Many have heard the story, an awkward landing, a ‘pop’ at the knee, immediate pain and swelling – you’ve already assumed the worst. Injuries to the anterior cruciate ligament (ACL) are at epidemic proportions in Australia. Unfortunately, we’re likely to see several cases of ACL rupture at Mallee Physio this football/netball season. Although many have heard recounts from those who’ve sustained an injury to their ACL, few may have heard the story from the person responsible for the diagnosis.
ACL Rupture and Acute Knee Injury
This post aims to inform the weekend warriors of the Swan Hill region regarding key signs and symptoms of an ACL rupture, whilst providing some insight as to what we physio’s look for if you’ve sustained an acute knee injury.
Assessment of a knee injury starts as soon as you greet a patient in the waiting room, usually, they will be sitting with the injured knee extended, wrapped in a bandage or ‘Tubigrip’. They’re often accompanied by a set of crutches.
A physio will begin to make general observations immediately. Even when being escorted to a consulting room, a physio will be taking note of how a patient is moving and whether the knee exhibits signs of a significant injury.
ACL rupture versus other knee injuries
Once the consult formally begins, we prompt the person to recount the event; how did it happen? Was there immediate swelling (a give-away of an ACL tear versus other knee injuries)? Did you feel a pop or crack? Is there a previous history of knee injury?
Next, a physio will begin to make observations of the knee. An ACL tear will present with a pattern of swelling, known as a haemarthrosis (bleeding within the joint). A haemarthrosis presents as a collection of fluid particularly prominent above the patella (kneecap) and medial knee – see the image below.
Test for an ACL Rupture (Lachman’s Test)
The most reliable test for an ACL is known as the Lachman’s test, in which one hand stabilises the femur (thigh bone) whilst the other drawers the tibia (shin bone) forward. When performing this test, a physio will monitor the following:
- A) Is there more movement than the unaffected side?
- B) Can you ‘feel’ the ligament restricting movement – this is known as the ‘endfeel’. At times, it can be hard to determine the ligaments integrity, but as an experienced therapist you get to know the sensation of a ruptured ligament well.
It’s often accompanied by a sinking feeling because you’re about to tell the patient they’ve sustained perhaps the most infamous sporting injury there is.
What follows the initial diagnosis of ACL rupture is months of rehabilitation; often, surgery is required but despite popular opinion, this isn’t the only management option!
Knee Injury Prevention
At Mallee Physio, we’ve worked hard to ensure we’re up-to-date with the latest research on knee injury prevention and management. If you need us, you know where we are!
Written By: Thomas Anderson
B. Hlth. Sci. M. Physio. Grad. Cert. Musculoskeletal Physiotherapy. (APAM).