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Highlights & Basics
- Anterior cruciate ligament (ACL) injury is typified by a palpable or audible pop noise. Patients experience pain, joint instability, and rapid development of hemarthrosis. If the injury occurs during a sporting activity, they are typically unable to return to play.
- Often tender at lateral femoral condyle, lateral tibial plateau, and tibiofemoral joint lines.
- A positive Lachman test is most accurate right after the injury. The pivot shift test is more useful in subacute or chronic cases.
- History and physical exam usually provide an accurate diagnosis.
- X-rays are obtained to rule out avulsion fractures or other related conditions, but do not directly identify ACL injury. Magnetic resonance imaging delineates ACL tears, along with associated injury to the menisci and other structures.
Quick Reference
History & Exam
Key Factors
Other Factors
Diagnostics Tests
Treatment Options
Definition
Epidemiology
Etiology
Pathophysiology
Images
T1-weighted MRI showing ACL tear
Lachman maneuver
Anterior and posterior drawer test starting position
Varus and valgus stability testing
Pivot start
Pivot finish
T2-weighted MRI showing lateral compartment femoral condyle and tibial plateau impaction fracture, effusion, and flattening of sulcus terminalis which occurs with pivot mechanism with an ACL injury.
Citations
Arundale AJH, Bizzini M, Dix C, et al. Exercise-based knee and anterior cruciate ligament injury prevention. J Orthop Sports Phys Ther. 2023 Jan;53(1):CPG1-34.[Abstract][Full Text]
American Academy of Orthopaedic Surgeons. Management of anterior cruciate ligament injuries: evidence-based clinical practice guideline. Aug 2022 [internet publication].[Full Text]
Padua DA, DiStefano LJ, Hewett TE, et al. National Athletic Trainers' Association Position Statement: Prevention of Anterior Cruciate Ligament Injury. J Athl Train. 2018 Jan;53(1):5-19.[Abstract][Full Text]
van Melick N, van Cingel RE, Brooijmans F, et al. Evidence-based clinical practice update: practice guidelines for anterior cruciate ligament rehabilitation based on a systematic review and multidisciplinary consensus. Br J Sports Med. 2016 Dec;50(24):1506-15.[Abstract][Full Text]
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99. Ye Z, Chen H, Qiao Y, et al. Intra-articular platelet-rich plasma injection after anterior cruciate ligament reconstruction: a randomized clinical trial. JAMA Netw Open. 2024 May 1;7(5):e2410134.[Abstract][Full Text]
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