Guidelines Summary

AAOS practice guideline for ACL tears

The American Academy of Orthopaedic Surgeons (AAOS) has issued evidence-based practice guideline for the management of ACL tears. Recommendations include the following^[22]:

To protect the knee joint, patients who are surgical candidates should undergo reconstructive surgery within 5 months fafter an ACL injury; however, the evidence for this recommendation is considered to be only moderate.
A relevant history should be obtained and a musculoskeletal exam of the lower extremities performed.
Magnetic resonance imaging (MRI) should be performed to confirm the ACL diagnosis and reveal any associated joint and cartilage problems.
Either autograft or appropriately processed allograft tissue can be used in ACL reconstruction, since measured outcomes for the 2 types of graft have been similar; however, the guideline cautions that such results may not apply in all cases.
Patellar or hamstring tendons should be used in intra-articular ACL reconstruction employing autograft tissue.
A single- or double-bundle technique should be used in intra-articular ACL reconstruction; the 2 techniques have similar measured outcomes.

American Academy of Pediatrics guidelines

The American Academy of Pediatrics released clinical guidelines on the diagnosis, treatment, and prevention of ACL injuries in children and adolescents. Recommendations include the following^[23]:

The best physical examination test for detecting an ACL tear is the Lachman test.
MRI may be necessary in young patients in whom physical examination is not possible because of pain, swelling, and/or lack of cooperation.
ACL tears in pediatric patients are not a surgical emergency, and patients should explore their options.
In young patients who are skeletally immature, measurement of skeletal age with an anteroposterior radiograph of the left hand and wrist and Tanner stage may help guide treatment.
Treatment of ACL injuries often involves surgery and/or months of rehabilitation.
Pediatric patients with ACL tears are at increased risk for early-onset osteoarthritis in the affected knee.
Musculoskeletal changes that affect dynamic joint stability may be the most important factor underlying the higher rate of noncontact ACL injuries in adolescent female athletes; neuromuscular training initiated in early to middle adolescence may reduce their risk.

Medication

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Media Gallery

Anatomy of the knee.
Knee ballottement.
Lachman test.
Anterior drawer sign.
Pivot test.
McMurray test.
Apley compression test.

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Author

David B Levy, DO, FAAEM Senior Consultant in Emergency Medicine, Waikato District Health Board, New Zealand; Associate Professor of Emergency Medicine, Northeastern Ohio Universities College of Medicine

David B Levy, DO, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, Fellowship of the Australasian College for Emergency Medicine, American Medical Informatics Association, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Howard I Dickey-White, MD Teaching Attending Physician, Department of Internal Medicine, St Elizabeth Hospital Medical Center

Howard I Dickey-White, MD is a member of the following medical societies: American Academy of Clinical Toxicology, American College of Emergency Physicians, American College of Physicians, American Institute of Ultrasound in Medicine, Sigma Xi, The Scientific Research Honor Society, Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Trevor John Mills, MD, MPH Chief of Emergency Medicine, Veterans Affairs Northern California Health Care System; Professor of Emergency Medicine, Department of Emergency Medicine, University of California, Davis, School of Medicine

Trevor John Mills, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians

Disclosure: Nothing to disclose.

Additional Contributors

Eric M Kardon, MD, FACEP Attending Emergency Physician, Georgia Emergency Medicine Specialists; Physician, Division of Emergency Medicine, Athens Regional Medical Center

Eric M Kardon, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Medical Association of Georgia

Disclosure: Nothing to disclose.

Acknowledgements

June E Sanson CNRP, MSN Nurse Practitioner, Take Care Health Systems

Disclosure: Nothing to disclose.

Tom Scaletta, MD President, Smart-ER (http://smart-er.net); Chair, Department of Emergency Medicine, Edward Hospital; Past-President, American Academy of Emergency Medicine

Tom Scaletta, MD is a member of the following medical societies: American Academy of Emergency Medicine

Disclosure: Nothing to disclose.