Materiały źródłowe

• #1 Anterior Cruciate Ligament Injury: Diagnosis, Management, and Prevention | AAFP

  https://www.aafp.org/pubs/afp/issues/2010/1015/p917.html

  There are an estimated 80,000 to 100,000 anterior cruciate ligament (ACL) repairs in the United States each year. […] Evaluation of the ACL should be performed immediately after an injury if possible, but is often limited by swelling and pain. […] When performed properly, a complete knee examination is more than 80 percent sensitive for an ACL injury. […] The Lachman test is the most accurate test for detecting an ACL tear. […] Magnetic resonance imaging is the primary study used to diagnose ACL injury in the United States. […] If performed properly, a complete knee examination for ACL injury can be highly accurate, with a sensitivity and specificity of 82 and 94 percent, respectively. […] The three most accurate tests for detecting an ACL tear are the Lachman test (sensitivity of 60 to 100 percent; mean 84 percent), the anterior drawer test (sensitivity of 9 to 93 percent; mean 62 percent), and the pivot shift test (sensitivity of 27 to 95 percent; mean 62 percent).

• #2 Anterior Cruciate Ligament Knee Injury – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK499848/

  The anterior cruciate ligament (ACL) is one of the two cruciate ligaments that aids in stabilizing the knee joint. […] This activity describes the evaluation and management strategies for such injuries and stresses the role of team-based interprofessional care for patients with anterior cruciate ligament injuries. […] Outline the detailed evaluation in patients with anterior cruciate ligament injuries. […] Although ACL injury can be diagnosed clinically, imaging with magnetic resonance (MRI) is often utilized to confirm the diagnosis. […] MRI is the primary modality to diagnose ACL pathology, with a sensitivity of 86% and a specificity of 95%. […] Diagnosis may also be made with knee arthroscopy to differentiate complete from partial tears and chronic tears. […] Magnetic Resonance Imaging (MRI) is 97% sensitive and 100 % specific: it confirms the diagnosis and assesses the presence of associated injuries.

• #3 ACL Injury Symptoms, Diagnosis and Treatment Options | Joint Replacement Institute

  https://www.jointinstitutefl.com/2024/07/05/acl-injury-symptoms-diagnosis-and-treatment-options/

  Injuries to the anterior cruciate ligament, or ACL, happen in 100,000 to 200,000 Americans every year. […] Proper diagnosis of an injury to the anterior cruciate ligament takes the expertise of a board-certified orthopedic specialist. Your physician will examine your knee, noting your expressed symptoms, circumstances of the injury and of course, your overall health and medical history. […] You may need some imaging studies, such as X-rays and an MRI or CT scan. Your doctor will manipulate the joint through various movements, too. […] If there is a tear, your injury will be graded one, two or three, according to its severity. A grade three is a complete ACL tear. Then, you and your orthopedic physician will discuss ways to treat your pain and other symptoms.

• #4 ACL injury – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/acl-injury/diagnosis-treatment/drc-20350744

  During the physical exam, your doctor will check your knee for swelling and tenderness comparing your injured knee to your uninjured knee. He or she may also move your knee into a variety of positions to assess range of motion and overall function of the joint. […] Often the diagnosis can be made on the basis of the physical exam alone, but you may need tests to rule out other causes and to determine the severity of the injury. These tests may include: […] X-rays may be needed to rule out a bone fracture. However, X-rays don’t show soft tissues, such as ligaments and tendons. […] An MRI uses radio waves and a strong magnetic field to create images of both hard and soft tissues in your body. An MRI can show the extent of an ACL injury and signs of damage to other tissues in the knee, including the cartilage. […] Using sound waves to visualize internal structures, ultrasound may be used to check for injuries in the ligaments, tendons and muscles of the knee.

• #5 Diagnosing Anterior Cruciate Ligament Tears | NYU Langone Health

  https://nyulangone.org/conditions/anterior-cruciate-ligament-tears/diagnosis

  NYU Langone sports medicine doctors specialize in diagnosing and treating anterior cruciate ligament (ACL) tears, a type of knee injury. […] Your doctor may perform a physical exam and imaging tests to diagnose an ACL tear. […] During a physical exam, your doctor checks the knee for swelling, tenderness, range of motion, stability, and ACL function. […] Your doctor may order an X-ray to rule out any broken bones in the knee joint that could be contributing to your symptoms. Additionally, an MRI enables your doctor to see detailed images of the soft tissues, including ligaments, tendons, and cartilage. An MRI can show whether you have an ACL tear, depict the severity of the injury, and diagnose other injuries such as a meniscus tear or knee cartilage injury.

• #6 Anterior Cruciate Ligament Injury: Diagnosis, Management, and Prevention | AAFP

  https://www.aafp.org/pubs/afp/issues/2010/1015/p917.html

  There are an estimated 80,000 to 100,000 anterior cruciate ligament (ACL) repairs in the United States each year. […] Evaluation of the ACL should be performed immediately after an injury if possible, but is often limited by swelling and pain. […] When performed properly, a complete knee examination is more than 80 percent sensitive for an ACL injury. […] The Lachman test is the most accurate test for detecting an ACL tear. […] Magnetic resonance imaging is the primary study used to diagnose ACL injury in the United States. […] If performed properly, a complete knee examination for ACL injury can be highly accurate, with a sensitivity and specificity of 82 and 94 percent, respectively. […] The three most accurate tests for detecting an ACL tear are the Lachman test (sensitivity of 60 to 100 percent; mean 84 percent), the anterior drawer test (sensitivity of 9 to 93 percent; mean 62 percent), and the pivot shift test (sensitivity of 27 to 95 percent; mean 62 percent).

• #7 ACL Diagnosis | ACL Injury | Anterior Cruciate Ligament Tear

  https://jameslubowitzmd.com/diagnosing-acl-injury/

  Whether from a sports collision or an accidental fall, an ACL injury is very common today. Initial ACL diagnosis will include the individual feeling a sudden pain and a giving way of the knee. Many patients report hearing a pop, followed by swelling, tenderness, and looseness (laxity) in the joint. […] A clinical ACL diagnosis will include an assessment of range of motion, limb alignment, muscle strength, neurovascular status, and a thorough comparison with the uninjured knee. During the initial consultation, your physician will evaluate the type of ACL injury, will obtain a full report on how the injury occurred, determine if the injury is new or pre-existing, determine if the injury is combined with other injury, and discuss the details of the treatment options. He will perform a physical examination that will involve several injury specific tests. These tests will help him to accurately diagnose the ligamentous and patellofemoral instabilities that exist within the knee.

• #8 Anterior Cruciate Ligament Injury: Diagnosis, Management, and Prevention | AAFP

  https://www.aafp.org/pubs/afp/issues/2010/1015/p917.html

  There are an estimated 80,000 to 100,000 anterior cruciate ligament (ACL) repairs in the United States each year. […] Evaluation of the ACL should be performed immediately after an injury if possible, but is often limited by swelling and pain. […] When performed properly, a complete knee examination is more than 80 percent sensitive for an ACL injury. […] The Lachman test is the most accurate test for detecting an ACL tear. […] Magnetic resonance imaging is the primary study used to diagnose ACL injury in the United States. […] If performed properly, a complete knee examination for ACL injury can be highly accurate, with a sensitivity and specificity of 82 and 94 percent, respectively. […] The three most accurate tests for detecting an ACL tear are the Lachman test (sensitivity of 60 to 100 percent; mean 84 percent), the anterior drawer test (sensitivity of 9 to 93 percent; mean 62 percent), and the pivot shift test (sensitivity of 27 to 95 percent; mean 62 percent).

• #9 Anterior Cruciate Ligament Knee Injury – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK499848/

  It is important to evaluate for associated injuries such as medial or lateral collateral ligamentous injury, injury to the posterior collateral ligament, or meniscal injuries. […] Multiple provocative maneuvers can be employed to assess the ACL, including the anterior drawer, pivot shift, and Lachman tests. […] The Lachman test is the most sensitive in assessing ACL rupture, with 95% sensitivity and 94% specificity. […] The anterior drawer test is performed with the patient lying supine with their affected knee flexed to 90 degrees and the foot planted. […] The pivot shift test mimics the actual giving way event experienced in ACL-deficient knees. […] Although ACL injury can be diagnosed clinically, imaging with magnetic resonance (MRI) is often utilized to confirm the diagnosis.

• #10 ACL Tears & Injuries: Diagnosis & Treatment | NewYork-Presbyterian

  https://www.nyp.org/orthopedics/columbia-orthopedics/ligament-injuries/acl-injury-tear/treatment

  How are ACL Injuries Diagnosed? Diagnosis Physicians use the Lachman test as the most accurate method for determining a torn ACL. This test allows doctors to see whether the tibia (shinbone) has increased motion relative to the femur (thigh bone), positioning the knee flexed. MRI (magnetic resonance imaging) is the primary imaging study used by doctors to diagnose ACL injuries. An MRI can also identify additional injuries sustained in addition to a torn ACL. […] If you believe you are experiencing symptoms of an ACL tear, you should contact a health professional for immediate treatment. A torn ACL is painful and will likely require a sports medicine professional visit. Once there, the sports medicine specialist may perform various tests to determine if the ACL is torn. Some of the tests your doctor might include are:

• #11 Anterior Cruciate Ligament Injury: Diagnosis, Management, and Prevention | AAFP

  https://www.aafp.org/pubs/afp/issues/2010/1015/p917.html

  There are an estimated 80,000 to 100,000 anterior cruciate ligament (ACL) repairs in the United States each year. […] Evaluation of the ACL should be performed immediately after an injury if possible, but is often limited by swelling and pain. […] When performed properly, a complete knee examination is more than 80 percent sensitive for an ACL injury. […] The Lachman test is the most accurate test for detecting an ACL tear. […] Magnetic resonance imaging is the primary study used to diagnose ACL injury in the United States. […] If performed properly, a complete knee examination for ACL injury can be highly accurate, with a sensitivity and specificity of 82 and 94 percent, respectively. […] The three most accurate tests for detecting an ACL tear are the Lachman test (sensitivity of 60 to 100 percent; mean 84 percent), the anterior drawer test (sensitivity of 9 to 93 percent; mean 62 percent), and the pivot shift test (sensitivity of 27 to 95 percent; mean 62 percent).

• #12 Anterior Cruciate Ligament Knee Injury – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK499848/

  It is important to evaluate for associated injuries such as medial or lateral collateral ligamentous injury, injury to the posterior collateral ligament, or meniscal injuries. […] Multiple provocative maneuvers can be employed to assess the ACL, including the anterior drawer, pivot shift, and Lachman tests. […] The Lachman test is the most sensitive in assessing ACL rupture, with 95% sensitivity and 94% specificity. […] The anterior drawer test is performed with the patient lying supine with their affected knee flexed to 90 degrees and the foot planted. […] The pivot shift test mimics the actual giving way event experienced in ACL-deficient knees. […] Although ACL injury can be diagnosed clinically, imaging with magnetic resonance (MRI) is often utilized to confirm the diagnosis.

• #13 Anterior Cruciate Ligament Injury: Diagnosis, Management, and Prevention | AAFP

  https://www.aafp.org/pubs/afp/issues/2010/1015/p917.html

  There are an estimated 80,000 to 100,000 anterior cruciate ligament (ACL) repairs in the United States each year. […] Evaluation of the ACL should be performed immediately after an injury if possible, but is often limited by swelling and pain. […] When performed properly, a complete knee examination is more than 80 percent sensitive for an ACL injury. […] The Lachman test is the most accurate test for detecting an ACL tear. […] Magnetic resonance imaging is the primary study used to diagnose ACL injury in the United States. […] If performed properly, a complete knee examination for ACL injury can be highly accurate, with a sensitivity and specificity of 82 and 94 percent, respectively. […] The three most accurate tests for detecting an ACL tear are the Lachman test (sensitivity of 60 to 100 percent; mean 84 percent), the anterior drawer test (sensitivity of 9 to 93 percent; mean 62 percent), and the pivot shift test (sensitivity of 27 to 95 percent; mean 62 percent).

• #14 Anterior Cruciate Ligament Knee Injury – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK499848/

  It is important to evaluate for associated injuries such as medial or lateral collateral ligamentous injury, injury to the posterior collateral ligament, or meniscal injuries. […] Multiple provocative maneuvers can be employed to assess the ACL, including the anterior drawer, pivot shift, and Lachman tests. […] The Lachman test is the most sensitive in assessing ACL rupture, with 95% sensitivity and 94% specificity. […] The anterior drawer test is performed with the patient lying supine with their affected knee flexed to 90 degrees and the foot planted. […] The pivot shift test mimics the actual giving way event experienced in ACL-deficient knees. […] Although ACL injury can be diagnosed clinically, imaging with magnetic resonance (MRI) is often utilized to confirm the diagnosis.

• #15 Anterior cruciate ligament injury – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/589

  Anterior cruciate ligament injury is typified by a sudden, painful, audible pop noise. The patient is typically unable to return to the ongoing sporting activity, and presents with joint instability, and rapid development of an effusion (haemarthrosis). […] A positive Lachman’s test is most accurate right after the injury and the pivot shift test is more useful in sub-acute or chronic cases. […] History and physical examination usually provide an accurate diagnosis. […] X-rays 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. […] Key diagnostic factors include presence of risk factors, audible pop, rapid knee swelling, inability to return to the ongoing sporting activity, sensation of knee instability or buckling, pain, positive Lachman’s test, and positive pivot shift manoeuvre. […] Other diagnostic factors include tenderness at lateral femoral condyle, lateral tibial plateau, and positive anterior drawer test. […] 1st investigations to order include x-rays. […] Investigations to consider include MRI and arthroscopy.

• #16 Clinical Examination in the Diagnosis of Anterior Cruciate Ligament Injury: A Blinded, Cross-sectional Evaluation

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9915950/

  A meta-analysis comparing these tests demonstrated that the Lachman test is the most valid test to evaluate ACL tears with a pooled sensitivity of 85% and a pooled specificity of 94%. […] The lever test was found to be statistically inferior to the Lachman test in sensitivity, specificity, PPV, and NPV. […] The Lachman test was found to be more sensitive than the anterior drawer and Lever tests, and these findings supported previously reported values for the sensitivity and specificity of the Lachman. […] The findings of this study are contrary to the findings of the initial study by Lelli et al, which demonstrated 100% successful diagnosis of ACL tears and subsequent studies supporting the use of the lever test. […] The physical examination has long been the mainstay of orthopaedic evaluation and diagnosis. The Lachman and anterior drawer tests are both clinically useful and highly specific, although the anterior drawer is less sensitive than Lachman. However, the lever test should have a more limited role, and findings should be interpreted with caution.

• #17 Clinical Examination in the Diagnosis of Anterior Cruciate Ligament Injury: A Blinded, Cross-sectional Evaluation

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9915950/

  This study was conducted to compare the effectiveness of clinical tests for anterior cruciate ligament (ACL) injury. […] This study showed notable differences in sensitivity and specificity between the Lachman test and the lever test and in specificity between the anterior drawer test and the lever test. The Lachman test was also found to be more sensitive than the anterior drawer. […] The Lachman test and the anterior draw test demonstrated clinical utility, but the results of the lever test should be interpreted with caution. Clinical examination was found to be highly specific but less sensitive than MRI. […] The physical examination remains a mainstay of orthopaedic diagnosis, and multiple physical examination maneuvers can be used to evaluate a possible anterior cruciate ligament (ACL) injury.

• #18 Diagnostic Accuracy of Physical Examination Tests for Suspected Acute Anterior Cruciate Ligament Injury: A Systematic Review and Meta-Analysis | Published in International Journal of Sports Physical Therapy

  https://ijspt.scholasticahq.com/article/36434-diagnostic-accuracy-of-physical-examination-tests-for-suspected-acute-anterior-cruciate-ligament-injury-a-systematic-review-and-meta-analysis

  Four tests are commonly used to diagnose or determine ACL injury: the Lachman test, the anterior drawer test, the pivot shift test, and the lever sign test. […] The diagnostic accuracy of these tests has been examined in systematic reviews and meta-analyses. […] Based on these findings of systematic reviews, physical examination is useful in clinical practice for diagnosing ACL injury. […] The sensitivity and specificity with 95% CI and forest plots for the four physical examinations for all included studies are shown in Figure 4. Pooled sensitivities for the Lachman, anterior drawer, pivot shift, and lever sign tests were 0.79 (95% CI = 0.74 0.83), 0.78 (95% CI = 0.730.83), 0.55 (95% CI = 0.490.60), and 0.82 (95% CI = 0.760.87), respectively. Pooled specificities were 0.91 (95% CI = 0.870.94), 0.91 (95% CI = 0.860.95), 0.96 (95% CI = 0.910.98), and 0.88 (95% CI = 0.820.93), respectively.

• #19 ACL injury – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/acl-injury/diagnosis-treatment/drc-20350744

  During the physical exam, your doctor will check your knee for swelling and tenderness comparing your injured knee to your uninjured knee. He or she may also move your knee into a variety of positions to assess range of motion and overall function of the joint. […] Often the diagnosis can be made on the basis of the physical exam alone, but you may need tests to rule out other causes and to determine the severity of the injury. These tests may include: […] X-rays may be needed to rule out a bone fracture. However, X-rays don’t show soft tissues, such as ligaments and tendons. […] An MRI uses radio waves and a strong magnetic field to create images of both hard and soft tissues in your body. An MRI can show the extent of an ACL injury and signs of damage to other tissues in the knee, including the cartilage. […] Using sound waves to visualize internal structures, ultrasound may be used to check for injuries in the ligaments, tendons and muscles of the knee.

• #20 ACL injury – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/acl-injury/diagnosis-treatment/drc-20350744

  During the physical exam, your doctor will check your knee for swelling and tenderness comparing your injured knee to your uninjured knee. He or she may also move your knee into a variety of positions to assess range of motion and overall function of the joint. […] Often the diagnosis can be made on the basis of the physical exam alone, but you may need tests to rule out other causes and to determine the severity of the injury. These tests may include: […] X-rays may be needed to rule out a bone fracture. However, X-rays don’t show soft tissues, such as ligaments and tendons. […] An MRI uses radio waves and a strong magnetic field to create images of both hard and soft tissues in your body. An MRI can show the extent of an ACL injury and signs of damage to other tissues in the knee, including the cartilage. […] Using sound waves to visualize internal structures, ultrasound may be used to check for injuries in the ligaments, tendons and muscles of the knee.

• #21 Anterior Cruciate Ligament Injury: Diagnosis, Management, and Prevention | AAFP

  https://www.aafp.org/pubs/afp/issues/2010/1015/p917.html

  A radiographic knee series, including anterior-posterior, lateral, tunnel, and sunrise views, should be the initial imaging study to assess for fractures, evaluate knee alignment, determine skeletal maturity, and identify degenerative changes in middle-aged patients. […] Magnetic resonance imaging (MRI) is the primary study used to diagnose ACL injury in the United States. […] The sensitivity and specificity of MRI for detecting an ACL tear is 86 and 95 percent, respectively, as confirmed on arthroscopy.

• #22 Can We Diagnose ACL Injuries Based on X-ray Findings Alone? | Axis Sports Med

  https://www.axissportsmedicine.co.nz/blog/can-we-diagnose-acl-injuries-based-on-x-ray-findings-alone

  One of the most commonly reported skiing injuries are those involving the anterior cruciate ligament (ACL). […] The majority of patients who are thought to have sustained an ACL injury require further imaging studies, usually an x-ray and MRI scan. […] While the MRI is clearly the most sensitive test and can directly visualise the ACL, there are a number of x-ray findings that can also be associated with ACL injuries. […] When an x-ray image shows a prominent sulcus affecting the lateral femoral condyle it is important to consider whether your patient has had an injury to their ACL. […] Other x-ray findings consistent with ACL injuries are a Segond fracture, the presence of a lipohaemarthrosis or an avulsion from the tibial spines.

• #23 ACL injury – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/acl-injury/diagnosis-treatment/drc-20350744

  During the physical exam, your doctor will check your knee for swelling and tenderness comparing your injured knee to your uninjured knee. He or she may also move your knee into a variety of positions to assess range of motion and overall function of the joint. […] Often the diagnosis can be made on the basis of the physical exam alone, but you may need tests to rule out other causes and to determine the severity of the injury. These tests may include: […] X-rays may be needed to rule out a bone fracture. However, X-rays don’t show soft tissues, such as ligaments and tendons. […] An MRI uses radio waves and a strong magnetic field to create images of both hard and soft tissues in your body. An MRI can show the extent of an ACL injury and signs of damage to other tissues in the knee, including the cartilage. […] Using sound waves to visualize internal structures, ultrasound may be used to check for injuries in the ligaments, tendons and muscles of the knee.

• #24 Anterior Cruciate Ligament Injury: Diagnosis, Management, and Prevention | AAFP

  https://www.aafp.org/pubs/afp/issues/2010/1015/p917.html

  A radiographic knee series, including anterior-posterior, lateral, tunnel, and sunrise views, should be the initial imaging study to assess for fractures, evaluate knee alignment, determine skeletal maturity, and identify degenerative changes in middle-aged patients. […] Magnetic resonance imaging (MRI) is the primary study used to diagnose ACL injury in the United States. […] The sensitivity and specificity of MRI for detecting an ACL tear is 86 and 95 percent, respectively, as confirmed on arthroscopy.

• #25 Anterior Cruciate Ligament Knee Injury – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK499848/

  The anterior cruciate ligament (ACL) is one of the two cruciate ligaments that aids in stabilizing the knee joint. […] This activity describes the evaluation and management strategies for such injuries and stresses the role of team-based interprofessional care for patients with anterior cruciate ligament injuries. […] Outline the detailed evaluation in patients with anterior cruciate ligament injuries. […] Although ACL injury can be diagnosed clinically, imaging with magnetic resonance (MRI) is often utilized to confirm the diagnosis. […] MRI is the primary modality to diagnose ACL pathology, with a sensitivity of 86% and a specificity of 95%. […] Diagnosis may also be made with knee arthroscopy to differentiate complete from partial tears and chronic tears. […] Magnetic Resonance Imaging (MRI) is 97% sensitive and 100 % specific: it confirms the diagnosis and assesses the presence of associated injuries.

• #26 ACL injury – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/acl-injury/diagnosis-treatment/drc-20350744

  During the physical exam, your doctor will check your knee for swelling and tenderness comparing your injured knee to your uninjured knee. He or she may also move your knee into a variety of positions to assess range of motion and overall function of the joint. […] Often the diagnosis can be made on the basis of the physical exam alone, but you may need tests to rule out other causes and to determine the severity of the injury. These tests may include: […] X-rays may be needed to rule out a bone fracture. However, X-rays don’t show soft tissues, such as ligaments and tendons. […] An MRI uses radio waves and a strong magnetic field to create images of both hard and soft tissues in your body. An MRI can show the extent of an ACL injury and signs of damage to other tissues in the knee, including the cartilage. […] Using sound waves to visualize internal structures, ultrasound may be used to check for injuries in the ligaments, tendons and muscles of the knee.

• #27 ACL Injury Diagnosis & ACL Surgery | Baptist Health

  https://www.baptisthealth.com/care-services/conditions-treatments/acl-injury

  Arthrography: During this test, a contrast iodine solution is injected into the knee to help highlight the joint structures, such as the ligaments, cartilage, tendons and joint capsule. Several X-rays of the joint are taken, using a fluoroscope, a special piece of X-ray equipment that immediately shows the image.

• #28 Anterior Cruciate Ligament Knee Injury – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK499848/

  The anterior cruciate ligament (ACL) is one of the two cruciate ligaments that aids in stabilizing the knee joint. […] This activity describes the evaluation and management strategies for such injuries and stresses the role of team-based interprofessional care for patients with anterior cruciate ligament injuries. […] Outline the detailed evaluation in patients with anterior cruciate ligament injuries. […] Although ACL injury can be diagnosed clinically, imaging with magnetic resonance (MRI) is often utilized to confirm the diagnosis. […] MRI is the primary modality to diagnose ACL pathology, with a sensitivity of 86% and a specificity of 95%. […] Diagnosis may also be made with knee arthroscopy to differentiate complete from partial tears and chronic tears. […] Magnetic Resonance Imaging (MRI) is 97% sensitive and 100 % specific: it confirms the diagnosis and assesses the presence of associated injuries.

• #29 TOP 6 ACL Tear Diagnostic Tests

  https://www.genourob.com/diagnostic-ligaments_news_top-6-acl-diagnostic-tests.phtml

  Determining whether your ACL is torn or not can be hard. Scientifically confirmed methods therefore need to be applied in order to ensure a good diagnosis of the ACL’s state. […] Arthroscopy can also be used to diagnose the state of the ACL. […] Radiography is also a recognized technique for analyzing the anterior cruciate ligament. […] This type of assessment is probably the first evaluation you will undergo if you suspect an ACL tear. […] MRI is a common technique for objectively diagnosing an ACL tear. […] However, it should still be noted that ACL injury management is critically dependent on accurate diagnosis of other surrounding ligamentous structures of the knee, in particular the lateral collateral ligament (LCL), the posterior cruciate ligament (PCL) and the meniscus. […] Finally, we placed arthrometers at N1 as they apply the less invasive and yet most reliable technique to assess the ACL.

• #30 Diagnosis and Treatment of an ACL Tear – Space Coast OrthopedicMerritt Orthopedics – Merritt Sports MedicineAccessibility ToolsIncrease TextDecrease TextGrayscaleHigh ContrastNegative ContrastLight BackgroundLinks UnderlineReadable FontReset

  https://spacecoastortho.com/diagnosis-and-treatment-of-an-acl-tear/

  An ACL tear, also known medically as an anterior cruciate ligament tear, consists of an injury to the knee’s ligaments. The anterior cruciate is one of the four ligaments that control the knee’s movement and connects the thighbone to the shinbone. This ligament plays an essential role in stabilizing the knee for rotational movement, and when damaged, can cause severe swelling, tenderness, and instability to that knee. ACL tears most commonly occur among athletes who participate in sports such as football, lacrosse, soccer, and basketball due to their reliance on rotation and sudden movement. […] Orthopedists will often diagnose the ACL in the following types, according to its severity and condition: Grade I (Stretched Ligament) – With a stretched ligament, the ligament exhibits some tenderness and swelling, but not enough to compromise the person from small activities such as walking. Grade II (Partial Torn Ligament) – There are significant signs of swelling and tenderness for a person with a partially torn ligament. The knee will feel unstable to walk on and give out during activity. Grade III (Torn Ligament) – A fully torn ligament exhibits extreme amounts of tenderness, pain, and swelling. The knee gives out during activity completely due to the severity of the tear.

• #31 Evaluating the diagnostic pathway for acute ACL injuries in trauma centres: a systematic review | BMC Musculoskeletal Disorders | Full Text

  https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-022-05595-0

  Emergency physicians have poor diagnostic accuracy, as low as 25.9%, compared to more experienced professionals such as sports medicine physicians when assessing acute ACL injury. […] This reinforces that clinicians cannot ensure diagnostic accuracy with the current clinical assessment methods, thus emphasising the importance of more accurate diagnostic tests readily available at acute trauma centres to improve patient outcomes. […] Early diagnosis is paramount as it can reduce the likelihood of the knee giving way, which is associated with secondary injury, specifically to the meniscus which can result in osteochondral damage. […] The British Orthopaedic Association not only highlights the importance of accurate, fast diagnosis, but it also recommends that any ACL injury is referred to a surgeon as soon as possible to facilitate optimal patient outcomes, be that surgical or conservative management.

• #32 Evaluating the diagnostic pathway for acute ACL injuries in trauma centres: a systematic review | BMC Musculoskeletal Disorders | Full Text

  https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-022-05595-0

  This review sought to evaluate the literature on the initial assessment and diagnostic pathway for patients with a suspected Anterior Cruciate Ligament (ACL) tear. […] Common assessment methods included: laxity tests, joint effusion, inability to continue activity, and a history of a pop and giving way at the time of injury. […] Gold standard diagnostics were MRI and arthroscopy. […] Clinicians in the Emergency Department are not proficient in performing the assessment methods that are used for diagnosis in acute ACL injury. […] There is an ever-growing demand to improve diagnostic accuracy and efficiency; further exploration into quantitative measures of instability would aid the assessment of peripheral joint assessment. […] ACL injuries are debilitating, for this reason, early diagnosis is key to facilitating efficient treatment outcomes.

• #33 Evaluating the diagnostic pathway for acute ACL injuries in trauma centres: a systematic review | BMC Musculoskeletal Disorders | Full Text

  https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-022-05595-0

  Emergency physicians have poor diagnostic accuracy, as low as 25.9%, compared to more experienced professionals such as sports medicine physicians when assessing acute ACL injury. […] This reinforces that clinicians cannot ensure diagnostic accuracy with the current clinical assessment methods, thus emphasising the importance of more accurate diagnostic tests readily available at acute trauma centres to improve patient outcomes. […] Early diagnosis is paramount as it can reduce the likelihood of the knee giving way, which is associated with secondary injury, specifically to the meniscus which can result in osteochondral damage. […] The British Orthopaedic Association not only highlights the importance of accurate, fast diagnosis, but it also recommends that any ACL injury is referred to a surgeon as soon as possible to facilitate optimal patient outcomes, be that surgical or conservative management.

• #34 Clinical Diagnostic Tests Versus MRI Diagnosis of ACL Tears in: Journal of Sport Rehabilitation Volume 27 Issue 6 (2018)

  https://journals.humankinetics.com/view/journals/jsr/27/6/article-p596.xml

  The evidence supports the use of clinical diagnostic tests when diagnosing an ACL tear. Clinical diagnostic tests are equally or more diagnostically accurate as an MRI in the diagnosis of an ACL tear. […] Grade C evidence supports that clinical diagnostic tests are equally or more diagnostically accurate than MRI in the diagnosis of ACL tears. […] When performed proficiently and in the case of single injuries, clinical diagnostic tests were more accurate than MRI when diagnosing an ACL tear. If the case was complex, MRI was more sensitive for diagnosing ACL injuries. […] The ability to diagnose an ACL tear using clinical diagnostic tests could have major implications for the patient. Diagnosing an ACL tear accurately using clinical diagnostic tests could disqualify the patient from further physical or work-related activity and prevent increased trauma to the knee.

• #35 Clinical Diagnostic Tests Versus MRI Diagnosis of ACL Tears in: Journal of Sport Rehabilitation Volume 27 Issue 6 (2018)

  https://journals.humankinetics.com/view/journals/jsr/27/6/article-p596.xml

  The anterior cruciate ligament (ACL) injury is a common knee injury within varying athletic levels. Clinical diagnostic tests and magnetic resonance imaging (MRI) are two methods of evaluating ACL injuries. […] Are clinical diagnostic tests as accurate as MRI when diagnosing ACL tears? […] One study found that clinical diagnostic tests were superior to MRI when diagnosing an ACL tear. Another study found that clinical diagnostic tests were equal to MRI when measuring sensitivity, but scored higher in specificity, positive predictive value, negative predictive value, and diagnostic accuracy. The last study found that clinical diagnostic tests scored higher than MRI on specificity and positive predictive value, were equal when measuring accuracy, and scored lower when measuring sensitivity and negative predictive value.

• #36 Clinical diagnosis of partial or complete anterior cruciate ligament tears using patients’ history elements and physical examination tests | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0198797

  Combining multiple history elements and physical examination tests is advocated to increase the validity of the diagnosis of ACL tears. […] In the hand of an expert evaluator a clinical examination for ACL tears can be equivalent to magnetic resonance imaging (MRI) findings. […] Therefore, the aim of this diagnostic study is to assess the diagnostic validity of combining an extensive set of selected history elements and physical examination tests to diagnose or exclude partial or complete ACL tears compared to other common knee disorders based on a composite reference standard using standardized physical assessment and imaging. […] We identified diagnostic clusters combining history elements and physical examination tests that can accurately support the differential diagnosis of partial or complete ACL tears compared to other knee disorders.

• #37 Evaluating the diagnostic pathway for acute ACL injuries in trauma centres: a systematic review | BMC Musculoskeletal Disorders | Full Text

  https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-022-05595-0

  Understanding current assessment methods and diagnostic pathways for patients with acute ACL tears is paramount to developing more efficient diagnosis recommendations and assessment measures. […] Although numerous papers investigated diagnostic accuracy for ACL tears, only 6 met the inclusion criteria for this review. […] A reoccurring theme in the literature, is that the time to reach a diagnosis is reliant on a thorough assessment at initial presentation, which is highly dependent on the proficiencies of the clinician in question. […] The difficulty arises when inexperienced assessors are presented with an acutely swollen knee, indicating a greater need for a quantifiable measure of instability amongst non-specialist departments, in order to reduce prolonged and false-negative diagnoses.

• #38 Diagnostic Accuracy of Physical Examination Tests for Suspected Acute Anterior Cruciate Ligament Injury: A Systematic Review and Meta-Analysis | Published in International Journal of Sports Physical Therapy

  https://ijspt.scholasticahq.com/article/36434-diagnostic-accuracy-of-physical-examination-tests-for-suspected-acute-anterior-cruciate-ligament-injury-a-systematic-review-and-meta-analysis

  Four tests are commonly used to diagnose or determine ACL injury: the Lachman test, the anterior drawer test, the pivot shift test, and the lever sign test. […] The diagnostic accuracy of these tests has been examined in systematic reviews and meta-analyses. […] Based on these findings of systematic reviews, physical examination is useful in clinical practice for diagnosing ACL injury. […] The sensitivity and specificity with 95% CI and forest plots for the four physical examinations for all included studies are shown in Figure 4. Pooled sensitivities for the Lachman, anterior drawer, pivot shift, and lever sign tests were 0.79 (95% CI = 0.74 0.83), 0.78 (95% CI = 0.730.83), 0.55 (95% CI = 0.490.60), and 0.82 (95% CI = 0.760.87), respectively. Pooled specificities were 0.91 (95% CI = 0.870.94), 0.91 (95% CI = 0.860.95), 0.96 (95% CI = 0.910.98), and 0.88 (95% CI = 0.820.93), respectively.

• #39 Clinical diagnosis of partial or complete anterior cruciate ligament tears using patients’ history elements and physical examination tests | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0198797

  Combining multiple history elements and physical examination tests is advocated to increase the validity of the diagnosis of ACL tears. […] In the hand of an expert evaluator a clinical examination for ACL tears can be equivalent to magnetic resonance imaging (MRI) findings. […] Therefore, the aim of this diagnostic study is to assess the diagnostic validity of combining an extensive set of selected history elements and physical examination tests to diagnose or exclude partial or complete ACL tears compared to other common knee disorders based on a composite reference standard using standardized physical assessment and imaging. […] We identified diagnostic clusters combining history elements and physical examination tests that can accurately support the differential diagnosis of partial or complete ACL tears compared to other knee disorders.

• #40 Clinical diagnosis of partial or complete anterior cruciate ligament tears using patients’ history elements and physical examination tests | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0198797

  To assess the diagnostic validity of clusters combining history elements and physical examination tests to diagnose partial or complete anterior cruciate ligament (ACL) tears. […] History elements and physical examination tests performed independently were compared to the reference standard: an expert physicians composite diagnosis including history elements, physical tests and confirmatory magnetic resonance imaging. […] Forty-three individuals received a diagnosis of partial or complete ACL tear (15.4% of total cohort). […] The Lachman test alone was able to diagnose partial or complete ACL tears (LR+: 38.4; 95%CI: 16.092.5). […] Combining a history of trauma during a pivot with a popping sensation also reached a high diagnostic validity for partial or complete tears (LR+: 9.8; 95%CI: 5.617.3).

• #41 Clinical diagnosis of partial or complete anterior cruciate ligament tears using patients’ history elements and physical examination tests | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0198797

  Combining a history of trauma during a pivot, immediate effusion after trauma and a positive Lachman test was able to identify individuals with a complete ACL tear (LR+: 17.5; 95%CI: 9.831.5). […] Finally, combining a negative history of pivot or a negative popping sensation during trauma with a negative Lachman or pivot shift test was able to exclude both partial or complete ACL tears (LR-: 0.08; 95%CI: 0.030.24). […] Diagnostic clusters combining history elements and physical examination tests can support the differential diagnosis of ACL tears compared to various knee disorders. […] Diagnostic validity of physical examination tests for ACL tears has been extensively studied. […] The three most studied tests are the Lachman, the pivot shift and the anterior drawer test. […] These three tests reach high specificity and can be used alone to make a valid ACL diagnosis, but only the Lachman reached moderate sensitivity.

• #42 TOP 6 ACL Tear Diagnostic Tests

  https://www.genourob.com/diagnostic-ligaments_news_top-6-acl-diagnostic-tests.phtml

  The tests are first done on the healthy knee and then on the pathological knee in order to compare both differentials, which lead to a precise and objective assessment of the anterior cruciate ligament and other ligamentous structures. […] We placed arthrometers / laximeters N1 at determining ACL tears because the assessments performed by these devices are automatically done while applying different forces or torques in a controlled manner.

• #43 Expert Knee Ligament Injury Diagnosis| ACL Tear Detection

  https://arthrometer.com/knee-ligament-injury-diagnosis/

  Immediate accurate results about the state of resistance of the ACL without waiting for imaging processing. […] The GNRB DyneeLax arthrometers precisely measure knee laxity by applying a controlled force/torque and evaluating the tibial displacement/rotation. […] This data can help identify and diagnose knee ligament injuries, including partial and complete tears. […] While MRI scans are essential for visualizing knee anatomy, GNRB DyneeLax arthrometers excel in identifying subtle ligament laxity with higher sensitivity. […] The GNRB DyneeLax arthrometers can provide immediate quantitative data on knee laxity during an office visit, facilitating quick and informed diagnostic decisions. […] Yes, the Dyneelax is designed to assess the laxity of all knee ligaments, providing valuable information for diagnosing injuries to the ACL, PCL, AM-PL AL-PM Corners. […] The GNRB DyneeLax arthrometers are excellent tools for tracking recovery progress post-surgery, allowing healthcare professionals to adjust rehabilitation plans as needed.

• #44 Expert Knee Ligament Injury Diagnosis| ACL Tear Detection

  https://arthrometer.com/knee-ligament-injury-diagnosis/

  Learn about the GNRB Dyneelax Arthrometers for enhanced knee ligament injury diagnosis, offering greater sensitivity and efficiency than MRIs. […] The need for precise, quick, and reliable diagnostic tools is evident, especially in the realms of sports medicine, orthopedics, and physical therapy. […] Enter the GNRB DyneeLax arthrometers: state-of-the-art diagnostic devices that have reshaped the landscape of knee injury diagnosis. […] These arthrometers stand out for their ability to provide highly sensitive and accurate measurements of knee laxity, thus enabling healthcare professionals to pinpoint even the most subtle ligament injuries with unparalleled precision. […] A recent study (DOI: 10.1016/j.knee.2023.03.017) has shown GNRB Dyneelax arthrometers exhibit superior sensitivity in diagnosing partial ACL ruptures.

• #45 Top 6 ACL Diagnostic Tests Explained: Unlocking Knee Stability

  https://arthrometer.com/top-6-acl-diagnostic-tests/

  Magnetic Resonance Imaging (MRI) is a cornerstone in the diagnostic arsenal for anterior cruciate ligament (ACL) injuries, renowned for its high-resolution images and excellent soft tissue contrast. MRI is non-invasive and provides detailed views of both the soft and hard tissues within the knee, which makes it invaluable for assessing the extent of an ACL injury and any associated damages such as meniscal or cartilage injuries. […] The primary benefit of MRI is its ability to provide detailed images without exposure to ionizing radiation. […] However, challenges in detecting partial tears and the high cost of MRI scans highlight the need for supplementary diagnostic tools. […] Robotic arthrometers, such as the DYNEELAX and GNRB, offer a significant technological advancement in assessing the integrity of the anterior cruciate ligament (ACL) and overall knee laxity. These devices automate the measurement process, providing objective and reliable assessments with minimal operator dependency.

• #46 Top 6 ACL Diagnostic Tests Explained: Unlocking Knee Stability

  https://arthrometer.com/top-6-acl-diagnostic-tests/

  The primary benefits of robotic arthrometers include their high precision and repeatability. They standardize the force application during testing, which is crucial for consistent measurements, and are particularly valuable in clinical settings and research for monitoring post-surgical recovery and evaluating ligament healing. […] Robotic arthrometers like DYNEELAX and GNRB are crucial tools in modern orthopedic diagnostics. They offer high precision and reliability in ACL assessments, supporting their increasing use in both clinical practice and research.

• #47 Using MRI Technology to Diagnose an ACL Injury | Midstate Radiology Associates

  https://www.midstateradiology.com/blog/orthopedic-imaging/mri-diagnose-acl-injury/

  Early signs like decreased range of motion may be dismissed as arthritis. For diagnostic purposes, your doctor may recommend undergoing magnetic resonance imaging (MRI). […] For ACL injuries, the diagnostic process starts with a physical exam. Your doctor will look for areas of swelling and tenderness, comparing both knees. You will also be asked to move the joint, so your doctor can compare the range of motion and degree of functionality. […] If clear differences are present, your doctor might make a definitive diagnosis or schedule imaging to confirm an ACL injury. MRI is the primary tool, although an X-ray may be ordered to rule out broken bones and an ultrasound to check for the extent of internal injuries. […] MRI technology offers the greatest insight, by assessing the bones and soft tissues in detail. It also helps with comparing the state of both knees through visualization of fiber issues in the body. A knee MRI can: Help determine the severity of the tear by assessing the ligaments, Indicate the presence of a partial rupture, Show if a tibial translocation, fracture or bone bruise is present. […] However, certain factors can affect the diagnostic process: Scarring along the ligament, which may occur if you wait too long to get an MRI, Blood pooling around the ligament, Any pre-existing damage or degeneration.

• #48 Evaluating the diagnostic pathway for acute ACL injuries in trauma centres: a systematic review | BMC Musculoskeletal Disorders | Full Text

  https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-022-05595-0

  Emergency physicians have poor diagnostic accuracy, as low as 25.9%, compared to more experienced professionals such as sports medicine physicians when assessing acute ACL injury. […] This reinforces that clinicians cannot ensure diagnostic accuracy with the current clinical assessment methods, thus emphasising the importance of more accurate diagnostic tests readily available at acute trauma centres to improve patient outcomes. […] Early diagnosis is paramount as it can reduce the likelihood of the knee giving way, which is associated with secondary injury, specifically to the meniscus which can result in osteochondral damage. […] The British Orthopaedic Association not only highlights the importance of accurate, fast diagnosis, but it also recommends that any ACL injury is referred to a surgeon as soon as possible to facilitate optimal patient outcomes, be that surgical or conservative management.

• #49 Evaluating the diagnostic pathway for acute ACL injuries in trauma centres: a systematic review | BMC Musculoskeletal Disorders | Full Text

  https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-022-05595-0

  When performed by a specialist clinician, the diagnostic performance characteristics of clinical tests increase significantly. […] Diagnostic rates during initial assessment within the emergency department are reported as low as 5%, this is attributable to few clinicians performing stability tests during their assessment, often secondary to an unconfident skill set. […] Although this triaging pathway ensures a more accurate assessment, relying solely on specialists to undertake initial assessments relies on Emergency Department clinicians to be able to recognise those suspicious of ACL injury appropriately. […] Nearly all studies used either MRI or arthroscopy to verify injury and these were the most popular assessment verification method, suggesting that many healthcare professionals are not confident in confirming diagnosis based on clinical assessment alone.

• #50 Anterior Cruciate Ligament Knee Injury – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK499848/

  It is important to evaluate for associated injuries such as medial or lateral collateral ligamentous injury, injury to the posterior collateral ligament, or meniscal injuries. […] Multiple provocative maneuvers can be employed to assess the ACL, including the anterior drawer, pivot shift, and Lachman tests. […] The Lachman test is the most sensitive in assessing ACL rupture, with 95% sensitivity and 94% specificity. […] The anterior drawer test is performed with the patient lying supine with their affected knee flexed to 90 degrees and the foot planted. […] The pivot shift test mimics the actual giving way event experienced in ACL-deficient knees. […] Although ACL injury can be diagnosed clinically, imaging with magnetic resonance (MRI) is often utilized to confirm the diagnosis.

• #51 TOP 6 ACL Tear Diagnostic Tests

  https://www.genourob.com/diagnostic-ligaments_news_top-6-acl-diagnostic-tests.phtml

  Determining whether your ACL is torn or not can be hard. Scientifically confirmed methods therefore need to be applied in order to ensure a good diagnosis of the ACL’s state. […] Arthroscopy can also be used to diagnose the state of the ACL. […] Radiography is also a recognized technique for analyzing the anterior cruciate ligament. […] This type of assessment is probably the first evaluation you will undergo if you suspect an ACL tear. […] MRI is a common technique for objectively diagnosing an ACL tear. […] However, it should still be noted that ACL injury management is critically dependent on accurate diagnosis of other surrounding ligamentous structures of the knee, in particular the lateral collateral ligament (LCL), the posterior cruciate ligament (PCL) and the meniscus. […] Finally, we placed arthrometers at N1 as they apply the less invasive and yet most reliable technique to assess the ACL.

• #52 ACL Injury Assessment Guide: Expert Methods for Accurate Diagnosis | Roar Pedersen

  https://about.cmrad.com/articles/acl-injury

  According to recent studies published in PMC: „MRI is generally considered the best imaging modality for diagnosing associated injuries in patients with ACL tears, though a comprehensive understanding of injury patterns is crucial for accurate diagnosis.” […] Roars lecture emphasizes that ACL tears are rarely isolated, urging clinicians to look beyond the primary injury to assess associated structures and complex injury patterns. […] Understanding complex injury patterns enables: more accurate prognosis, better stability outcomes, reduced risk of complications, optimized rehabilitation planning. […] A: ACL tears rarely occur in isolation; associated injuries can significantly impact treatment planning and patient outcomes. […] A: Critical structures include menisci, collateral ligaments, posterior corner structures, and bone injuries. […] A: Understanding complex injury patterns enables more precise surgical approaches and better-informed treatment decisions.

• #53 Anterior Cruciate Ligament Injuries: MR Imaging Diagnosis with Surgical Implications

  https://www.jscimedcentral.com/jounal-article-info/Annals-of-Sports-Medicine-and-Research/Anterior-Cruciate-Ligament–Injuries%3A-MR-Imaging-Diagnosis–with-Surgical-Implications-11263

  The majority of ACL injuries are associated with medial or lateral meniscus injuries, and collateral ligament injuries. Detecting associated injuries of other stabilizing and supporting structures in the knee is important in surgical planning, and therefore should be sought for preoperative knee imaging. […] The clinical significance of meniscal ramp lesions in patients with ACL tear has gathered attention in the past decade. […] Therefore, it is important to recognize ramp lesions in patients sustaining ACL injury. […] The goal of operative treatment is to restore the biomechanical stability of the knee and reduce secondary injury to the articular cartilage and menisci. […] For operative treatment of ACL injuries, ligament reconstruction with a tendon graft is considered the current gold standard.

• #54 Diagnosis of ACL tear – Primary Care Notebook

  https://primarycarenotebook.com/pages/orthopaedics/anterior-cruciate-ligament-acl-tears/diagnosis-of-acl-tear

  The injured knee should be compared with the contralateral knee (1) […] In the acute setting, possible associated injuries such as multi ligament injuries or knee dislocation should be ruled out (1). […] Examination of the knee for ACL tears involves the following: Lachman’s test – sensitivity of 60% to 100%; mean 84% […] anterior drawer test – sensitivity of 9% to 93%; mean 62% […] pivot shift test – sensitivity of 27% to 95% mean 62% (1,2) […] plain x-ray should be the first imaging study in patients with suspected ACL injury […] MRI provides excellent soft tissue detail of the site of ACL injury […] helps in evaluating associated meniscal tears – seen in approximately 60 to 75% of ACL injuries […] collateral ligament injuries – seen in upto 46% of ACL injuries […] bone bruises, occult fractures, chondral injuries (1,2).

• #55 Anterior Cruciate Ligament Injuries: MR Imaging Diagnosis with Surgical Implications

  https://www.jscimedcentral.com/jounal-article-info/Annals-of-Sports-Medicine-and-Research/Anterior-Cruciate-Ligament–Injuries%3A-MR-Imaging-Diagnosis–with-Surgical-Implications-11263

  The majority of ACL injuries are associated with medial or lateral meniscus injuries, and collateral ligament injuries. Detecting associated injuries of other stabilizing and supporting structures in the knee is important in surgical planning, and therefore should be sought for preoperative knee imaging. […] The clinical significance of meniscal ramp lesions in patients with ACL tear has gathered attention in the past decade. […] Therefore, it is important to recognize ramp lesions in patients sustaining ACL injury. […] The goal of operative treatment is to restore the biomechanical stability of the knee and reduce secondary injury to the articular cartilage and menisci. […] For operative treatment of ACL injuries, ligament reconstruction with a tendon graft is considered the current gold standard.

• #56 Diagnostic Accuracy of Physical Examination Tests for Suspected Acute Anterior Cruciate Ligament Injury: A Systematic Review and Meta-Analysis | Published in International Journal of Sports Physical Therapy

  https://ijspt.scholasticahq.com/article/36434-diagnostic-accuracy-of-physical-examination-tests-for-suspected-acute-anterior-cruciate-ligament-injury-a-systematic-review-and-meta-analysis

  The AUC of the Lachman, anterior drawer, pivot shift, and lever sign tests suggests high accuracy for use of each in the diagnosis of ACL injury. The lever sign test had the lowest LR and the pivot shift test had the highest LR+. Thus, the lever sign test is recommended to rule out among the tests, and the pivot shift test is recommended to confirm an ACL injury in an acute setting.

• #57 Clinical Diagnostic Tests Versus MRI Diagnosis of ACL Tears in: Journal of Sport Rehabilitation Volume 27 Issue 6 (2018)

  https://journals.humankinetics.com/view/journals/jsr/27/6/article-p596.xml

  According to Kostov et al, if an ACL tear is diagnosed clinically, an MRI is an unnecessary and expensive test. A clinically diagnosed ACL tear may not warrant an MRI, due to lack of significance, and if the clinical diagnostic tests are accurate, a negative clinical exam could negate the need for the MRI. Accurately diagnosing or ruling out an ACL tear with clinical diagnostic tests could save the patient, patients family, employer, or school money by avoiding an MRI. Early diagnosis and prevention of additional knee trauma, along with preoperative rehabilitation, and cost savings may lead to improved patient outcomes. […] Future research is necessary to determine if clinical diagnostic tests are more diagnostically accurate than MRI in the diagnosis of ACL tears.

• #58 Clinical Diagnostic Tests Versus MRI Diagnosis of ACL Tears in: Journal of Sport Rehabilitation Volume 27 Issue 6 (2018)

  https://journals.humankinetics.com/view/journals/jsr/27/6/article-p596.xml

  According to Kostov et al, if an ACL tear is diagnosed clinically, an MRI is an unnecessary and expensive test. A clinically diagnosed ACL tear may not warrant an MRI, due to lack of significance, and if the clinical diagnostic tests are accurate, a negative clinical exam could negate the need for the MRI. Accurately diagnosing or ruling out an ACL tear with clinical diagnostic tests could save the patient, patients family, employer, or school money by avoiding an MRI. Early diagnosis and prevention of additional knee trauma, along with preoperative rehabilitation, and cost savings may lead to improved patient outcomes. […] Future research is necessary to determine if clinical diagnostic tests are more diagnostically accurate than MRI in the diagnosis of ACL tears.

• #59 The Importance of Timely Diagnosis and Treatment of ACL Injuries –

  https://regenorthosport.in/orthopedics/blog/the-importance-of-timely-diagnosis-and-treatment-of-acl-injuries/

  ACL injuries are common knee injuries, mostly affecting athletes who engage in physically strenuous activities. […] As a result, timely diagnosis and treatment of ACL injuries are essential to prevent further damage and reduce the risk of long-term complications. […] To diagnose an ACL injury, your doctor will conduct a physical exam and take a medical history to assess the severity of the symptoms. Additionally, imaging tests like X-rays, MRI, and ultrasound may help confirm the diagnosis and evaluate the injury type. […] Diagnosing an ACL injury usually involves a physical examination by a healthcare professional. The healthcare professional may move the knee joint in different directions and apply pressure to check for looseness or instability. […] It is essential to seek a second opinion from a qualified healthcare professional if you are unsure about the diagnosis or the recommended treatment plan. A second opinion can help confirm the diagnosis and ensure you receive appropriate treatment for your condition.

• #60 Evaluating the diagnostic pathway for acute ACL injuries in trauma centres: a systematic review | BMC Musculoskeletal Disorders | Full Text

  https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-022-05595-0

  This review sought to evaluate the literature on the initial assessment and diagnostic pathway for patients with a suspected Anterior Cruciate Ligament (ACL) tear. […] Common assessment methods included: laxity tests, joint effusion, inability to continue activity, and a history of a pop and giving way at the time of injury. […] Gold standard diagnostics were MRI and arthroscopy. […] Clinicians in the Emergency Department are not proficient in performing the assessment methods that are used for diagnosis in acute ACL injury. […] There is an ever-growing demand to improve diagnostic accuracy and efficiency; further exploration into quantitative measures of instability would aid the assessment of peripheral joint assessment. […] ACL injuries are debilitating, for this reason, early diagnosis is key to facilitating efficient treatment outcomes.

• #61 ACL Injury: Diagnosis & Treatment | Mass General Brigham

  https://www.massgeneralbrigham.org/en/patient-care/services-and-specialties/sports-medicine/conditions/knee/acl-injuries/treatment

  If left untreated, ACL tears can alter joint mechanics and lead to arthritis later in life. You may also be more likely to injure yourself in other ways since, without a functioning ACL, the knee is more likely to buckle during activity. […] Yes, it’s possible to re-tear your ACL after it’s been repaired or reconstructed. Some studies show that ACL tears are more likely among those who have already had a prior ACL injury than among uninjured individuals. […] A torn ACL can feel like devastating news, especially for a competitive athlete. Fortunately, an ACL tear isn’t the career-ending injury it once was. Many athletes can return to high-level play after their recovery. However, they need to be patient, careful, and especially attentive to their form and technique once they return to play.

• #62 Clinical Diagnostic Tests Versus MRI Diagnosis of ACL Tears in: Journal of Sport Rehabilitation Volume 27 Issue 6 (2018)

  https://journals.humankinetics.com/view/journals/jsr/27/6/article-p596.xml

  According to Kostov et al, if an ACL tear is diagnosed clinically, an MRI is an unnecessary and expensive test. A clinically diagnosed ACL tear may not warrant an MRI, due to lack of significance, and if the clinical diagnostic tests are accurate, a negative clinical exam could negate the need for the MRI. Accurately diagnosing or ruling out an ACL tear with clinical diagnostic tests could save the patient, patients family, employer, or school money by avoiding an MRI. Early diagnosis and prevention of additional knee trauma, along with preoperative rehabilitation, and cost savings may lead to improved patient outcomes. […] Future research is necessary to determine if clinical diagnostic tests are more diagnostically accurate than MRI in the diagnosis of ACL tears.

• #63 Anterior Cruciate Ligament Knee Injury – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK499848/

  The anterior cruciate ligament (ACL) is one of the two cruciate ligaments that aids in stabilizing the knee joint. […] This activity describes the evaluation and management strategies for such injuries and stresses the role of team-based interprofessional care for patients with anterior cruciate ligament injuries. […] Outline the detailed evaluation in patients with anterior cruciate ligament injuries. […] Although ACL injury can be diagnosed clinically, imaging with magnetic resonance (MRI) is often utilized to confirm the diagnosis. […] MRI is the primary modality to diagnose ACL pathology, with a sensitivity of 86% and a specificity of 95%. […] Diagnosis may also be made with knee arthroscopy to differentiate complete from partial tears and chronic tears. […] Magnetic Resonance Imaging (MRI) is 97% sensitive and 100 % specific: it confirms the diagnosis and assesses the presence of associated injuries.

• #64 Anterior Cruciate Ligament Injury: Diagnosis, Management, and Prevention | AAFP

  https://www.aafp.org/pubs/afp/issues/2010/1015/p917.html

  There are an estimated 80,000 to 100,000 anterior cruciate ligament (ACL) repairs in the United States each year. […] Evaluation of the ACL should be performed immediately after an injury if possible, but is often limited by swelling and pain. […] When performed properly, a complete knee examination is more than 80 percent sensitive for an ACL injury. […] The Lachman test is the most accurate test for detecting an ACL tear. […] Magnetic resonance imaging is the primary study used to diagnose ACL injury in the United States. […] If performed properly, a complete knee examination for ACL injury can be highly accurate, with a sensitivity and specificity of 82 and 94 percent, respectively. […] The three most accurate tests for detecting an ACL tear are the Lachman test (sensitivity of 60 to 100 percent; mean 84 percent), the anterior drawer test (sensitivity of 9 to 93 percent; mean 62 percent), and the pivot shift test (sensitivity of 27 to 95 percent; mean 62 percent).

• #65 Evaluating the diagnostic pathway for acute ACL injuries in trauma centres: a systematic review | BMC Musculoskeletal Disorders | Full Text

  https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-022-05595-0

  The varied time periods to reach a diagnosis is attributable to the differences in the study design and the assessing clinician. […] There is a clear correlation between faster diagnoses and more efficient diagnostic pathways. […] ACL deficient knees are associated with an increase in giving way episodes and knee instability. […] Further research should begin to investigate methods of instability quantification in order to tackle the repercussions of delayed diagnoses.

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