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.
- Blanke, F., Haenle, M., Feitenhansl, A., Vogt, S., Camathias, C. The Forced Active Buckling Sign: A New Clinical Test for the Diagnosis of ACL Insufficiency. The Journal of Knee Surgery 2020; 1: 42-47
- Cooperman, J. M., Riddle, D. L., Rothstein, J. M. Reliability and validity of judgments of the integrity of the anterior cruciate ligament of the knee using the Lachman's test. Physical Therapy 1990; 4: 225-33
- Jarbo, K. A., Hartigan, D. E., Scott, K. L., Patel, K. A., Chhabra, A. Accuracy of the Lever Sign Test in the Diagnosis of Anterior Cruciate Ligament Injuries. Orthopaedic Journal of Sports Medicine 2017; 10: 2325967117729809
- Juyal, A., Variyani, A., Sharma, S. C., Chauhan, V., Maheshwari, R. Evaluation of clinical diagnosis by knee arthroscopy. J Indian Med Assoc 2013; 2: 86-8
- Shelbourne, K. D., Benner, R. W. Correlation of joint line tenderness and meniscus pathology in patients with subacute and chronic anterior cruciate ligament injuries. The Journal of Knee Surgery 2009; 3: 187-90
- Sobrado, M. F., Bonadio, M. B., Ribeiro, G. F., Giglio, P. N., Helito, C. P., Demange, M. K. Lever Sign Test for Chronic Acl Injury: A Comparison with Lachman and Anterior Drawer Tests. Acta Ortopedica Brasileira 2021; 3: 132-136
- (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.
- Fowler, P. J., Lubliner, J. A. The predictive value of five clinical signs in the evaluation of meniscal pathology. Arthroscopy 1989; 3: 184-6
- Pookarnjanamorakot, C., Korsantirat, T., Woratanarat, P. Meniscal lesions in the anterior cruciate insufficient knee: the accuracy of clinical evaluation. J Med Assoc Thai 2004; 6: 618-23