Anterior Cruciate Ligament

Question 1

Is anterior cruciate or posterior cruciate more common injury

Answer 1

Anterior cruciate ligament injury

Question 2

ANATOMY

What do anterior and posterior cruciate attach to

Answer 2

Anterior - anterior intercondylar area on tibia and lateral intercondylar notch on femur

Posterior - posterior intercondylar area on tibia and medial intercondylar notch on femur

Question 3

ANATOMY

What is intercondylar area

Answer 3

Area between medial and lateral condyles of tibia

Question 4

What does each ligament prevent

Answer 4

Anterior - tibia from sliding forwards in relation to femur

Posterior - tibia from sliding backwards in relation to femur

Question 5

AETIOLOGY

Risk factors

Answer 5

• Acute trauma
• Poor technique for landing
• History of injury
• Fatigue
• Ground condition/weather

Question 6

CLINICAL FEATURES

Presentation

Answer 6

• Typically damaged during twisting injury of knee causing
  
  • Pain
  • Swelling
  • Pop sound or sensation
• Instability of knee joint, tibia moving more anteriorly below femur

Question 7

2 special tests

Answer 7

Anterior drawer test

Lachman test

Question 8

What is anterior drawer test

Answer 8

• Patient supine with hips 45 degrees and knees 90 degrees, with foot flat on couch
• Examiner sits on patients toes to stabilise foot, hold leg just below knee and pull proximal tibia anteriorly sliding it forward from femur
• In normal knee there be slight anterior movement of proximal tibia, with damage moves excessive amount

Question 9

What is Lachman test

Answer 9

• Similar to anterior drawer test but knee is tested while flexed at around 20-30 degrees

Question 10

INVESTIGATIONS

First choice

Answer 10

• MRI scan - first line imaging investigation for diagnosis
• Arthroscopy - can be used to visualise ligament and gold standard investigation for diagnosing ligament tear

Question 11

MANAGEMENT

General principles

Answer 11

• Conservative management
• Analgesia
• Crutches and knee braces
• Physiotherapy
• Arthroscopic surgery

Question 12

MANAGEMENT

Conservative management

Answer 12

• Remember RICE
  
  • Rest
  • Ice
  • Compression
  • Elevation

Question 13

MANAGEMENT

First line analgesia

Answer 13

Usually always NSAIDs for MSK injuries

Question 14

What is arthroscopic surgery

Answer 14

• New ligament formed using graft tendon from another location
  
  • Hamstring tendon
  • Quadriceps tendon
  • Bone-patellar tendon-bone