Introduction

Background of the Study

Basketball is one of the most popular sport in the world that is enjoyed
by players of all ages. Basketball is a very physically and demanding sport
because it requires not only strength, but also speed and endurance. Since
it involves sudden stops or changes in direction, jumping and landing, injuries
can and do happen as it is a fast game with frequent and aggressive body
contacts.

Injuries to basketball players are usually minor, mostly sprains and

strains. However, the ankle and knee are the most common sites of injury,
followed by the lower back, hand, and wrist. Knee injuries are very prevalent
in sports; knowing and understanding the injury mechanism is a significant
aspect to efficiently diagnose and manage them (UKEssays, 2018). One of
the most common knee injuries is anterior cruciate ligament injury which is
particularly common among basketball players (Wood, 2011).

Anterior cruciate ligament is one of the bands of tissue and key

ligaments that holds the bones together within a person's knee. This ligament
also helps to stabilize a person’s knee joint (WebMD, n.d.).

Athletes often get ACL injuries when they stop and quickly change
directions while they’re running (WebMD, n.d.). People who play basketball
are more likely to twist their knees by mistake when they compete. While
making an accurate diagnosis, the knee needs to be reevaluated at distinct
phases as acute inury testing is often hard and may be incorrect (Olsson et
al., 2016).

Over the last decades, many biomechanical and clinical studies have
explored the impacts and processes of the biology, disruption and restoration
of the anterior cruciate ligament (ACL). The knee is the body's biggest joint
and one of the easiest to injure (OrthoInfo, 2014) The ACL has a strong
impact on the subsequent kinematics as one of the intra-articular
ligaments and other meniscal or ligamentous injuries often accompany
ACL breakdowns and further deteriorate the kinematics and clinical
findings that result (Domnick, Raschke, & Herbort, 2016)

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 According to Duthon et al. (2005), the anterior cruciate ligament (ACL)
is a thick connective tissue cluster that runs from the femur to the tibia. They
defined ACL as a main framework in the knee joint, as it is resistant to
anterior tibial conversion and kinetic stresses. When the knee is expanded,
the ACL has a mean length of 32 mm and a width of 7-12 mm. Theyalso
stated that there are two parts of the ACL, the antromedial cell (AMB) and
the posterolateral cell (PLB). They are not isometric, the primary shift being
the lengthening of the AMB and the shortening of the PLB during flexion. The
ACL has a multi-type collagen bundle microstructure (mostly type I) and a
matrix consisting of a network of proteins, glycoproteins, elastic structures,
and glycoproteins.

Johns Hopkins Medicine (n.d.) describes that ACL injuries are

commonly classified in grades of 1,2 and 3. Grade 1 accidents include ACLs
that have suffered slight damage, e.g., the ACL is mildly stretched but
nonetheless offers adequate stability to the knee joint. Grade 2 ACL injuries
are uncommon and describe an ACL that is stretched and partly torn. Grade
3 ACL tears occur when the ACL is torn in half and the knee joint is no longer
stable.

As stated by Sutton & Bullock in 2013, females are more prone than
men to have a tight A-shaped intercondylar notch, and unique surgical
factors are needed in such instances. Female athletes are more likely to
rupture the contralateral ACL after ACL reconstruction than male athletes;
however, men and women are similarly likely to rupture the rebuilt knee.
While self-reported results are worse for females than for males in the first 2
years after reconstruction, longer-term studies do not show a difference
between male and female.

To specify an example of a previous case study of a man from Thomas

Stein (n.d.), a 27-year-old man was taken to the local emergency room, after
a motorcycle accident. In a conventional brace, the leg was initially stabilized.
The patient identified an isolated injury to the knee, but the actual injury
sequences could not be empirically verified. The attempt to take into account
the injury mechanism suggests that the lower leg has a combined rotation

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effect and an external force of rotation. The first preclinical report showed an
acute anteromedial knee pain with possible anteromedial knee dislocation
and simultaneous reduction with no signs of abnormalities throughout the
nerves and blood vessels. Positive results for the anterior Lachman test and
the anterior drawer test (ADT) were observed by examination of the anterior
cruciate ligaments (ACL). Defined by Nall (n.d.), the anterior drawer test is a
physical examination used by physicians to test the stability of the knee’s
anterior cruciate ligament while anterior Lachman test is considered a
reliable way to diagnose an ACL injury and decide what treatment is best for
your injury (Jewell, n.d)

According to the study of Nessler, Denney, & Sampley in 2017, the risk
of ACL injury is increased by faulty mechanics during dynamic motion that
trigger excessive force on the knee. Faulty mechanics may lead from lateral
trunk displacement, unequal limb loading, and absence of control to prevent
the position of the valgus knee. The best way to identify altered motions that
put the ACL at risk is in a fatigued state; however, a normal dynamic
assessment could recognize them. The defective patterns of motion are
modifiable and should be resolved in a program of injury prevention.
Prevention programs include different exercise methods, including
plyometrics, neuromuscular training, and strength training.

In terms of cognitive aspect from an injury, cognitive assessment

designs of injury reconstruction (Brewer, 1994; WieseBjornstal, Smith,
Shaffer, & Morrey, 1998) indicate that personal understanding or
interpretation will affect the cognitive, mental, and behavioral reactions of the
athlete. Objectively, Gallagher and Gardner (2007) have shown that
emotional and situation factors predict emotional response to sports injuries,
and specifically, early maladaptive differences determine various affective
responses at different stages of the injury process. Tracey (2003) further
proposed that both main and secondary assessments vary based on each
wounded person's private and situation variables; Even so, the primary and
secondary evaluations and coping strategies have significant relationships
(Albinson and Petrie, 2003). Albinson and Petrie observed that ineffective
coping strategies lead to increased stress when injured and suggested that
an injured individual's social support should be focused on reducing negative
assessments. Coping strategies have generally been broken down into three
separate areas: (a) problem-oriented, (b) emotionally-oriented and (c)
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avoidance-coping (Kowalski & Crocker, 2001). Problem-focused coping
involves coordinated efforts to handle a stressful situation, emotion-focused
coping aims at regulating emotional responses, and coping avoidance
involves activities or cognitive adjustments in order to avoid the situation
through distraction or social diversion (Endler & Parker, 2000)

This case study is then highlighted on one player who suffered an

anterior cruciate ligament injury during a competitive match with friends last
April 21, 2016 at West Triangle Thomas Benitez street court.

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 Review of Related Literature

Related literature

The anterior cruciate ligament (ACL) is one of the four major ligaments
that stabilize the knee joint; ligaments are tough, non-stretchable fibers that
hold bones together. The ACL—along with the posterior cruciate ligament
(PCL), medial collateral ligament (MCL), lateral collateral ligament (LCL),
and menisci (cartilage pads) —help keep the knee stable from sliding,
rotating, and hyperextending during running, jumping, and landing.

According to Wolf S. (2019), most athletes who participate in sports

that involve running, jumping, pivoting, or contact—such as basketball,
soccer, and football—are likely to need surgical ACL reconstruction to
continue playing their sport. Playing on a torn ACL can lead to recurrent
episodes of knee instability that can interfere with ability to perform sports
skills and sometimes result in further injury to the knee cartilage and
meniscus. Athletes who participate in low-impact, non-pivot sports—like
bicycling or swimming—may be able to continue their sport without having
their ACL tear surgically reconstructed.

An ACL injury develops when the ACL, a ligament that links the
thighbone and shinbone, stretches beyond its capacity and tears.This type
of injury frequently occurs during active sports that involve a lot of jumping
and rapid starts and stops. More than 70% of ACL injuries occur without any
contact or blow to the knee. ACL injuries affect roughly 1 in 3,000 people in
the United States. Many people who sustain this type of injury are young and
active. ACL injuries are also more common in females than in males, even
among those who play the same sport. When a person has an ACL injury, it
is fairly common for there to be injuries to other parts of the knee, including
the cartilage, tendons, and bones (Dresden D., 2019).

Related Studies

Hersey, A. (2017) mentioned in her study, “In this Case: ACL Tears in
Female Athletes”, that female athletes experience ACL tears at a higher rate
than their male counterparts. Elucidating the most pertinent factors that
contribute to this discrepancy is important for designing effective prevention
and intervention for female athletes to reduce, and thereby equalize, injury
rate.

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 Dr. Thomas Stein (2009) have once meet a ACL patient and the
applied treatment strategy results in a good ligamental consolidations. The
ACL shows minimal remaining partial instability without rotational instability.
The medial ligament complex showed a full ligamental stability in 0° flexion
and partial instability in 30° flexion. The goal of the postoperative
rehabilitation remains to decrease the persisting dynamic instability and
neuromuscular deficits.

Plan/Proposed treatment

Start first aid right away. These first-aid tips will reduce swelling and
pain. Use the RICE method. The letters stand for Rest the knee, put Ice on
it, use an elastic bandage to give gentle Compression to the knee, and
Elevate the leg by propping it up above the level of your heart. And at first
it's also important to move your leg as little as possible.

Take over-the-counter pain medicine. Be safe with medicines. Read

and follow all instructions on the label.

You may need to walk with crutches and use a knee immobilizer to
keep your knee still for the first few days after the injury.

Your knee will need to be checked by your doctor. It's important to get
treatment. If you don't, the injury may become a long-lasting problem. There
are two ways to treat the injury:

* Exercises and training, also called rehab. It takes several months of

rehab for your knee to get better.

* Surgery. You and your doctor can decide if rehab is enough or if

surgery is right for you.

If you have surgery, you will also have several months of rehab
afterward.

Your treatment will depend on how much of the ACL is torn, whether
other parts of the knee are injured, how active you are, your age, your overall
health, and how long ago the injury occurred.

There are three main treatment goals:

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 * Make the knee stable if it is unsteady, or at least make it stable
enough to do your daily activities.

* Make your knee strong enough to do all the activities you used to do.

* Reduce the chance that your knee will be damaged more.

After Treatment

Rehabilitation and return to normal function after surgical repair of an

ACL tear can take six to nine months. There needs to be a balance between
trying to do too much work in physical therapy returning strength and range
of motion and doing too little. Being too aggressive can damage the surgical
repair and cause the ligament to fail again. Too little work lengthens the time
to return to normal activities.

Subjective Data

Patient’s History
 Date of Birth: February 26, 1986
 Age: 33
 Height: 6’2
 There is no history of surgery
 The had a previous injury that could possibly torn the ACL. He reports
playing basketball 3 years ago when he landed his one foot he heard
a “pop” on his knees. He went to the doctor and they claimed that it
was an ACL a tear or sprain of the anterior cruciate ligament- one of
the major ligaments in his knee.

SURGERY
 There is no surgery happened to the patient.

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 Objective Data
PROGRESS

 3 weeks after the 2nd opinion

 The patient’s pain at the time was 2 out of 10. His best pain was 0 out
of 10 and his worst pain within the last 2 weeks was 2 out of 10, he
said that since his therapy began, the pain has definitely decreased
and does not feel constant pain at all.
 The patient had a 127 degrees knee flexion of bilaterally.

INITIAL EVALUATION
 Subjective
 Feels better when resting or activity modification
 Feels worse when walking or doing stairs

 Objective
 Palpation: TTP right medial knee joint line
 Manual testing; patient scored a 4\5 in all planes of the manual
muscle tests on her left extremity. When testing her right
extremity, he was a 3+\5 in knee extension\flexion. He had a
moderate muscle atrophy in her right lower extremity compared
to her left. He also had minimum joint infusion in the
medial\lateral knee.

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Conclusion

With the case study conducted, we have learned that Tendons are
solid groups of tissue that associate one unresolved issue. The ACL, one of
two tendons that cross in the knee, interfaces your thighbone (femur) to your
shinbone (tibia) and balances out your knee joint.

ACL injuries often happen during sports and fitness activities that can
put stress on the knee; suddenly slowing down and changing direction
(cutting), pivoting with your foot firmly planted, landing awkwardly from a
jump, or stopping suddenly. Receiving a direct blow to the knee or collision,
such as a football tackle.

Proper training and exercise can help reduce the risk of ACL injury. A
sports medicine physician, physical therapist, athletic trainer or other
specialist in sports medicine can provide assessment, instruction and
feedback that can help you reduce risks. Programs to reduce ACL injury, like
exercises that strengthen leg muscles, particularly hamstring exercises, to
ensure an overall balance in leg muscle strength, raining to improve
technique when performing pivoting and cutting movements and more.
Wearing the proper gear would also help lower the risk that the player or the
person to experience ACL.

Numerous individuals hear or feel a "pop" in the knee when ACL

damage happens. Your knee may expand, feel shaky and become too
difficult to even think about bearing weight. Depending upon the seriousness
of your ACL damage, treatment may incorporate rest and recovery activities
to enable you to recapture quality and dependability or medical procedure to
supplant the torn tendon pursued by restoration.

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Recommendation

For the improvement of the study, the researchers suggests the

following:

 Interview or ask 5 or more people who had experience ACL.

 Try to consult a doctor on what process they usually do to a person
with ACL.
 Try to ask the difference of treatments before and in the present.

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 Sample questioner

Survey Questionnaire
I. Name: ________________________________________________
(Optional)
Age: ____ Birthday: _______________________
(Month/Date/Year)
II. ACL Injury in Basketball
Directions: Read the following statements and ( / ) the box that corresponds
to your answer. The following description is Yes or No.

Items Yes No

1. Does ACL injury hurt?

2. Is ACL injury permanent?

3. Can ACL tear heals without a surgery?

4. Can I delay a surgery for an ACL tear?

5. If you have a case of ACL can you come back to play sports again?

6. Activities like cycling, bicycle, swimming can be performed despite of

having ACL?
7. Can this injury or condition be prevented?

8. Can you tear your ACL while walking?

9. Can you do squat exercise if you have ACL?

10. Can a torn ACL heal itself?

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