JOSEPH NOAH, M.D. SUNCOAST ORTHOPAEDIC SURGERY AND SPORTS MEDICINE.
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Transcript of JOSEPH NOAH, M.D. SUNCOAST ORTHOPAEDIC SURGERY AND SPORTS MEDICINE.
ACL ANATOMY
TWO BUNDLE LIGAMENT (ANTEROMEDIAL AND POSTEROLATERAL)
ORIGINATES FROM FEMUR AND INSERTS ONTO TIBIA
HIGHLY INNERVATED AND VASCULAR
ACL FUNCTION
ESSENTIAL FOR NORMAL KNEE FUNCTION
PREVENTS EXCESSIVE ANTERIOR TRANSLATION AND ROTATION OF THE TIBIA ON THE FEMUR
PREVENTS EXCESSIVE HYPEREXTENSION
SECONDARY RESTRAINT TO VALGUS/VARUS STRESS
ACL INJURIES AS MANY AS 200,000
INJURIES OCCUR ANNUALLY
CAN OCCUR IN BOTH WITH CONTACT AND NONCONTACT SPORTS
INJURY RATES SHOW A SIGNIFICANT GENDER DISPARITY ESPECIALLY IN NONCONTACT INJURY
ACL INJURIESCONTACT
HYPEREXTENSION INJURY
ASSOCIATED MORE WITH COLLISION SPORTS
REQUIRES A LOAD APPLIED TO A PLANTED FOOT
ASSOCIATED WITH A HIGHER RATE OF MULTIPLE STRUCTURE (LIGAMENT) DAMAGE
ACL INJURIESCONTACT
VALGUS COLLISION
NO EFFECTIVE BRACING TECHNIQUE
NO EFFECTIVE EXERCISE OR PREVENTATIVE PROGRAM ESTABLISHED
NOT PART OF THIS DISCUSSION
ACL INJURIESNONCONTACT
HYPEREXTENSION/ ROTATIONAL FORCE
VALGUS/ROTATIONAL FORCE
DECELERATION INJURY SEEN MORE IN
FEMALE ATHLETES
ACL INJURY STATS 46,000 GIRLS 19 YRS
AND YOUNGER IN 2006 (CDC).
GIRLS 8X AS LIKELY TO INJURE ACL
GIRLS UNDER 14 HAVE 5X RATES OF TEARS COMPARED TO BOYS
70% OF INJURIES WERE NONCONTACT
ACL INJURIESWHY SHOULD WE CARE?
SIGNIFICANT INJURY SURGICAL
RECONSTRUCTION OFTEN REQUIRED
LENGTHY REHABILITATION
POSSIBLE LONGTERM DAMAGE (POST TRAUMATIC ARTHRITIS)
ACL INJURYINTERNAL FACTORS
SMALLER FEMORAL NOTCH (SMALLER ACL)
WIDER PELVIS (INCREASE IN “Q” ANGLE)
HORMONAL FACTORS QUAD/HAMSTRING
RATIO NERVE AND MUSCLE
COORDINATION FOOT PRONATION
ACL INJURYEXTERNAL FACTORS
ATHLETE BEING DISTRACTED OR BUMPED JUST BEFORE DECELERATION OR LANDING
WOMEN RUN AND CUT IN A MORE ERECT POSTURE (KEEPS KNEE MORE EXTENDED)
HIPS BEHIND KNEES LANDING FROM A JUMP
ACL INJURYPREVENTION
ACL PREVENTION PROTOCOL ESSENTIAL FOR THE FEMALE ATHLETE EVEN AFTER INJURY
INCREASED RATE OF REINJURY AFTER RECONSTRUCTION
20% INJURY RATE TO THE CONTRALATERAL KNEE
CAN ALSO BE EFFECTIVE FOR MALE ATHLETES
HELPS PREVENT NONCONTACT INJURIES
NO IMPACT ON CONTACT INJURIES
ACL PREVENTIONGOALS OF PROGRAM
AVOIDING VULNERABLE POSITIONS
LEARNING HOW TO FALL INCREASING FLEXIBILITY INCREASING STRENGTH PLYOMETRIC EXERCISES
IN TRAINING INCREASING
PROPRIOCEPTION
ACL INJURY PREVENTION PROGRAM
PERFORMED 2-3/WK DURING SEASON
WARM UP STRETCHING STRENGTHENING PLYOMETRICS SPORTS SPECIFIC
AGILITY TRAINING COOL DOWN
ACL INJURY PREVENTION PROGRAM
WARM UPS STRETCHING
JOG LINE TO LINE SHUTTLE RUN (SIDE
TO SIDE) BACKWARDS RUN
CALF STRETCH QUAD STRETCH HAMSTRING STRETCH ADDUCTOR STRETCH HIP FLEXOR STRETCH
ACL INJURYPREVENTION PROGRAM
GENERAL EXERCISES
WALKING LUNGES RUSSIAN HAMSTRINGS SINGLE TOE RAISE LATERAL HOPS OVER
CONE OR BALL FORWARD/BACKWARD
HOPS SINGLE LEG HOPS
OVER CONE
ACL INJURYPREVENTION PROGRAM
PLYOMETRIC EXERCISES SHOULD BE INCLUDED IN WORK OUT.
EXPLOSIVE EXERCISES DESIGNED TO BUILD POWER, STRENGTH AND SPEED
IMPORTANCE IS ON LANDING TECHNIQUE
IT MUST BE SOFT
ACL INJURYPREVENTION PROGRAM
SPORTS SPECIFIC EXERCISES
VERTICAL JUMPS WITH SPORTS SPECIFIC ACTIVITY (HEADER, CATCHING A BALL)
SQUATTING (HIPS BACKWARDS AS IF SITTING)
SCISSOR JUMPS LUNGES DIAGONAL RUNS BOUNDING RUNS
ACL INJURY PREVENTION PROGRAM
COOL DOWN IMPORTANT, SO DON’T
SKIP ALLOWS MUSCLES TO
ELONGATE AND DETERS MUSCLE SORENESS
ACL INJURY PREVENTION PROGRAM
CAN SIGNIFICANTLY REDUCE RISK IN NONCONTACT ACL INJURIES (MORE IN WOMEN)
HELP PREVENT REINJURY AFTER ACL RECONSTRUCTION
REDUCE INJURY IN THE CONTRALATERAL LIMB