Anterior Cruciate Ligament Rupture Case File

https://medical-phd.blogspot.com/2021/03/anterior-cruciate-ligament-rupture-
case.html

Author: Eugene C. Toy, MD, Lawrence M. Ross, MD, PhD, Han Zhang, MD, Cristo
Papasakelariou, MD, FACOG

CASE 7
A 25-year-old woman is on her first ski trip to Colorado. She has advanced from the
bunny (gentle) slopes and, during the last run of the day, falls and twists her right leg.
She cannot stand on her right leg because of pain and is brought down the hill in a
snowmobile. On examination, the right knee is swollen and tender. With the patient
sitting on the stretcher with her knee flexed, the lower leg seems to have several
centimeters of excess anterior mobility.

⯈ What is the most likely diagnosis?

⯈ What is the mechanism of the injury?

ANSWER TO CASE 7:

Anterior Cruciate Ligament Rupture

Summary: A 25-year-old woman twists her right lower limb in a ski accident. She has
right knee swelling and tenderness, and excessive anterior mobility with the knee
flexed.
• Most likely diagnosis: Anterior cruciate ligament (ACL) tear
• Mechanism of injury: Excessive rotational force strains or ruptures the ligament

CLINICAL CORRELATION
Injuries to the knee are very common because it bears weight, combines mobility in
flexion and extension, and allows some rotation. The stability of the knee depends
entirely on its ligaments and muscles. Sports injuries to the knee are most commonly
caused by high-speed and rotational forces applied to the leg through the knee joint. In
addition, certain ligaments are anatomically related to the menisci, on which the distal
femur articulates. This 25-year-old woman was involved in a ski injury, a common
setting for ACL injury. The twisting force to the lower limb when a ski becomes
lodged in snow and the body continues to rotate can produce significant trauma to the
knee. The ACL passes from the posterior aspect of the distal femur to the
intercondylar region of the anterior aspect of the proximal tibia; it limits anterior
movement of the tibia in relation to the femur. Thus, on examination, this patient
exhibits the “anterior drawer sign,” or excessive anterior mobility of the tibia with the
knee flexed. This injury will usually require surgical repair.

APPROACH TO:
The Knee Joint

OBJECTIVES
1. Be able to describe the anatomy of the knee joint, including the bones, ligaments,
possible movements, and muscles responsible for these movements
2. Be able to describe the mechanism of injury to the four main ligaments of the knee

DEFINITIONS
Knee: Hinge joint between the femur and proximal tibia
Patella: A triangular bone approximately 5 cm in diameter situated in the front of the
knee at the insertion of the quadriceps tendons
Meniscus: Crescent-shaped intraarticular cartilage