Clinical Evaluation of ACL Tear

Abstract

The anterior cruciate ligament (ACL) is a structure that serves to control both anterior translation of the tibia on the femur and rotation of the knee joint. Tears of the ACL are commonly sustained by a noncontact pivoting movement, while the foot is planted with the knee in slight flexion (Tjoumakaris et al. Am J Orthop, 40:92–7, 2011; McConkey et al. Curr Rev Musculoskelet Med 4:37–44, 2011; Mall and Paletta Curr Rev Musculoskelet Med 6:132–40, 2013). Historically it was believed that true midsubstance tears of the ACL were uncommon in pediatric patients and limited to adults, but recent studies have shown increasing numbers of these injuries in young populations (Andrews et al. Am J Sports Med 22:48–54, 1994). This chapter discusses the sentinel exam tests of the clinical evaluation that are important in reaching an accurate diagnosis in a pediatric patient with an ACL tear. Most importantly, all available information including patient history, physical exam, imaging studies, and any available arthrometric measurements should be considered together in order to reach the diagnosis. Understanding the most important factors in clinically evaluating ACL tears in pediatric patients will ultimately help to identify and treat patients with these injuries more efficiently and effectively.