct the new ACL tendon. The second type is hamstring tendon auto graft this is when the surgeon uses two tendons from the back of the knee and doubles them to become the new ACL tendon. The third type is when tissue is taken from a cadaver to for the new ACL. Patella tendon-bone auto graft and hamstring auto graft are the most common and preferred because it produce the best results. After the surgery, rehabilitation is required in order to strengthen the surrounding muscles and stabilize the joint.

After one week of surgery on the ACL, a rehabilitation routine is developed with the physical therapist. It is recommended that the patient engage in ten weeks or twenty sessions of physical therapy for complete recovery. A couple of weeks after the surgery the physical therapist are focused on decreasing pain and swelling by improving the range of motion and strengthening muscle activity. The third or fourth week after surgery the physical therapy is focused on promoting joint protection and more exercises are performed during these weeks. Bending and straightening of the knee in the pool along with walking is incorporated into the rehabilitation routine. The stair master in a sitting positions helps strengthen the surrounding muscles of the knee joint. Mini wall squats at a 45 degree angle are important along with Balance activities. During the sixth week, walking or moving from one place to another is the most important. The development of motion among the patient is accomplished through getting the knee to bend from zero to 130 degrees along with single leg mini squats, step ups and downs with a four to eight inch block, and exercises to strengthen the gastrocnemius. The eighth week moderate exercises are performed because the main focus is gaining full range of motion of the knee and this is done by increasing the resistance of previous exercises. The final week of rehabilitation the patient engage in light activities the main focus is on strengthening of the quadriceps and hamstring and mobility. After these ten weeks of rehabilitation, the patient should be able to perform the same activities prior to the injury with the same ease. —Preceding unsigned comment added by Kjnavalta (talk • contribs) 16:51, 4 June 2010 (UTC)

References

Gender differences

Have just moved a great wall of text from "Evolution" (??!?) down to the bottom. Needs a big pruning, but at least it's now sitting in a logical place under a sensible heading. Snori (talk) 05:33, 22 September 2015 (UTC)

2011 Rview

[1] --Doc James (talk · contribs · email) 06:27, 14 December 2011 (UTC)

Work plan to edit “ACL tear” for WikiProject Medicine

My planned edits for the month are by section, as follows:

Intro: improve evidenced-based information in lead paragraphs, especially clarifying most common mechanisms of injury.
1 Signs and symptoms: Will add content and edit for shorter sentence structure.
2 Causes: I may re-conceptualize this section to make it more digestable to a lay audience and focus on specific risk factors. Also, I will clarify role of Q angle in injury; replace diagrammatic photo of ACL tear; fix anatomical photos to match leg sides, per scientific convention.
2.1 Ligament dominance: clarify valgus stress
2.2 Quadriceps dominance: explain why this phenomenon increases risk of tear
2.3 Trunk and leg dominance: explain why this phenomenon increases risk of tear
3 Diagnosis: increase references in this section; add radiographs before MRI; add concept of “bone bruising” as a common finding on MRI
4 Prevention: add new evidence to this section about ACL tear prevention, especially in young athletes and women
5 Treatment: this section is good but has minimal references; I will add in references and edit for grammar and structure.
5.1 Conservative
5.2 Surgery
5.3 Rehabilitation
6 Gender differences: this section relies on a single study and is given a large amount of space in the article for its relevance. I will re-conceptualize this section and consider incorporating key points into the above section on “Cause”
6.1 Hormonal Differences: update this section with current evidence, or combine with the above
6.2 ACL, muscular stiffness and strength: same
7 References: ensure all current references are current, relevant

In addition to the above edits, I will 1) edit the info box in the upper right corner to match the style of other disease pages, e.g. hepatitis 2) add a “Prognosis” section 3) add an “Epidemiology” section 4) add a “Special populations” section for pediatric ACL tear, focusing on increase in youth athlete injury

Jhandcox (talk) 16:06, 28 November 2016 (UTC)

Peer Review for Jordan, by Ranvir

Overall I feel that you did a great job with the article! It hits on all the points I was looking to learn about before reading it and then some. There are a lot of technical terms and concepts in the article for a layperson and I like how you explained and simplified them. Here are the areas I see for potential improvement.

Lead-in section: I wonder if the “unhappy triad” paragraph can be moved into the body of the article as it is not a major point that is discussed much afterwards. Maybe with the second paragraph in treatment where associated injuries are mentioned or in the diagnosis section?

Signs and symptoms: This is the only section I was hoping for some more info. Questions that just popped into my head are: how painful is it usually and can it often be painless, is it usual for people to still bear weight and walk afterwards, how quickly does it swell up, tenderness and range of motion in the knee?

Causes: Helpful to have a citation in the section

Hormonal and anatomic differences: Image of Q angle can help clarify further exactly what this looks like.

Diagnosis: Image of the tests could be helpful but I realize the links for those have something so don’t feel strongly about it. I’m also wondering about ACL sprains and what overlap they have with the presentation with an ACL tear. There is also some overlap with this section and the signs and symptoms section but didn’t find that problematic.

Conservative: What sort of long-term effects occur after just taking the conservative route and are their limitations on activities. Also, could possibly add citation in this section.

Readability and References: I felt like it was easy to follow with the use of simple terms and simple sentences whenever possible, especially given how technical it gets at times. Also felt like you added reliable references throughout the article.

Overall, great job! — Preceding unsigned comment added by Randhillon (talk • contribs) 17:15, 14 December 2016 (UTC)

Support for text about OA

"After a complete ACL tear, some patients are unable to participate in cutting or pivoting-type sports, while others have instability during even normal activities, such as walking. There are some rare individuals who can participate in sports without any symptoms of instability."

than it says

"Secondary damage may occur in patients who have repeated episodes of instability due to ACL injury. With chronic instability, up to 90 percent of patients will have meniscus damage when reassessed 10 or more years after the initial injury. Similarly, the prevalence of articular cartilage lesions increases up to 70 percent in patients who have a 10-year-old ACL deficiency"

This is OA. Test is paraphrased as is required. Doc James (talk · contribs · email) 18:36, 24 January 2018 (UTC)

Nowhere in that text is claimed that the ACL reconstruction surgery changes this. I'm not disputing the increase in patients who have ACL deficiency. But the OA prevalence might increase 70 percent in all cases after ACL injury, with the surgery or without it. The words "without surgery" are not supported by citation and can mislead readers to think that the surgery reduces OA probability (what it might do or might not). jni ^(delete)_{...just not interested} 19:08, 24 January 2018 (UTC)

Workplan to Edit "Anterior cruciate ligament injury" for UCSF WikiProject Medicine

My planned edits for the month are by section, as follows:

OVERALL - edit sections in order to follow one of the "model" orthopedic-related articles (osteochondritis dissecans). The new sections will be: signs/symptoms, causes, diagnosis, treatment, prognosis, epidemiology, notable cases, references.

Intro: expand section to provide an organized summary of the information presented in the article; add a brief description of the anatomy/role of the ACL 1 Signs and symptoms: simplify terminology and update content 2 Causes: This new section will discuss the mechanism by which ACL injury occurs, and also absorb several previous sections (ligament/quads/trunk and leg dominance, prevention) 3 Diagnosis: provide explanations of the various exam maneuvers; remove section on laximetry 5 Treatment: briefly explain procedures and differences in grafts; change subsections to non-surgical vs surgical, include rehabilitation subsection 6 Prognosis: create brief new section regarding outcomes of nonsurgical vs surgical management 7 Epidemiology: include updated incidence, expand with more demographics (gender, age, etc). Include special populations here as a subsection 8 Notable cases: add section 7 References: ensure all current references are current, relevant — Preceding unsigned comment added by [[User:UCSFMS3T (talk) 10:41, 25 March 2018 (UTC)UCSFMS3T|UCSFMS3T]] (talk • contribs) 01:02, 7 March 2018 (UTC)

Significant

"

• Derrick Rose, American basketball player
• Adrian Peterson, American football player
• Gale Sayers, American football player"

What effect has these cases had on the history of the condition in question? Doc James (talk · contribs · email) 05:45, 22 March 2018 (UTC)

User:UCSFMS3T can you comment here please. Doc James (talk · contribs · email) 03:10, 25 March 2018 (UTC)

Hello! My initial motivation to add a section on "Notable Cases" was that the Model article upon which I structured the organization of this (Osteochondritis Dissecans) had a notable cases section. I felt it was helpful to put those cases in context and give people a concrete example of an individual they may have heard about with a certain condition. I added the following preamble to the section to explain the importance of this section:

"ACL injury frequently receives attention in the media when professional athletes rupture their ACL, as it is often a season- or career-ending injury. There is a great range of recovery for these athletes, with some returning at a better-than-expected level of play, and others suffering multiple injuries following their ACL tear. Some of the most famous cases of ACL tears include: - Derrick Rose, American basketball player - Adrian Peterson, American football - Gale Sayers, American football" UCSFMS3T (talk) 10:40, 25 March 2018 (UTC)UCSFMS3T

References

WP:MEDMOS

We do not tend to use the term "suffer".

Also we do not tend to use the term patient.Doc James (talk · contribs · email) 22:38, 23 March 2018 (UTC)

Anatomy

Per WP:MEDMOS the first section is not "anatomy". Generally for disease related articles we discuss anatomy under pathophysiolopy. Doc James (talk · contribs · email) 08:27, 27 March 2018 (UTC)

WikiMed peer-review

Hello, I am in the WikiMed course at UCSF doing a peer- review for UCSFMS3T. Initially this article was rated C-class and high importance so I am glad you have made your edits to improve it. I had the chance to review it briefly before and now looks much better. Great job!

Some suggestions: Lead: They may also experience instability in the knee when they resume daily activities, such as walking, since their ligament can no longer stabilize the knee joint and keep the tibia from sliding forward

Causes: Would it be helpful to add arrows to image to show the forces that lead to how the ACL injury occurs?

Female predominance: Great Q angle picture! Really helped me understand. The theory section is a little wordy. I’m wondering if subheadings would be helpful.

Treatment: Very long run-on sentence, I’d cut it up. Also, currently it says its “suggested for individuals who are not highly active or engage in sports that cutting and twisting motions..” Is this correct?? Wouldn’t nonsurgical be for people who DO NOT engage in sport that have cutting and twisting motion Overall, great improvements. I think that there are several paragraphs that could benefit from some bullets in order to make it easier for the reader. For example, the manual test and classification sections.

Let me know if you have any questions. Joanalo44 (talk) 19:23, 27 March 2018 (UTC)Joanalo44

epidemiology peer-review

Why is the epidemiology section so short then the subcategory of youth injuries? I think that it needs to have more information on it.-sharksfan26

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