ACL Tears Part 2 Symptoms and Evaluation
(light rock music) Most anteriorcruciate ligament tears are acute, traumatic injury, so the symptoms occur with a sporting event, or an accident, and the symptoms are acute pain, swelling, discomfort, inability to ambulate or walk. The most commonhistory a patient gives
with an anterior cruciate ligament tear is participating in a cutting or twisting sport. They plant their foot. quot;I felt my knee twist and pop, quot;and I was unable to continue playing basketball.quot; However, the symptoms are variable. There are patients that tear their anterior cruciate ligament.
They can continue to play four quarters of a football game, or continue to ski all day. However, that is rare. The amount of swelling or pain usually precludes the athlete from continuing in their sport. Darla is an elite levelmartial art athlete who actually injured her anterior cruciate ligament
less than 24 hours ago. This is what an acute anterior cruciate ligament tear looks like and what you see is a normal left knee that's straight on the bed without swelling. The right knee is puffy. As I ballot the kneeit's filled with blood. She has 40 or 50 cc of blood in the knee. You can barely make out the landmarks of her patella.
She can bend the knee up to 70 degrees before she begins to have pain. Like a water balloon, it won't bend further. The classic test to determine anterior cruciate ligament integrity is called the drawer test. Resting over my knee ina position of comfort, I apply a posterior force,
and one could see the knee come forward like a drawer. It's like a drawer in a dresser. She tore her medial collateral ligament, which attaches the femurto the tibia right here, which is the ligament that connects the femur bone to the shin bone, and it's disrupted in its midsubstance. So she has a terrible triad:
ACL Exam Lachmans Test Pivot Shift Drawer Test performed by Eric Janssen
Hi I'm Eric Janssen with Sportsmed Orthopedic Surgery and Spine Center in Huntsville Alabama. today's tutorial is an office examination foran ACL sports injury The patient is a fifteenyearoldcompetitive soccer player who recently reinjured her right kneewhich had had a prior ACL reconstruction She now has an unstable knee again After initial evaluation in the office we orderedan m_r_i_ she's now back in to review that with us
and then we'll go ahead proceed with herphysical examination to demonstrate how we diagnose an a c l tear in a al exam So this is called a lachman's exam where we flex the knee up to about 90 degrees hold with the outside hand on the femur and the inside hand on the tibia and move that knee back and forth We feel for a solid endpoint
You can see there's not much motion as we're looking at the joint line right here where my thumb is. and she's got a very solid feel to that. Now we have the patient positioned where we can demonstrate the injured knee where she has torn this anterior cruciate ligament the same thing we will flex the knee to 90 degrees
you can see as we move the knee how much play is in that kneeas the tibia comes forward The other thing I wanted to show is calledthe pivot shift maneuver we let the leg hang down and extend we have the patient relax we turn in the foot just a little bit then we try to shift the knee. Now thisis normal where the tibia against the femur just glides up and downand doesn't shift
which I will be able to demonstrateon her injured knee we talked about the pivot shift manuever as we come up, you can see the tibia jump against the femur Here her knee is subluxed and her it is reduced another thing you can do iscalled a drawer test at 90 degrees
we will hold the knee and get thehamstrings to relax and try to pull forward you need to make sure you have the kneepushed back when you attempt to do that As you can see, this knee is verysolid once again the drawer test relax the hamstrings you can see how far forward the tibia comes here the tibia is forward here it is back where it belongs