2 day old ACL TEAR Evaluation

Welcome to Ortho Eval Pal, where we help you build confidence in your orthopedic assessment and management skills. Hi, I'm Paul from ortho eval pal and today I'm really excited to show you this young lady and her knee presentation and the first thing I do. I'm going to say to Kylie, thank you for doing this because I really appreciate this, these are the meat potatoes, okay, we get to talk about knee injuries and stuff like that, and that's all great, but I think seeing the real thing It's probably the most educational part of what we do and I hope you really appreciate this content, it's great and again Carolina, thank you for taking the time to do this, how old are you? 14 14 and when did you hurt your left knee on Tuesday.

Two days ago, right, and you were, what were you doing at that time playing football? Okay, and when you were playing, how did it happen? Did someone crash into you? Were you changing direction? He was running behind the goalie to get the rebound. and my foot planted on my knee and bent inwards, well so it didn't bend back or forwards, it was more of an inwards thing, you fell to the ground, yes you did, did you have a hard time getting back up , Yeah? yeah it's okay and it swelled up right away or it swelled a little bit over time it wasn't good so it's been two days where you haven't played since then have you been freezing it a little bit and elevating it?

She didn't have an MRI or no one has checked her yet, she's fine, so with that in mind and when she came in today she also had a bent knee posture. It's a little flexed right now. I can put my hand under his knee. I want to sit down real good, okay, as you can see, she already has a stroke, her knee is warm, okay, this one is nice and cool, this one is nice and warm and she has this bent knee posture. He had an inward position when his knee gave way and his foot was planted, okay, that's very important because as you'll see in a moment, as we continue to test, we suspect something and this presentation really paints a good picture, so the first thing I want to do is go. to ask her to lie down on the table I just want to see how well I can straighten her and as you can see she obediently straightens up here when I do this this isn't that comfortable is it? and that's because it's full of effusion and that puts your knee in this loose position, so we have an intra-articular effusion that tells us that something inside the joint is bleeding and swelling, which is causing your knee to not straighten very well, right? can you tighten this muscle?

Can you push? Place your knee on the table, see how hard it is for her to do that, what if she keeps squeezing too hard? She squeezes really well and the kneecap moves up, so she has some quads that disable reflex inhibition. How far can you slide your heel towards your Slide it down back about 95 degrees and where do you feel the pain at the top? And that's because it's so full that it pushes up, okay, so we'll let you go down if I spread you out a little bit. A little pain isn't bad, so I'm going to do a couple of special tests and just talk to you about what we found and where we go from here, so the first thing I'll start with is just to see.

If you have any collateral instability we will do a simple Darris and valgus stress test. I'm going to start with zero degrees, a zero degree valgus stress test, okay, so I'm going to keep it full extension. Give it a little push inward, I don't notice any instability, you have any pain with that, no, I'm going to flex it to about 30 degrees and I'm going to do the same, I'm going to give it a little push inward, okay? now I'm going to take it outside and take it to 0 and when I hold it at 0 and make this very stressed sound, look to see if it has any capsular instability, I'm not going to push it too much. of instability there is no opinion with that it's okay now I'm going to lower it to 30 degrees I'm going to do the same a little bit of laxity but I already tried the other leg and it has the same amount of laxity and that doesn't It doesn't hurt, is that okay?

Great, now I know you have fluid all over your knee, so trying to assess if you have a meniscus

tear

is going to be very difficult with so much swelling because I can't fully flex it, so doing the MacMurray test may not be great in Right now, the good thing I'm going to do is a Lachman test. Well, this is where I really want the patient to relax. Well, I'm going to hold her femur and we'll keep it at about 20 or 25 degrees. Your left hand will be under her tibia. Okay, now relax that leg. I'm going to give a little anterior tug and notice that we have some anterior instability.

There is no good ending point either. I don't feel an end point, so I'm I'm going to sneak up on the other leg and show you what that other leg looks like so we can compare, so I want you to relax, you feel the difference, okay, you feel like this one has a punch. , okay, and I Don't do this extra excursion, so come back this way if you can't handle the leg very well with your hands, put that leg right on your thigh, give it a little stability here and it will be a lot easier. a little tug before and it's very subtle.

I watched the excursion and I don't understand a final point, so we highly suspect that this young woman has a torn ACL. We have already spoken to her and her father about it at this stage. game we need to order an MRI and recommend seeing an orthopedist, but what we're going to do is work to get rid of the swelling, elevate it by doing some compression, re-educate this quadriceps because if she needs to have the surgery, she's going to need a lot of quads. and a lot of balance, so we're going to work on getting you started with PT from here, though thank you so much for watching and listening to this video, feel free to leave any questions or comments and if you have any other questions, please contact me at WWF eval calm.

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