ACL Injury

Symptoms of an acute ACL injury may include the following:

Feeling or hearing a pop sound in the knee

Pain and inability to continue activity

Swelling and instability of the knee

Development of a large hemarthrosis

Epidemiologi
The incidence of ACL injury is higher in people who participate in high-risk sports such as
basketball, football, skiing, and soccer. When the frequency of participation is considered, a
higher prevalence of injury is observed in females over males, at a rate 2.4-9.7 times greater
for females.

Diagnosis
Inspeksi: looking for any gross effusion or bony abnormality.
Palpasi :
1. Assess the patient's range of motion (ROM), especially looking for lack of complete
extension.
2. bony structures may suggest an associated tibial plateau fracture.
3. Palpation of the joint lines to evaluate a possible associated meniscus tear.
4. Palpation over the collateral ligaments to suggest any possible injury (sprain) of
these structures.
Lachman test
The Lachman test is the most sensitive test for acute ACL rupture. It is performed with the
knee in 30 of flexion, with the patient lying supine. The amount of displacement (in mm)
and the quality of endpoint are assessed (eg, firm, marginal, soft). Asymmetry in side-to-side
laxity or a soft endpoint is indicative of an ACL tear. Although difficult to measure, a side-toside difference of greater than 3 mm is considered abnormal.
Pivot shift test
The pivot shift test is performed by extending an ACL-deficient knee, which results in a small
amount of anterior translation of the tibia in relation to the femur. During flexion, the
translation reduces, resulting in the "shifting or pivoting" of the tibia into its proper alignment

on the femur. It is performed with the leg extended and the foot in internal rotation, and a
valgus stress is applied to the tibia.
Anterior drawer test
The anterior drawer test is performed with the knee at 90 flexion, with the patient lying
supine. There is an attempt to displace the tibia forward from the femur. If there is more than
6 mm of tibial displacement, an ACL tear is suggested. This test is not very sensitive and has
been found to be positive in only 77% of patients with complete ACL rupture.
MRI, Xray, arthrogram.
MRI has a sensitivity of 90-98% for ACL tears. MRI also may identify bone bruising, which
is present in approximately 90% of ACL injuries.
An MRI allows the physician to confirm an ACL tear, but it should not be used as a substitute
for a good history and physical examination.
Pemeriksaan laboratorium: arthrocentesis (blood with fat globules),
.Management
Nonoperative treatment
Nonoperative treatment may be considered in elderly patients or in less active athletes who
may not be participating in any pivoting type of sports (eg, running, cycling). Arthroscopy
may also be considered for persons who are poor candidates for reconstruction but have a
mechanical block to range of motion.
Physical Therapy
Before any treatment, encourage strengthening of the quadriceps and hamstrings, as well as
ROM exercises. Performance of ROM helps reduce the amount of effusion and helps the
patient regain motion and strength.
Surgical intervention
Generally, the recommendation is that surgical intervention be delayed at least 3 weeks
following injury to prevent the complication of arthrofibrosis. The methods of surgical repair
may be categorized into 3 groups: primary repair, extra-articular repair, and intra-articular
repair.
Primary repair is not recommended except for bony avulsions, which are mostly seen in
adolescents. Because the ACL is intra-articular, the ligamentous ends are subjected to
synovial fluid, which does not support ligamentous healing.
Extra-articular repair generally involves a tenodesis of the iliotibial tract. This may prevent a
pivot shift but has not been shown to decrease anterior tibial translation.

Intra-articular reconstruction of the ACL has become the criterion standard for treating ACL
tears.