HISTORY AND PHYSICAL

There were six high quality (Blanke 2020, Cooperman 1990, Jarbo 2017, Juyal 2013, Shelbourne 2009, Sobrado 2021), two moderate quality (Rayan 2009, Fowler 1989), and one low quality study (Pookarnjanamorakot 2014) evaluating history and physical examination as diagnostic tools for ACL injury. 

Relevant history is important for diagnosing ACL injuries and concomitant pathology and should include at a minimum the mechanism and date 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.

History of hearing/feeling a popping sensation and associated swelling is important in predicting an ACL injury. 

Appropriate physical exam is important in diagnosing ACL injuries and concomitant pathology and should also be performed including at a minimum: a neurovascular exam of the lower extremity with documentation of both distal perfusion and tibial/peroneal nerve function, assessment of varus and valgus laxity at 0 and 30 degrees of flexion, dial testing at 30 and 90 degrees of flexion, and evaluation of anterior-posterior laxity with Lachman’s and anterior drawer and rotational laxity with pivot shift and active buckling sign tests.

Benefits/Harms of Implementation

A thorough history and physical exam will assist the practitioner in prompt and accurate diagnosis of ACL injuries and concomitant pathology. There are no known harms associated with appropriate implementation of this recommendation. 

Outcome Importance

The six high quality studies reviewed demonstrated the high significance of a sound history and physical toward assessing ACL injury.

Cost Effectiveness/Resource Utilization

Performing a sound history and physical should not add any significant cost to ACL injury assessment.

Acceptability

Evaluation and diagnosis of ACL injury using a relevant history and physical examination should have universal acceptability.

Feasibility

Most feasible to expect healthcare professionals to perform and incorporate relevant history and physical examination in assessment of ACL injury.

Future Research

Future research could help confirm the most useful history and physical exam findings for the diagnosis of ACL injury and concomitant pathology.