 Question: How does the doctor diagnose an ACL injury? Answer: All exams will initially begin with the physician taking a history of the injury from the patient. Here the physician will be trying to determine if the signs and symptoms of an ACL injury are present.
The history will then be followed by a physical exam of the knee. The physician will then perform several manual tests to determine if the ACL is intact or the amount of instability present. Additionally, the physician will examine for other ligaments and structures around the knee that may have been injured as well.
The manual tests for ACL integrity determine how much the tibia moves in relation to the femur. The exam directly tests the integrity of the ACL.
In the early stages of an acute knee injury, pain, swelling, and muscle spasms may make it difficult for both the doctor and patient to perform the needed manual tests. In these cases, several options exist. Sometimes a few days of ice, elevation, and rest will help decrease the swelling and muscle spasm, allowing the doctor to perform that manual exam. Other options include using an arthrometer, which measures joint "looseness" in millimeters.
Diagnostic studies are also used in conjunction with the patient's history and physical exam. These tests include plain X-rays, which cannot identify an ACL injury directly, but can diagnose associated conditions or other pathology which might present like an ACL. Examples of pathology which can be seen on X-ray include: bone fractures, chips, and arthritis. An MRI (magnetic resonance imaging) is used to look at soft tissues surrounding the knee, such as ligaments, tendons, and cartilage. An MRI is a diagnostic non-operative or invasive procedure, which allows the orthopaedist to assess the amount of damage present to the soft tissues inside and around the knee, including the ACL.
If, after the history, physical exam and correct diagnostic imaging studies have been performed and the diagnosis continues to remain in doubt, a diagnostic arthroscopy may be recommended. During this invasive procedure, a tiny fiber optic lens (or arthroscope) connected to a video system is directly inserted into the knee joint through a 4-millimeter incision. The arthroscope allows the orthopaedists to directly examine and assess the inside of the knee joint and the damage to the soft tissues. However, in the vast majority of cases, a diagnosis can be made without performing this surgical procedure.
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