A 22-year-old intramural soccer player presents to the clinic complaining of pain, swelling, and instability of her left knee. She states that the night before, she went to turn and felt a pop in her knee. She did not have immediate pain and tried to continue playing. She was unable to continue due to her knee giving out. Most likely diagnosis The patient is presenting with classic ACL tear symptoms. It is not uncommon to lack pain in the acute phase of a tear, but instability is the hallmark sign of an ACL tear. Special Tests The Lachman test is the gold standard to check for ACL tears. An anterior drawer test also helps to determine ACL laxity. It would also be prudent to check a McMurray test to evaluate the meniscus as well. Imaging Considerations Obtaining an x-ray would be important to ensure that there is not a fracture. In adolescents, it is common to have a tibial spine avulsion rather than an ACL tear. An MRI is the definitive imaging for an ACL evaluation because it allows visualization of the soft tissues of the knee. Definitive Treatment ACL reconstruction is the definitive treatment in a young, athletic patient. Unique Population Considerations Some patients can do well without having a surgical ACL reconstruction. Typically, these people are not as active and are slightly older. They can try a course of physical therapy to see how they recover and move to surgical intervention if they are not pleased with conservative measures. Questions: Please answer the following questions providing a rationale for your answers that is supported by the literature credible medical journal, CDC, and cited using APA format (7th edition). Please use in text citations for each question and reference 1) What other information do you want to know from this patient that was not addressed? 2) What are the outcomes for a patient who opts for physical therapy instead of ACL reconstruction? Use the literature to support your answer. 3) How do you want to educate the patient on post-op care after ACL surgery?
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