Case outline

Meniscus and ACL Injury 
Case Study: Leewan Yomen 

What happened?

            Our case study is about a 42-year-old woman who injured her knee while teaching a tumbling class at a dance studio. This woman is a former gymnast and is moderately athletic. While demonstrating how to land and transition into a twisting move, her knee popped. She was not able to put any pressure on her leg and was in extreme pain. Her leg immediately began to swell and was sensitive to the touch. She was admitted to the emergency room.

           Emergency room Doctors requested x-rays of both lower extremities, to view any                    discrepancies. No fractures or breaks were noted. The woman was prescribed Hydrocodone/acetaminophen and told to take ibuprofen. She was given a full leg brace to keep the leg stable and crutches to support her weight. She was advised to see her family Dr. within 24 hours, and she was released.

           Her family Dr. was seen the following day. He ordered MRI of the right knee to see the ligaments. The ACL was completely torn, and the Meniscus tear was visible. The woman was referred to a sports medicine specialist.

The sports medicine specialist scheduled a surgery after a review of her case. He recommended arthroscopic surgery, due to the torn ACL not healing itself. An arthroscopic surgery is a minimally invasive surgical procedure that allows most patients to return home several hours after surgery.

                                

An anterior cruciate ligament (ACL) injury 
The over stretching or tearing of the ACL in the knee. ACL is one of the key ligaments that help stabilize your knee joint. The ACL connects your thigh bone (femur) to your shinbone (tibia). It's most commonly torn during sports that involve sudden stops and/or changes in direction. ACL injuries are one of the most common knee injuries among athletes. According to the American Orthopedic Society for Sports Medicine, about 150,000 ACL injuries occur in the United States every year. Also, according to the American Academy of Orthopedic Surgeons, about 70 percent of ACL injuries in athletes happen through mechanisms such as pivoting, cutting, sidestepping, out of control play or awkward landings, while about 30 percent of ACL injuries occur from contact with other players. This information is taken from Live Strong.

          

A meniscus tear injury 
This occurs when its structural integrity is compromised and the fibrocartilage that makes up the meniscus tears, breaks, cracks, ruptures, or splits. These injuries are caused by a combination of axial loading and rotational forces that create a shearing force on the meniscus. A meniscus tear usually occurs with an ACL injury.

            The meniscus are crescent shaped pads of fibrocartilage between the femoral condyles and tibial plateaus that help with load distribution, knee stabilization during rotation, and lubrication of the knee joint, it also helps to absorb shock so our bone surfaces are not damaged. The medial and lateral menisci attach to their corresponding lateral collateral ligaments with the medial meniscus attached more rigidly than the lateral meniscus.

            Knee meniscal injuries are common with an incidence of 61 cases per 100,000 persons and a prevalence of 12% to 14%. There is an increased incidence of meniscal tears with anterior cruciate ligament (ACL) injury ranging from 22% to 86% in the US, of the estimated 850,000 cases per year, 10% to 20% of orthopedic surgeries involve surgical repair of the meniscus. This information is taken from PM&R Knowledge now.

Surgery

Arthroscopy is a type of surgical procedure that surgeons use to look within a joint and diagnose and treat problems within a joint. Arthroscopy is done by making a small incision in the skin and sticking a small pencil-sized instrument with a lighting system and lens. Surgeons look at what’s inside the joint by using a miniature television camera, which is hooked up to the arthroscope. Arthroscopy is necessary because the diagnoses that are made can sometimes be more accurate than X-ray studies or “open” surgery. Recovering from arthroscopy is much more easy than recovering from “open” surgery, though arthroscopy still requires use of a general, spinal, or a local anesthetic, and special equipment in a hospital operating room. With this procedure the ligament must be replaced because they could not reattach existing ACL. ACL once torn cannot regenerate or repair itself. The replacement ligament is harvested from a corpse or from the person’s own tissue (autograft). Using your own tissue reduces the chance of your ACL to rupturing again. The thigh or the vastus medialis is the newest place to harvest tissue and has been proven to have high success rate and less chance of re injure over time.

The vastus medialis muscle is a part of the quadriceps muscle group, located on the front of the thigh. It is the most medial, or inner, of the quadriceps muscles. It extends the entire length of the thigh. The portion of the muscle that is just above the knee is sometimes referred to as the vastus medialis obliquus, or VMO. This muscle is used to extend the leg at the knee and to stabilize the patella or kneecap.

RecoveryFive days after surgery

The small incision that the instrument (arthroscopy) goes into skin will take several days to weeks to heal. Patient advice on gaining full mobility of leg through stretches demonstrated by physical therapist. Massaging scars will be painful but will lesson scar tissue intrusion of leg mobility. Scar tissue build up will interfere with gaining full mobility long term. Patient should visit Physical therapy three times a week for the best results. Stationary bike and band work to gradually strengthen muscles will be gradually added as mobility increases. ACL and Meniscus will take a minimum of 3 months to heal. Full recovered estimated to take one year if the patient continues with recommended treatment plan.

3 month after surgery

Sources:

North Bay Healthcare, Robert Peterson, MD

https://www.northbay.org/doctors/our-doctors/phys977.cfm

Live Strong Statistics on ACL Injuries in Athletes

ERIN COLEMAN, R.D., L.D.

PM&R Knowledge NOW Article on MENISCUS INJURIES OF THE KNEE https://now.aapmr.org/meniscus-injuries-of-the-knee/