Hi I’m Dr. Eric Janssen with Sportsmed Orthopedic Surgery and Spine Center in Huntsville Alabama. today’s tutorial is an office examination for an ACL sports injury The patient is a fifteenyearold competitive soccer player who recently reinjured her right knee which had had a prior ACL reconstruction She now has an unstable knee again After initial evaluation in the office we ordered an mri she’s now back in to review that with us and then we’ll go ahead proceed with her physical examination to demonstrate how we diagnose an a c l tear in a clinical exam.
So this is called a lachman’s exam where we flex the knee up to about 90 degrees hold with the outside hand on the femur and the inside hand on the tibia and move that knee back and forth We feel for a solid endpoint You can see there’s not much motion as we’re looking at the joint line right here where my thumb is. and she’s got a very solid feel to that. Now we have the patient positioned where we can demonstrate the injured knee where she has torn this anterior cruciate ligament.
The same thing we will flex the knee to 90 degrees you can see as we move the knee how much play is in that knee as the tibia comes forward The other thing I wanted to show is called the pivot shift maneuver we let the leg hang down and extend we have the patient relax we turn in the foot just a little bit then we try to shift the knee. Now this is normal where the tibia against the femur just glides up and down and doesn’t shift.
ACL Exam Lachmans Test, Pivot Shift, Drawer Test performed by Dr. Eric Janssen
Which I will be able to demonstrate on her injured knee we talked about the pivot shift manuever as we come up, you can see the tibia jump against the femur Here her knee is subluxed and her it is reduced another thing you can do is called a drawer test at 90 degrees we will hold the knee and get the hamstrings to relax and try to pull forward you need to make sure you have the knee pushed back when you attempt to do that As you can see, this knee is very solid.