Abstract
Traditionally, anterior cruciate ligament (ACL) injuries have been difficult to diagnose in the Casualty Department. Studies have shown that the anterior drawer test has a poor sensitivity both in acute and chronic ACL deficient knees [4, 6, 9]; thus, more emphasis has been placed on the pivot shift and Lachman tests [3]. We report four cases of proven ACL rupture where clinical examination revealed an absent pivot shift and a near normal Lachman test following a displaced bucket handle tear of the medial meniscus. This finding has been reproduced in cadaver studies, and we conclude that if the history strongly suggests an ACL injury and examination reveals a stable knee, then the dual pathology of medial meniscus tear and ACL rupture should be suspected.
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Bargar WL, Moreland JR, Markolf KL et al. (1980) In vivo stability testing of postmeniscectomy knees. Clin Orthop 150:247
Daniel D, Akeson W, O'Connor J (1990) Knee ligaments. Structure, function, injury and repair, 1st edn. Raven Press, New York, p 481
Galway HR, MacIntosh DL (1980) The lateral pivot shift: a symptom and sign of anterior cruciate ligament insufficiency. Clin Orthop 147:45
Katz JW, Ringeroth RJ (1986) The diagnosis accuracy of ruptures of the anterior cruciate ligament comparing the Lachman test, the anterior drawer sign and the pivot shift test in acute and chronic knee injuries. Am J Sports Med 14:88–91
Levy IM, Torzilly PA, Warren RF (1982) The effect of medial meniscectomy on anterior posterior motion of the knee. J Bone Joint Surg [Am] 64:883
Mitson A, Vallianatos P (1988) Clinical diagnosis of ruptures of the ACL: a comparison between the Lachman test and anterior drawer sign. Injury 19:427–428
Müller W (1983) The knee: form, function and ligament reconstruction. Springer, Berlin Heidelberg New York, p 2
Noyes FR, DeLucas JL, Torvik PJ (1974) Biomechanics of ACL ligament failure. II. An analysis of strain rate sensitivity and mechanisms of failure in primates. J Bone Joint Surg [Am] 56:236
Torg JS, Conrad W, Kalen V (1976) Clinical diagnosis of anterior cruciate ligament instability in the athlete. Am J Sports Med 4:84
Welsh RP (1980) Knee joint structure and function. Clin Orthop 147:7
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Kong, K.C., Hamlet, M.R., Peckham, T. et al. Displaced bucket handle tears of the medial meniscus masking anterior cruciate deficiency. Arch Orthop Trauma Surg 114, 51–52 (1994). https://doi.org/10.1007/BF00454738
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DOI: https://doi.org/10.1007/BF00454738