Question
A 22 year old netballer twisted her knee landing from a jump, felt a pop and had immediate swelling. Three weeks later the knee gives way.
- What is the likely diagnosis and how would you confirm it?
- What associated injuries would you look for?
- Outline your management, including graft choice.
Answer
Diagnosis
- Anterior cruciate ligament rupture, typically from a non-contact pivoting injury
- Haemarthrosis within hours suggests ACL rupture in most adults
- Positive Lachman test (most sensitive), anterior drawer and pivot shift tests
- MRI confirms the tear and associated injuries, and a Segond fracture on radiographs is pathognomonic
Associated injuries
- Meniscal tears, lateral more often acutely and medial in chronic ACL deficiency
- Ramp lesions of the posterior medial meniscus
- Bone bruising of the lateral femoral condyle and posterolateral tibial plateau
- Collateral ligament and posterolateral corner injuries
- Chondral injuries
Management
- Prehabilitation to regain motion and quadriceps control before surgery
- Reconstruction for active patients with pivoting sports or instability, while some lower demand patients do well with rehabilitation alone (KANON trial)
- Hamstring or quadriceps tendon autograft, or bone patellar tendon bone autograft with more anterior knee pain
- Anatomic tunnel placement
- Lateral extra-articular tenodesis reduces graft failure in young high risk patients (STABILITY trial)
- Return to sport after about 9 to 12 months with passed functional testing
Related pages
Author Contributions
Orthofracs team
Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.