Anterior Cruciate Ligament (ACL) Injury

Last updated 20.05.13

 

 

Definition

-  Injury to the anterior cruciate ligament of the knee joint

 

Features

-  Almost always requires surgical reconstruction

 

Cause

-  Heel strike on weight bearing limb with valgus or rotational force

 

Associated S/S

-  Pain

-  Immedate severe pain

-  Improves within minutes

-  Antalgic gait, limp

-  May be able to weight bear

-  Instabililty worse with changing direction

-  Sensation of pop or shifting

-  Knee examination

-  Rapid swelling, erythema, warmth

-  Stiff joint

-  Bruising

-  Haemarthrosis

 

DDx

-   

 

Grades

-   

 

Ix

-  Lachmans Test

-  Pivot Shift Test

-  AP Draw Test: tibia displaces anteriorly on femur

-  X-ray

-  Fractures

-   Tibial plateau

-   Avulsion

-  Effusion

-  MRI

-  Out-of-pocket if referred by LMO but may expediate referral & reduce overall costs

-  Dx of degree of injury

-  Associated injuries: meniscal tears, bone bruising

 

Mx

-  Analgesia

-  RICE

-  Referral to Ortho

-  +/- MRI prior

-  Rehabilitation

-  9-12months prior to returning to competitive sport

-  Surgery

-  6 weeks post injury when swelling resolved, full ROM, pain free gait

-  Reconstructive surgery

 

 

 

References

 

Sports Knee Injuries: Assessment & Mangement, AFP Vol 39, No 1/1 2010