History and Physical
Strong evidence supports that the practitioner should obtain a relevant history and perform a musculoskeletal exam of the lower extremities, because these are effective diagnostic tools for ACL injury.
Rationale
There were six high-strength and four moderate-strength studies evaluating history and physical examination as diagnostic tools for ACL injury. 8, 23, 32, 55, 58, 60, 87, 91, 104, 105 A relevant history is important for diagnosing ACL injuries and concomitant pathology and should include at a minimum the mechanism of injury, history of hearing/feeling a popping sensation, ability to bear weight, ability to return to play, history of mechanical symptoms of locking or catching, localization of pain if possible, and any history of prior knee injuries. 55, 60, 91 History of hearing/feeling a popping sensation and associated swelling is important in predicting an ACL injury.87
Appropriate physical exam is important in diagnosing ACL injuries and concomitant pathology and should also be performed including at a minimum: a neurovascular exam with documentation of both distal perfusion and tibial/peroneal nerve function, assessment for joint line tenderness or obvious step off/deformity, evaluation for an effusion, assessment of varus and valgus laxity at 0 and 30 degrees of extension, evaluation of anterior-posterior and rotational laxity. 8, 32, 58, 104, 105 Lachman’s test should be performed and has been shown to be sensitive for ACL injury.23
Benefits of Implementation
A thorough history and physical exam will assist the practitioner in prompt and accurate diagnosis of ACL injuries and concomitant pathology.
Possible Harms of Implementation
There are no known harms associated with appropriate implementation of this recommendation.
Future Research
Future research could help confirm the most useful history and physical exam findings for the diagnosis of ACL injury and concomitant pathology.
Appropriate physical exam is important in diagnosing ACL injuries and concomitant pathology and should also be performed including at a minimum: a neurovascular exam with documentation of both distal perfusion and tibial/peroneal nerve function, assessment for joint line tenderness or obvious step off/deformity, evaluation for an effusion, assessment of varus and valgus laxity at 0 and 30 degrees of extension, evaluation of anterior-posterior and rotational laxity. 8, 32, 58, 104, 105 Lachman’s test should be performed and has been shown to be sensitive for ACL injury.23
Benefits of Implementation
A thorough history and physical exam will assist the practitioner in prompt and accurate diagnosis of ACL injuries and concomitant pathology.
Possible Harms of Implementation
There are no known harms associated with appropriate implementation of this recommendation.
Future Research
Future research could help confirm the most useful history and physical exam findings for the diagnosis of ACL injury and concomitant pathology.
- (104) Shelbourne KD, Gray T, Haro M. Incidence of subsequent injury to either knee within 5 years after anterior cruciate ligament reconstruction with patellar tendon autograft. Am J Sports Med 2009;37:246-251.
- (105) Siddiqui MA, Ahmad I, Sabir AB, Ullah E, Rizvi SA, Rizvi SW. Clinical examination vs. MRI: Evaluation of diagnostic accuracy in detecting ACL and meniscal injuries in comparison to arthroscopy. Polish Orthopaedics and Traumatology 2013;78: 59-63.
- (23) Cooperman JM, Riddle DL, Rothstein JM. Reliability and validity of judgments of the integrity of the anterior cruciate ligament of the knee using the Lachman's test. Phys Ther 1990;70:225-233.
- (32) Fowler PJ, Lubliner JA. The predictive value of five clinical signs in the evaluation of meniscal pathology. Arthroscopy 1989;5:184-186.
- (55) Jah AAE, Keyhani S, Zarei R, Moghaddam AK. Accuracy of MRI in comparison with clinical and arthroscopic findings in ligamentous and meniscal injuries of the knee. Acta Orthop Belg 2005;71:189-196.
- (58) Juyal A, Variyani A, Sharma SC, Chauhan V, Maheshwari R. Evaluation of clinical diagnosis by knee arthroscopy. Journal of Indian Medical Association 2013;111: 86-88.
- (60) Kocabey Y, Tetik O, Isbell WM, Atay OA, Johnson DL. The value of clinical examination versus magnetic resonance imaging in the diagnosis of meniscal tears and anterior cruciate ligament rupture. Arthroscopy 2004;20:696-700.
- (8) Akseki D, Ozcan O, Boya H, Pinar H. A new weight-bearing meniscal test and a comparison with McMurray's test and joint line tenderness. Arthroscopy 2004;20:951-958.
- (87) Pookarnjanamorakot C, Korsantirat T, Woratanarat P. Meniscal lesions in the anterior cruciate insufficient knee: the accuracy of clinical evaluation. J Med Assoc Thai 2004;87:618-623.
- (91) Rayan F, Bhonsle S, Shukla DD. Clinical, MRI, and arthroscopic correlation in meniscal and anterior cruciate ligament injuries. Int Orthop 2009;33:129-132.