d7 - sami2004

[ArchivalUser]

An 18-year-old female gymnast lands her dismount
from the balance beam awkwardly. She reports the
knee buckling, hearing a pop and experiencing immediate
right knee pain. She presents to your office
45 minutes after the injury. She is able to bear some
weight on the leg but reports it is already swollen and
feels loose. On exam there is a knee effusion present.

The MOST likely isolated injury experienced by
this athlete is:
A) Medial meniscus tear.
B) Medial collateral ligament (MCL) sprain.
C) Distal quadriceps/patellar tendon rupture.
D) Anterior cruciate ligament (ACL) rupture.
E) None of the above

[ArchivalUser]

D) Anterior cruciate ligament (ACL) rupture.

[ArchivalUser]

d.

[ArchivalUser]

aa

[ArchivalUser]

D IS THE ANSWER

[ArchivalUser]

d............

[ArchivalUser]

The correct answer is D. Did the patient or someone
else hear a pop? If yes, suspect ACL tear (80%), meniscal
injury (15%), and rarely a fracture. When did you
notice swelling? If 0–12 hours after the injury, suspect
ACL tear or patellar dislocation/subluxation; if 12–24
hours, suspect meniscal injury. If there is hemarthrosis
on aspiration, suspect ACL injury (greater than 75%), patellar subluxation,
or intraarticular fracture. A history of “My
knee gives way; buckles; feels loose; or comes apart”
may be secondary to patellar subluxation/dislocation,
ACL deficiency, or arthritis. Collateral ligament injuries,
MCL, or lateral collateral ligament (LCL) do not typically
present with significant effusion and typically feel
stable with forward ambulation but are painful with sideto-
side movements. Muscle or tendon rupture may
cause buckling, but will not typically cause effusion and
will generally have an obvious deformity and inability to
bear weight.