Anterior Cruciate Ligament Tear 1.

Definition An anterior cruciate ligament (ACL) tear is a partial or complete rent or laceration of the anterior cruciate ligament, one of the four main ligaments that connect the tibia to the femur. The anterior cruciate ligament stabilizes the knee and minimizes stress across the knee joint. Overstretching of this ligament is usually due to a sudden stop and twisting motion of the knee or a force to the anterior aspect of the knee. Instability of the knee joint is a major complaint following this injury. 2. Pathogenesis Movements of the knee that place a great strain on the ACL can damage this vital ligament. Hyperextension of the knee or straightening the knee more than ten degrees beyond its fully extended position can cause overstretching or tearing of the ACL. Pivoting injuries of the knee where there is excessive inward turning of the lower leg can also damage the ACL. Briefly, any athletic or non-athletic activity where the knee is forced into hyperextension and/or internal rotation can result in an ACL tear. 3. Complications If left surgically untreated, an ACL tear results in recurrent knee instability. This increases the risk of damage to the joint surface and menisci (cartilage) since the bones are rubbing against each other. This can lead to osteoarthritis. With surgical reconstruction complications are uncommon recurrent knee instability, graft rupture, numbness, bleeding, painful or abnormal scar formation, infection, fracture of kneecap or thigh bone, blood clots, nerve injury, persistent looseness of the knee, allergies and serious reaction to anesthesia, and stiffness or loss of motion comprise these uncommon post-surgical problems. 4. Problems brought by the medical diagnosis (ACL tear) include knee instability, swelling, pain, limited knee movement, damage to bone, cartilage, and the possible onset of osteoarthritis. 5. Nursing Interventions a) Pre-op Control of swelling and inflammation using rest, ice, compression, and elevation (RICE): rest the knee, put ice on it, apply elastic bandage to give gentle compression to the knee, and elevate the leg above the level of the heart. Use of simple analgesics, immobilization, and reassurance are also very helpful. b) Intra-op Nursing interventions intra-op center on maintenance of normal vital signs, prevention of possible contamination and infection, and promotion of hemostasis. c) Post-op Monitoring of airway patency and adequate gas exchange, hemostasis, deep-breathing exercises, pain alleviation, monitoring of vital signs, reassurance, and rehabilitative exercises. 6. References: a) Web MD - http://www.webmd.com/a-to-z-guides/anterior-cruciate-ligament-aclinjuries-topic-overview?page=2

b) E Health MD - http://www.ehealthmd.com/library/acltears/acl_whatis.html

c) MedlinePlus -http://www.nlm.nih.gov/medlineplus/ency/article/001074.htm#visualContent

d) Sports Injury Clinic http://www.sportsinjuryclinic.net/cybertherapist/front/knee/anteriorcruciate.htm e) Surgical Anatomy by Philip Thorek f) Current Surgical Diagnosis and Treatment