GRADE III – COMPLETE TEAR OF THE ANTERIOR CRUCIATE LIGAMENT (ACUTE)

MEKANISME KECEDERAAN

 Berhenti mengejut sewaktu larian deras dan menukar arah secara tiba- tiba.
 Lompatan dan mendarat yang tidak stabil.
 disebabkan pergerakan kaki yang berpusing ketika tapak kaki sedang berpijak di tanah
(implanted foot). Ini dikenali sebagai ‘pivoting injury’. Tidak kurang juga pesakit yang
mengalami masalah ini akibat kemalangan jalanraya

SYMPTOMS

 Bunyi "pop" yang terdengar atau perasaan sesuatu yang muncul di lutut anda.

 Kesakitan yang teruk

 Tidak dapat meneruskan aktiviti yang anda lakukan.

 Kaki yang tercedrah tidak dapat menampung berat badan.

 Bengkak pada lutut dalam beberapa masa

 Julat pergerakan terhad pada kaki yang terkena (tidak dapat menekuk lutut).

MATLAMAT REHABILITASI
A) Matlamat jangka pendek
 Mengawal kesakitan dan bengkak
 Menjaga lutut 
 Melakukan latihan julat pergerakan

B) Matlamat jangka panjang

 Kembalikan julat pergerakan normal
 Mengurangkan risiko kecederaan semula
 Mengelakan pengecutan otot-otot quadriceps
 Meningkatkan kekuatan otot yang mencukupi untuk berjalan normal dan ADL
 Kembali berlatih dan bersukan

STRATEGI INTERVENSI

Week 1

 Regular icing and elevation are used to reduce swelling. The goal is full extension and
70 degrees of flexion by the end of the first week. The use of a knee brace and
crutches are imperative.

 Multidirectional mobilizations of the patella should be included for at least 8 weeks.

Other mobilization exercises in the first 4 weeks are passive extension of the knee
 (no hyperextension) and passive and active mobilization towards flexion.
Strengthening exercises for the calf muscle, hamstring and quadriceps (vastus
medialis) can be performed.

Week 3-4

 The patient must try to genuinely increase the stance phase in an attempt to walk
with one crutch. With good hamstring/quadriceps control, the use of crutches can be
reduced earlier.

Week 5

 The use of the knee brace is progressively reduced. Passive mobilizations should
normalize motility but flexion should not yet be thorough. 9 Tonification of
hamstrings and quadriceps (vastus medialis) can start in close chain exercises. The
exercises should be started on light intensity (50% of maximum force) and
progressively increased to 60-70%. The closed chain exercises should be built from
less responsible positions (bike, leg presses, step) to more congested starting
positions (ex.squad). The progress of the exercise depends on pain, swelling and
quadriceps control. Proprioception and coordination exercises can start if the general
strength is good. This includes balance exercises on boards and toll.

Week 10

 Forward, backward and lateral dynamic movements can be included as well as

isokinetic exercises

Month 3

 After 3 months, patient can move on to functional exercises as running and jumping.
As proprioceptive and coordination exercises become heavier, quicker changes in
direction are possible. To stimulate coordination and control through afferent and
efferent information processing, exercises should be enhanced by variation in visible
input, surface stability (trampoline), speed of exercise performance, complexity of
the task, resistance, one or two-legged performance, etc..

Month 4-5

 Final goal is to maximize endurance and strength of the knee stabilizers, optimize
neuromuscular control with plyometric exercises and to add the sport-specific
exercises. Acceleration and deceleration, variations in running and turning and
cutting manoeuvers improve arthrokinetic reflexes to prevent new trauma during
competition.

MODALITI TERAPEUTIK

1. Ultrasound
What?
 Terapi ultrasound atau mesin ultrasound
Why?
  Rawatan pemanasan yang digunakan untuk merawat keadaan muskuloskeletal
seperti tendon dan strain.

When?
 Penggunaan dilakukan selama 5- 10 minit di kawasan cedera.
How?
 Ultrasound dilakukan dengan mesin yang mempunyai transduser ultrasound
( kepala bunyi )
 Sebilangan kecil gel digunakan untuk bahagian badan yang tercedera.
 Gel disapukan pada kawasan cedera tersebut untuk membantu gelombang bunyi
menembusi kulit sama rata.
 Ahli terapi akan menggerakkan kepala transduser ke atas dan di sekitar kawasan
kecederaan yang dipilih.
 Pastikan kepala transduser terus digerakkan bagi mengelakkan membakar tisu
dibawahnya.
2. Cold Therapy
What
 cold therapy atau terapi sejuk merupakan fisioterapi yang banyak digunakan
untuk cedera akut.
why?
 Could therapy adalah kaedah terapi yang berguna untuk mengurangkan kesakitan dan
mengurangkan bengkak. Sekiranya pengurusan kesakitan dan pembengkakan telah
dicapai akan membantu meningkatkan jangkauan gerakan sendi (ROM)
When?
 Kaedah could therapy biasanya diberikan kepada pesakit setelah menjalani latihan
kerana berguna untuk melarutkan kumpulan asid lemak yang terbentuk selepas
melakukan latihan.
How?
 Cold therapy berkaitan dengan metode RICE (Rest, Ice, Compression, dan Elevation)

SENAMAN TERAPEUTIK/ SENAMAN PELAZIMAN

 LONG SITTING TOWEL CALF STRETCH
Sit up with good posture and place towel on the bottom of your foot, while holding on
to the ends. Now pull the towel across the foot, so that your toes are being pulled
towards you. Repeat for 2 sets for 30 seconds.

 SUPINE HAMSTRING STRETCH

Sit up and place towel over your foot, while holding on to the towel with both hands.
Lie down on your back and bring your leg up until you feel a stretch in the back of
your leg. Hold this for 30 seconds. Repeat twice, 30 seconds each time.

 QUAD SETS
Lie down on your back, place a small towel roll behind your knee. Tighten the
muscles at the front of your leg, and hold 3-5 seconds. Repeat for 2 sets of 10
repetitions.
 ANKLE PUMPS
Lie on your back, or sit in a chair. Life your ankles and toes up, then point them down.
Repeat this for 2 sets of 10 repetitions.

 HEEL SLIDES
Sit down with a towel over your foot. lide your foot back by pulling the towel with
your arms, bend your knee as far as you can. Hold it bent for 3-5 seconds. Continue to
bend and straighten your knee for 2 sets of 10 repetitions.
 PRONE HIP EXTENSION
Lie on your stomach with your head on a pillow. On your stomach, lift your leg up
with your knee completely straight.
Continue this for 2 sets of 10 repetitions.