Unit 1: Case Study Analysis in Physical Therapy

What Is ACL?

The ACL, or anterior cruciate ligament, is one of the four main ligaments in the knee. It connects the thigh bone (femur) to the shin bone (tibia) and plays a crucial role in stabilizing the knee joint, particularly during movements that involve twisting, pivoting, or sudden changes in direction.

Key Functions of the ACL:

1. Stabilization: It helps prevent excessive forward movement of the tibia relative to the femur.

2. Control of Knee Rotation: It controls knee rotation, especially important for activities that require quick turns or stops.

3. Injury Prevention: It helps absorb forces during jumping and landing, protecting other knee structures.

Common Causes of ACL Injuries:

ACL injuries are common in high-intensity sports such as soccer, basketball, skiing, and football, especially during actions like:

• Sudden stopping or changing direction

• Pivoting with the foot planted

• Landing awkwardly from a jump

• Receiving direct blows to the knee

Types of ACL Injuries:

• Partial Tear: A portion of the ligament is torn.

• Complete Tear: The ligament is fully torn, often requiring surgical reconstruction for athletes or active ind

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Symptoms of an ACL Injury:

1. A loud "pop" sound or sensation in the knee.

2. Severe pain and inability to continue activity.

3. Rapid swelling in the knee.

4. Instability or "giving way" of the knee during movement.

Treatment and Rehabilitation:

Treatment varies based on the injury's severity and the individual's activity level, ranging from physical therapy for mild injuries to reconstructive surgery for full tears. Rehabilitation focuses on restoring knee strength, flexibility, and stability, with return-to-sport timelines varying depending on the treatment approach.

An ACL tear is a serious injury, especially for athletes, as it can significantly impact mobility and performance if not properly treated and rehabilitated. 

Comprehension Questions:

1. What does ACL stand for, and where is it located?

2. What are the primary functions of the ACL in the knee joint? List at least two.

3. Why is the ACL especially important for athletes or individuals involved in high-intensity sports?

4. Describe two common movements or actions that could lead to an ACL injury.

5. What is the difference between a partial and a complete ACL tear?

6. What are three common symptoms of an ACL injury?

7. How might treatment for a minor ACL injury differ from treatment for a severe or complete tear?

8. Why might someone with a complete ACL tear require surgery?

9. What are the primary goals of rehabilitation following an ACL injury?

10. How can an ACL injury impact an athlete's performance if not treated properly?

Sample Case Study: Rehabilitation Plan for ACL Tear in a 22-Year-Old Soccer Player

Patient History

• Age/Sex: 22-year-old

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• Sport: Competitive soccer player at the collegiate level

• Injury Background:

  • • Occurred during a high-intensity game while making a sharp turn.

    • Immediate pain, swelling, and instability in the right knee.

    • Diagnosed with a complete ACL tear via MRI.

Treatment Protocol

Phase 1: Preoperative Preparation

• • • • Goals: Reduce swelling, restore full range of motion, and strengthen surrounding muscles.

      • Activities:

        • • 1. Low-impact exercises, such as stationary biking and swimming.

            2. Quadriceps and hamstring strengthening exercises.

            3. Ice and compression to manage swelling.

      • Timeline: 3–4 weeks before surgery.

Phase 2: Surgical Intervention

• • • • Procedure: ACL reconstruction surgery using a patellar tendon graft.

      • Goals: Repair ligament and prepare for rehabilitation.

      • Recovery: Initial rest and immobilization with a knee brace.

Phase 3: Postoperative Early Rehabilitation (Weeks 1–6)

3. • • • Goals: Minimize pain and inflammation, regain knee extension, and begin gentle mobilization.

       • Activities:

         1. 1. Gentle passive range of motion exercises.

            2. Isometric quadriceps exercises (e.g., quad sets).

            3. Weight-bearing as tolerated, with crutches for support.

Phase 4: Strength and Mobility (Weeks 7–12)

4. • • • Goals: Restore knee flexion and extension, strengthen leg muscles, and improve balance.

       • Activities:

         1. 1. Progression to resistance exercises (leg press, hamstring curls).

            2. Balance training on stable and unstable surfaces.

            3. Treadmill walking and light cycling to improve cardiovascular endurance.

Phase 5: Advanced Strengthening and Conditioning (Months 4–6)

5. • • • Goals: Build full strength and stability, increase functional movement.

       • Activities:

         1. 1. Plyometric exercises (jump squats, box jumps).

            2. Lateral movement drills and agility exercises.

            3. Strength training, including single-leg exercises and controlled lunges.

Phase 6: Return to Sport-Specific Drills (Months 7–9)

6. • • • Goals: Achieve near-full strength and functional stability, integrate sport-specific drills.

       • Activities:

         1. 1. Sport-specific movement patterns (e.g., cutting drills, pivoting).

            2. Full-speed running and gradual reintegration into scrimmages.

            3. Ongoing monitoring to address any lingering pain or instability.

Recovery Outcomes

• Physical Assessment: By month 9, the patient demonstrated full knee extension, minimal pain, and improved stability.

• Return to Sport: Cleared to resume full competitive play after nine months.

• Long-Term Outlook: Encouraged to continue strength and flexibility training to prevent re-injury.

True or False Questions:

1. The ACL connects the thigh bone to the shin bone and helps stabilize the knee joint.

2. Rehabilitation for an ACL tear is typically completed within four weeks.

3. The first phase of ACL rehabilitation focuses on reducing swelling and restoring range of motion.

4. Isometric exercises involve joint movement to strengthen the knee.

5. Plyometric exercises are introduced in the final phase to improve the patient’s agility and power.

6. Balance training is unnecessary for ACL rehabilitation and is generally skipped.

7. A patellar tendon graft is a common method used for ACL reconstruction surgery.

8. Functional movement exercises are only performed at the beginning of the rehabilitation plan.

9. Monitoring progress is important to adjust the rehabilitation program as the patient improves.

10. Cutting drills help the athlete practice sharp changes in direction, which are crucial for returning to sports like soccer.

Lexical Exercises

Writing

Case Study Summary on ACL Rehabilitation

Instructions: Write a summary of the ACL rehabilitation case study, focusing on the main elements of the patient’s history, the rehabilitation process, and outcomes. Your summary should be between 200 and 300 words, capturing key details while remaining concise and accurate.

1. Begin with a brief overview of the injury and the initial challenges faced by the patient.

2. Summarize the rehabilitation phases, focusing on the goals and main exercises in each phase.

3. Conclude with the expected outcomes and any final steps in the recovery plan, particularly related to returning to sports.

Use your own words to explain the process and avoid copying directly from the text.

Prompts to Guide Your Writing:

• What were the main objectives of each rehabilitation phase?

• How did the treatment plan address specific needs of an athlete in a sport like soccer?

• How does the case study describe the patient’s progress through the rehabilitation stages?

• Why are certain exercises or techniques (e.g., plyometrics, balance training) included in the plan?

• What is the final goal for the patient by the end of the rehabilitation?

Evaluation Criteria:

1. Content Accuracy (40%):

   • Does the summary accurately capture the patient’s history, treatment phases, and outcomes?

   • Are the main points of the rehabilitation plan clearly and correctly conveyed?

2. Conciseness and Clarity (25%):

   • Is the summary concise yet comprehensive, including only the most relevant details?

   • Does each sentence add value to the overall summary without unnecessary repetition?

3. Organization and Flow (20%):

   • Is the summary well-organized, moving logically from the injury to the treatment phases and then the expected outcomes?

   • Does it use appropriate transitions for smooth flow?

4. Language and Vocabulary Use (15%):

   • Are the sentences grammatically correct and well-constructed?

   • Does the student use appropriate vocabulary and medical/sports terms where necessary?

Speaking

Instructions: Work with a partner or in small groups. Discuss and answer the following questions.

1. Patient Perspective:

   • Imagine you are the patient recovering from an ACL tear. Describe how each phase of rehabilitation feels and what challenges you might face.

   • What would be the most difficult part of the recovery process for you, and why?

2. Professional Perspective:

   • Imagine you are a physical therapist. How would you explain the importance of following each rehabilitation phase to your patient?

   • What strategies might you suggest to keep the patient motivated during the recovery process?

3. Real-Life Application:

   • Discuss with your partner how ACL rehabilitation might differ depending on the sport (e.g., a runner vs. a soccer player).

   • What additional exercises might you recommend for each type of athlete to target sport-specific movements?

Listening

Comprehension Exercise 2: Short Answer Questions

1. Explain why it is beneficial to perform exercises before ACL surgery.

2. Describe how to perform an ankle pump exercise. 

3. What is a short arc quad (SAQ), and how is it performed? 

4. How can weights be incorporated into the straight leg raise exercise? 

5. What is the purpose of using a knee prop during rehabilitation?

Physical Therapy Case Study Template

Bibliography

1. Parker, L. (2017). ACL Injury Prevention: What Does Research Tell Us? Journal of Athletic Training, 52(6), 600-611. Retrieved from PMC. 

2. Mount Sinai Health System. (n.d.). Acute Cruciate Ligament (ACL) Injury Prevention. Retrieved from Mount Sinai.

3. UPMC Orthopaedics. (n.d.). ACL Injuries Causes, Symptoms, and Treatments. Retrieved from UPMC.