Case presentation

Post Reconsrtruction
ACL Injury
By: Nurdina afini izamudin
(031390)
diploma fisioterapi
unisza

PHYSIOTHERAPY AX.

Name:Mr. A
Age: 19 years old
Sex: Male
Date of referred:15. June 2014
Date of Ax.: 5.August.2014
Dr. : Lt. ACL tear and meniscus injury
Dr. Mx.:operative, post recon.(6 weeks ago)
conservative, refer physio

SUBJECTIVE Ax.
Problem: pt. c/o weakness Lt.
LL.
Pain scale: NIL
weaknes
s

 Current Hx.: h/o sudden stop and

change direction during playing
football since 2 years ago. Gradually
increase pain about 1 weeks and
went to HD then transfer to HSNZ on
the same day for further mx. Done
MRI. Dr. diagnosis Lt. ACL tear and
meniscus injury. Pt. refer for ACL
reconstruction. Done reconstruction
on June 2014. On braces for 2
weeks.Dr. refer him to physio for
further mx.
Past Hx.: NIL

 Special question:
Occupation:Student
House: Single storey house
currently stay at hostel.
Toilet: Squatting
Ix.:
X-ray/medication/MRI
Done 2 years ago before recon.
Result: Lt ACL tear and meniscus
injury.

 Fx. Activity
pt. difficult to climb up and walking
down stairs.
pt. feel week when prolong walking
and standing

OBJECTIVES Ax.
General observation: A medium size
Malay Male come to department
independantly. Normal gait. Normal
posture.
Local observation:
redness
dry skin
Lt. knee
swelling
ms. wasting at Lt. thigh

scar at ant. Part of Lt. knee (5 cm)

deformity at Lt.LL
open wound at Lt. LL
bruising at Lt. LL
Palpation:
increase in warmth at Lt. foot
tenderness Lt. LL

OBJECTIVES Ax.
General observation: A medium size
Malay Male come to department
independantly. Normal gait. Normal
posture.
Local observation:
redness
dry skin
Lt. knee
swelling
ms. wasting at Lt. thigh

 ROM:
Jt.

Movt.

AROM
Rt.

Hip

Kn.
Ank.

Flex.
Ext.
Abd.
Add.
Int. rot.
Ext. rot.
Flex.
Ext.
Dorsiflex.
Plantarflex.
Inversion
Eversion

AFROM of bilateral LL.

)
Lt.

PROM (
Rt.

)
Lt.

AFROM

AFROM

AFROM

AFROM

A
F
R
O
M

A
F
R
O
M

A
F
R
O
M

A
F
R
O
M

 Ms. power
Jt.
Hip

Kn.

Movt.
Flexor
Extensor
Abductor
Adductor
Int. rotator
Ext. rotator

Lt.

Rt.

} }
4

}4

Flexor
Extensor

Ank.

}5

Dorsiflexor
Plantarflex
or
ms. Power of Inversion
Rt. LL d/t prolong immobilised
Eversion

 Ms. girth
From
suprapatte
la
Vastusmed
ialis (5
cm)
Quadricep
s (10 cm)
Harmstrin
g (15 cm)

Rt.(cm)

Lt.(cm)

42

38

45

42

47

43

ms. wasting of Rt. thigh d/t lack of activity

(cm)

ANALYSIS
Problem identification:
1. ms. Power of Lt. LL d/t prolong
immobilised
2. ms. wasting of Lt. thigh d/t lack of
activity
3. Functional activity d/t ms.
weakness.

 Short term goal

1. ms. power of Lt.LL within 3/52
2. ms. wasting of Lt. thigh within 3/52

 Long term goal

1. To regain functional activity
2. To maintain endurance

PLAN OF TX.
1.
2.
3.
4.

Strengthening exs.
Jt. sense
HEP
Pt. education

Intervention
Strengthening exs.
pt. sitt., quad bench exs. (1 kg) at
Lt. quad, kn.ext., hold 10 sec, 15
rept. 3 set.
pt. high. sitt., theraband (yellow)at
Lt.foot, dorsiflex., hold 10 sec, 15
rept.
pt.high. sitt., theraband (yellow) at
Lt.foot,plantarflex., hold 10 sec, 15
rept.
Cycling exs., 20.

Jt. Sense exs.

pt. stand.on wobbleboard, 15.
HEP
Give exs. pamplet to pt.
Ask pt. to do all prescribe exs. at
home
Pt. education

EVALUATION
pt. give cooperation to do all exs.
pt. feel increase strength of Lt. LL.
Pt. feel light of Lt. LL compare to
before exs.

REVIEW
review
Review ms. girth of Lt. thigh on next
tx.
Repeat intervention on next tx.

Follow up
Name: Mr. A
Date of Ax.: 19. August. 2014
S: Problem: pt. c/o weakness Lt.
LL.

OBJECTIVES Ax.
General observation: A medium size
Malay Male come to department
independantly. Normal gait. Normal
posture.
Local observation:
redness
dry skin
Lt. knee
swelling
ms. wasting at Lt. thigh

scar at ant. Part of Lt. knee (5 cm)

deformity at Lt.LL
open wound at Lt. LL
bruising at Lt. LL
Palpation:
increase in warmth at Lt. foot
tenderness Lt. LL

 ROM:
Jt.

Movt.

AROM
Rt.

Hip

Kn.
Ank.

Flex.
Ext.
Abd.
Add.
Int. rot.
Ext. rot.
Flex.
Ext.
Dorsiflex.
Plantarflex.
Inversion
Eversion

AFROM of bilateral LL.

)
Lt.

PROM (
Rt.

)
Lt.

AFROM

AFROM

AFROM

AFROM

A
F
R
O
M

A
F
R
O
M

A
F
R
O
M

A
F
R
O
M

 Ms. power
Jt.
Hip

Kn.

Movt.
Flexor
Extensor
Abductor
Adductor
Int. rotator
Ext. rotator

Lt.

Rt.

} }
4

}4

Flexor
Extensor

Ank.

Dorsiflexor
Plantarflex
or
ms. Power of Inversion
Rt. LL d/t lack of exercise.
Eversion

}5

}
5

 Ms. girth
From
suprapatte
la
Vastusmed
ialis (5
cm)
Quadricep
s (10 cm)
Harmstrin
g (15 cm)

Rt.(cm)

Lt.(cm)

42

39

45

43

47

44

ms. Wasting of Lt. thigh d/t lack of activity

(cm)

ANALYSIS
Problem identification:
1. ms. Power of Lt. LL d/t lack of
exercise
2. ms. wasting of Lt. thigh d/t lack of
activity
3. Functional activity d/t ms.
weakness.

 Short term goal

1. ms. power of Lt.LL within 3/52
2. ms. wasting of Lt. thigh within 3/52

 Long term goal

1. To regain functional activity
2. To maintain endurance

PLAN OF TX.
1.
2.
3.
4.

Strengthening exs.
Jt. sense
HEP
Pt. education

Intervention

Strengthening exs.
pt. sitt., quad bench exs. (1.5 kg) at Lt.
quad, kn.ext., hold 10 sec, 15 rept. 3
set.
pt. high. sitt., theraband (yellow)at
Lt.foot, dorsiflex., hold 10 sec, 15 rept.
pt.high. sitt., theraband (yellow) at
Lt.foot,plantarflex., hold 10 sec, 15
rept.
Squatting exs., hold 10 sec, 10 rept.
3 set.
Cycling exs., 20.

Jt. Sense exs.

pt. stand.on wobbleboard, 15.
HEP
Ask pt. to do all prescribe exs. at
home aggrisevly.
Pt. education

EVALUATION
pt. give cooperation to do all exs.
pt. feel increase strength of Lt. LL.
Pt. feel light of Lt. LL compare to
before exs.

REVIEW
review
Review ms. power of Lt. thigh on
next tx.
Repeat intervention on next tx and
add more aggressive exs.

REFERENCES
http://www.sportsinjuryclinic.net/
http://emedicine.medscape.com/
John Crawford Adams, David
Hamblen(1999). Outline of Fractures
including joint injuries, Eleventh
Edition, CHURCHILL LIVINGSTONE.