The ACL is vital in preventing the femur (thigh bone) from sliding backward on the tibia. It also stabilizes the knee from rotating, the motion that occurs when the foot is planted and the leg pivots. When the strength of the ACL is compromised, the knee becomes unstable. It can also buckle, especially when the leg is planted and the athlete tries to stop or turn quickly. The ligament tears when it gets stretched after the knee twists and the foot is planted.
The patient will often describe hearing a loud popping sound and an intense pain in the knee. This makes walking or weight-bearing very difficult. The knee joint will swell after only a few hours, making it even harder to stand or walk.
The diagnosis of an ACL injury begins with the doctor taking a history of how the injury occurred. The knee is then examined for obvious swelling, bruising, and deformity. The doctor will note any areas of tenderness and evidence of knee joint fluid. After this, stability is assessed. This is done using the Lachmann test, the pivot-shift test, and the anterior drawer test. Doctors may do a plain x-ray of the knee to look for any broken bones. However, MRIs are the test of choice to image the knee looking for ligament injury. Surgery is needed for athletes or for significant tears, but usually physical therapy, anti-inflammatories, and pain meds are sufficient.
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