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Technical Information about Anterior Cruciate Ligament Reconstruction.

Last updated Thursday, January 13, 2005

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Review of the condition

Diagnosis

The vast majority of ACL disruptions can be diagnosed by physical examination alone. Common exceptions include the patient with significant muscular guarding, a mechanically locked knee, or an exceptionally large extremity. Comparisons should always be made to the contralateral non-injured side. Documentation of neurovascular integrity must be done. Range of motion of the knee must be carefully evaluated. The Lachman test is one of the most reliable tests to determine the integrity of the ACL. Both the translational quantity and the presence of an end-point are important to determine. The pivot shift is also extremely important to document; however, patient guarding can easily obscure the findings of this test in the unanesthetized patient. The anterior drawer can also be used to help confirm the diagnosis. A complete knee examination is always done to look for concomitant injuries.

Some form of radiographic imaging is required after this injury. This could simply be radiographs of the knee or a magnetic resonance imaging scan of the knee if there is a question of the ACL or other injuries. If there is any question of vascular injury, an emergent arteriogram or its equivalent should be performed.

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