ACL REHABILITATION

difference) compared with the other leg, along with a soft, mushy or spongy end feel, not the usual sharp one equates to a positive test.

compared to the other knee, along with a soft, mushy or spongy end feel, not the usual sharp one indicates a positive test.

Figure 2: Lachman’s test

ANTERIOR DRAW TEST Another highly reliable test for assessing the relative degree of anterior tibial trans- lation. The knee is held in 90º flexion and the tibia is drawn anteriorly (Fig.3). Excessive translation (greater than 10mm)

PIVOT SHIFT TEST There are numerous variations on this test, which assesses the ACL’s ability to control internal tibial rotation and abduc- tion of the femur. The least traumatic ver- sion of the test is if the test is started in the extended position. The lower limb is held in extension just clear of the plinth, with the entire leg held in internal rota- tion. The examiner’s other hand applies a firm pressure against the lateral aspect of the knee, creating an abduction/valgus force, this is maintained as the knee is flexed (Fig.4). The test is positive if at about 30º of knee flexion the lateral

tibial condyle is felt to jerk forward. In the author’s opinion, the test should also be regarded as positive if the patient experiences apprehension and a feeling similar to the knee giving way, or if exces- sive hamstring muscle protective spasm occurs during the test manoeuvre.

ACL reconstruction Once a diagnosis of ACL rupture has been made the patient should not be rushed straight into surgery. It is now generally agreed that conservative physiotherapy/- exercise rehabilitation management should be tried first following an ACL injury. Most specialist knee surgeons are of the opinion that only if the patient is still affected by symptomatic instability after a period of rehabilitation should surgery still be considered. This is because if functional instability is not present, acceptable results will occur with conser- vative treatment (1).

The factors associated with success of conservative management of the ACL defi- cient knee are an absence of collateral ligament damage, meniscal injury or degenerative changes within the knee and the patient is returning to a low demand sport only.

Figure 3: Anterior draw test Figure 4: Pivot shift test

If a surgical repair of the ACL ligament is undertaken the most likely operation is