ACL Injury

Female athlete involved in running/jumping sports presents with sudden onset knee pain. Reports that she was playing basketball and landed with her foot planted laterally and her upper leg rotated medially when she heard a popping sound. She noted instant knee pain and instability immediately after the injury and was unable to bear weight on the joint. Knee effusion with a ballotable patella and positive Lachman test, anterior drawer test, and lateral pivot-shift test tests on exam.

• Suspected ACL injury with knee effusion and/or instability: Obtain MRI

• Confirmed ACL tear:

  • Refer to physical therapy

  • Pt informed that operative reconstruction is recommended for

    • Young athletes planning to continue sports involvement

    • Patients with significant knee instability affecting quality of life

• Pt counseled that

  • Non-operative management may increase risk for chronic pain and future meniscal tears

  • Risk for degenerative arthritis is the same with operative and non-operative management

Notes

• Mechanism of injury: Sudden deceleration or change in direction resulting in rotation or valgus knee stress

• Injury may produce an audible “pop” and sensation of knee instability

• Physical exam

  • Effusion due to hemarthrosis

  • Anterior translation with Lachman test and/or anterior drawer test

  • Lateral pivot-shift test produces posterior movement (reduction) of tibia at 30 to 40 degrees of flexion

Meniscal Tear

Treatment

• Patient counseled that arthroscopic meniscal surgery is equivalent to nonoperative management