Anterior cruciate ligament (ACL) injury
Alternative names:
ACL injury; cruciate ligament injury - anterior; injury - ACL; injury - anterior cruciate ligament; injury - knee - ACL; knee injury - anterior cruciate ligament
Symptoms:
Signs and tests:
Physical examination may show signs of ACL injury. Manipulations of the joint may show: - Lachman's test - the health care practitioner will have you lay on your back with your knee bent at a 30 degree angle. He/she then holds the end of your thigh (distal femur) in one hand, and the top of the shin (proximal tibia) in the other, and applies slow pressure to the back of the proximal tibia just below the knee. Increased looseness in the knee joint is indicative of ACL injury. You must be sure to relax your hamstring muscles or it could result in a false positive Lachman's test.
- anterior drawer test - This test is less accurate at diagnosing ACL injury. The health care practitioner will have you lay on your back with your knee bent to 90 degrees and foot resting on the table. The practitioner then grasps the top of the shin (proximal tibia) with both hands and places both thumbs on the end of the thigh bone (tibial condyles). Your foot is stabilized by another person, or by the practitioner sitting on it, then slow pressure is placed on the proximal tibia. Any looseness in the joint could indicate ACL injury.
- pivot shift test of MacIntosh - this test requires relaxation and usually cannot be performed in acute injury. The health care practitioner will have you lay on your back. The foot on the symptomatic side is lifted with the leg straight and the foot turned inward. Pressure is applied to the outside of the knee while the knee joint is slowly bent. ACL injury is noted if the tibia moves out of joint at 30-40 degrees of knee flexion. Note: this test can be painful.
- ballotment test for hemarthrosis (joint bleeding) - a physical examination test that allows the practitioner to detect the presence of fluid in a body space.
Procedures that show ACL injury include:
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