Anterior Cruciate Ligament and Meniscus Repair Rehabilitation
For the Collegiate Athlete
Gary Johnson SPT, ATC, LAT, CSCS
Overview
Anterior Cruciate Ligament reconstruction and meniscus repair are subjects that I have first hand experience with. I have had 6 knee surgeries involving ACL reconstruction, meniscus repair, meniscectomy, micro-fracturing as well as other ligament reconstruction. I have the scars to prove it.
Pictured above is my right knee, with scars from 2 ACL reconstructions, an MCL reconstruction, meniscus repair, and micro-fracture surgery.
Given my personal experience rehabilitating myself and others with these 2 common knee injuries as an athletic trainer and physical therapy student, I decided to focus my Capstone project on the anatomy & physiology, injury, healing and treatment of post-operative ACL reconstruction and meniscus repairs. I decided to present my Capstone to students and staff members in the sports medicine department of my alma mater North Carolina Central University (NCCU). The NCCU athletic training and exercise sports science majors, as well as certified athletic trainers, will find this information very relevant to the athletes they see daily in a college sports medicine environment.
Some information on ACL and Meniscus injuries23,24:
- The ACL is the most commonly injured knee ligament with approximately 100,000 to 200,000 ruptures a year in the United States.
- The majority of ACL injuries are non-contact, especially in the female population, which
has a higher predisposition to the injury. - The NCAA injury surveillance system states that American football has the highest ACL injury rate among collegiate athletes (33%).
- The meniscus is the most commonly injured tissue in the knee, and accounts for approximately 750,000 surgeries a year in the United States.
- Meniscus injuries can either be acute-traumatic or chronic-degenerative.
- The C-shaped medial meniscus is less mobile and more susceptible to injury than the O-shaped lateral meniscus.
Products
I presented to a group of approximately 30 NCCU students, 5 members of the NCCU sports medicine faculty, and 5 staff members from the outpatient PT clinic I work at part-time. My presentation focused on the anatomy and function of the ACL and menisci, how the tissues are injured, how they heal after surgical intervention, and a general rehabilitation time-line with goals, precautions and interventions. To view a more interactive version of my presentation with videos click here. (Note: if videos do not play on your computer, clink the link below each video in the slide notes to watch). Enjoy!!
I also wrote a paper for those that were interested in my Capstone topic, but could not attend my presentation, or feel a written document is more beneficial to their learning style.
Evaluation and Reflection
After my presentation I asked the participants in attendance to fill out a brief paper survey. The survey comments can be viewed here.
Overall, I am please with my Capstone project, I feel as though I presented relevant information to my audience. I felt proud that I was able to go back to my college alma mater and present to the current students and staff. It is something I hope I get to do again.
Acknowledgments
I’d like to thank Elizabeth Jewell, who has helped me through every step of my clinical education and career, and who made it possible for me to present to NCCU faculty and students. I would also like to thank Nate Kauk, who has helped me along the path to becoming a physical therapist, as early as the graduate admissions phase. A special thanks to Hannah Smith who I only met this past year, but agreed to assist me with this Capstone, and who has given me valuable professional advice as I approach becoming an entry level therapist. As my Capstone committee your feedback and guidance was invaluable. Thank you to Mike Gross for being an excellent Capstone advisor, your feedback made things a lot clearer and easier. Also, an additional thank you to Mike for the awesome advanced orthopedics class in which I gained a new level of understanding in knee anatomical function, which translated into great information for my Capstone.
References
- Duthon et al. Anatomy of the anterior cruciate ligament. Knee Surg Sports Traumatol Arthrosc. 2006; 14: 204-213.
- Krossgard MR, Dyhre-Poulsen P, Fischer-Ramussen T. Cruciate ligament Reflexes. Journal of Electromyography and Kinesiology. 2002; 12: 177-182.
- Chivers MD, Howitt SD. Anatomy and physical examination of knee menisci: a narrative review of orthopedic literature. JCCA. 2009; 53(4): 319-333.
- Gross MT. Meniscal fibrocartilage: composition, structure, function, mechanical properties, and healing. [PowerPoint – Voice thread]. University of NC Chapel Hill DPT; 2014.
- LaBella CR, Hennrikus W, Hewett TE. Anterior cruciate ligament injuries: diagnosis, treatment, prevention. Pediatrics. 2014; 133(5): 1437-1450.
- Hauser RA, Dolan EE. Ligament injury healing: an overview of current clinical concepts. Journal of Prolotherapy. 3(4): 836-846.
- Kiapour AM, Murray MM. Basic science of the anterior cruciate ligament injury and repair. BJR. 3(2): 20-31.
- Pinczewski LA et al. A 10-year comparison of anterior cruciate ligament reconstructions with hamstring tendon and patellar tendon autograft: a controlled, prospective trial. AJSM. 2007; 35(4): 564- 574.
- Goldblatt JP, Fitzsimmons SE, Balk E, Richmond JC. Reconstruction of the anterior cruciate ligament: Meta-analysis of patellar tendon versus hamstring tendon autograft. The Journal of Arthroscopic and Related Surgery. 21(7): 791-803.
- Schmidt T et al. Sterilization with electron beam irradiation influences biomechanical properties of and the early remodeling of tendon allografts for reconstruction of the ACL. Cell Tissue Bank. 2012; 13: 387-400.
- van Grinsven S, van Cingel REH, Holla CJM, van Loon CJM. Evidence-based rehabilitation following anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc. 2010;18: 1128-1144.
- Fu FH, Bennett CH, Lattermann C, Ma CB.Current trends in anterior cruciate ligament reconstruction. Part 1: Biology and biomechanics of reconstruction. American Journal of Sports Med. 27(6): 821-830.
- Chen CH. Graft healing in anterior cruciate ligament reconstruction. Sports Medicine, Arthroscopy, Rehabilitation, Therapy & Technology. 2009; 1: doi:10.1186/1758-2555-1-21.
- Muller B, Bowman KF, Bedi A. ACL graft healing biologics. Clin Spors Med. 2013; 32: 93-109.
- Janssen RP, Scheffler SU. Intra-articular remodeling of hamstring tendon grafts after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc. 2014; 22: 2102-2108.
- Smigielski R et al. Medial meniscus anatomy-from basic science to treatment. Knee Surg Sports Traumatol Arthrosc. 2015; 23: 8-14.
- Haklar U et al. Results of arthroscopic of partial or full thickness longitudinal medial meniscus tears by single or double vertical sutures using the inside-out technique. Am J Sports Med. 2013; 41(3): 596-602.
- Noyes FR, Heckmann TP, Barber-Westin SD. Meniscus repair and transplantation: a comprehensive update. JOSPT. 2012; 42(3): 274-290.
- Brindle T, Nyland J, Johnson DL. The meniscus: review of basic principles with application to surgery and rehabilitation. Journal of Athletic Training. 2001; 36(2): 160-169.
- Petersen W et al. The effect of locally applied vascular endothelial growth factor on meniscus healing: gross histological findings. Arch Orthop Trauma Surg. 2007; 127: 235-240.
- Kawamura S, Lotito K, Rodeo SA. Biomechanics and healing response of the meniscus. Operative Techniques in Sports Medicine. 2003; 11(2): 68-76.
- Baechle TR & Earle RE. Essentials of strength training and conditioning 3rd ed. Champaign, IL: Human Kinetics; 2008.
- Friedberg RP. ACL injuries. In: UpToDate, Post TW (Ed), UpToDate, Waltham, MA. Accessed: 02/22/2015. uptodate.com.
- Anderson BC. Meniscus injury of the knee. In UpToDate. Post TW (Ed), UpToDate, Waltham, MA. Accessed : 02/23/2015. uptodate.com.
- Hacke J. The Knee Joint: examination/intervention. [PowerPoint]. UNC Chapel Hill: UNC-DPT; 2013.
- Quatman CE, Hewett TE. The anterior cruciate ligament injury controversy: is valgus collapse “a sex-specific” mechanism? Br J Sports Med. 2009; 43(5): 328-335.
- Lyons ME. Isokinetic hamstring: quadriceps strength ratio in males and females: implications of ACL injury .2006; 64: 1-14.
One Response to “Anterior Cruciate Ligament and Meniscus Repair Rehabilitation For the Collegiate Athlete”
Michael Gross
Gary- Looks like you put a lot of good effort into this. I am sure that you and the recipients of your presentation benefitted greatly form all of that work. There are just a few things that could have improved your work:
a. You do not have any references on any of the slides in your power point, only a list at the end.
b. Your paper indicates that the ACL-R Rehab protocol comes from multiple sources, but you have only one reference, number 11, to support the information in the table.
c. Figures probably could have helped what you were trying to convey in the paper.
All in all, this capstone accomplished what you had wanted from it. Good job. Best regards, Mike Gross