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Please help! (torn ACL or Sprained? - Page 2

post #31 of 34
Quote:
Originally Posted by hbear View Post
 

A Sprain is a tear....it's the severity that matters.  Grade 1 through 3, with 3 being a complete rupture that can only be fixed with reconstruction.  

(Sprains are tears to ligaments, Strains are tears to muscle/tendon)

 

ACL is EASY for a physio/Athletic Trainer/ortho to test.  Can literally figure things out in less than a minute provided your hamstrings aren't crazy tight and resistive to the testing.  

 

After hearing your history and the mechanism of injury, the 2 main tests are the Anterior Drawer and Lachman's drawer.....no you can't do them to yourself (even if you know what your are doing).

The MRI is used to confirm but remember something like a 95% accuracy level using the ACL tests mentioned. They'd also perform PCL tests (like posterior sag and the like) to also check PCL quality....although even if ruptured, the PCL doesn't get reconstructed....not worth it as it's function is limited anyway.

 

Go see somebody that specializes in sport medicine.  Didn't get where you live, but pretty much all University's/Colleges with sport programs have MANY qualified professionals to assist. There usually is a sport med clinic on campus. Even a 1st year physio student could figure it out.  If that fails I'm sure the National Athletic Trainer's Association (NATA) should have a database of it's members you can search.  

 

I used to be a Sport Physio and Certified Athletic Therapist/Trainer (Trainer was my American equivalent through the NATA which I held membership with as well) (as well as an Exercise Physiologist) in a previous life, working with a number of national programs up here in Canada if that provides any context.  


There is a simple test you can can do with a help of a friend, it's called LELLI. if your ACL is gone it will be positive.

post #32 of 34
Not familiar with that test. Looks like looking for the signs of instability vs. getting a sense of the end feel. I'd prefer using the drawer tests as they are less violent and won't give off false positives given the feedback the professional can get from the end feel.

A knee can show unstable but still have an end feel....which is critical in determining prognosis and course of action.

Thanks for the share.

As for swelling, yes excessive swelling/fluid can impede testing. Normally it's the time after a hour or so after injury and a couple days where this normally happens. After that the majority or time we can still find the end feel (stop sensation from the ligament stopping further progression of the limb) so if we don't find it the ligament is gone. Determining grade 2 or 2+ is more challenging, but usually easy to tell if it's gone (grade 3).
post #33 of 34
Quote:
Originally Posted by hbear View Post

Not familiar with that test. Looks like looking for the signs of instability vs. getting a sense of the end feel. I'd prefer using the drawer tests as they are less violent and won't give off false positives given the feedback the professional can get from the end feel.

A knee can show unstable but still have an end feel....which is critical in determining prognosis and course of action.

Thanks for the share.

As for swelling, yes excessive swelling/fluid can impede testing. Normally it's the time after a hour or so after injury and a couple days where this normally happens. After that the majority or time we can still find the end feel (stop sensation from the ligament stopping further progression of the limb) so if we don't find it the ligament is gone. Determining grade 2 or 2+ is more challenging, but usually easy to tell if it's gone (grade 3).

 

The “Lever Sign”: a new clinical test for the diagnosis of anterior cruciate ligament rupture

Knee Surgery, Sports Traumatology, Arthroscopy. 2014

Quote:

Results

All tests were nearly 100 % sensitive for patients with chronic, complete tears of the ACL. However, for patients with acute, partial tears, the sensitivity was much lower for the Lachman test (0.42), Anterior Drawer test (0.29), and Pivot Shift test (0.11), but not the Lever Sign test (1.00).

Conclusion

In general, chronic, complete tears were most successfully diagnosed but acute, partial tears were least successfully diagnosed. The Lever Sign test is more sensitive to correctly diagnosing both acute and partial tears of the ACL compared with other common manual tests. The clinical relevance is that some ACL ruptures may be more accurately diagnosed.

 

It's not very popular yet, but it seems to be a solid test (pending more research) I think it should be added to any ACL battery of tests! Thumbs Up Also, it is not as "violent" as it looks, there a video of the original surgeon doing it on in the OR and that looks a lot worse than this video. In reality you used about the same amount of force as a lachman, it just looks more intense because it's "dynamic".

I agree on everything else! 

post #34 of 34

Very cool, nice to see continual progression in medicine.....it's not often a new test/sign is created these days so thanks for the share.

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