53 y.o. male skier with a history of falling backwards after catching the tip of his ski on a mound of snow. He complains of medial R knee pain that is mild, and a sense of marked instability of the R knee.
Here is the video of his exam (about 3 MB file, so may take time to download):
The Lachmann test.
ACL tears are the most common ligament injury seen in skiers. A combined ACL and MCL tear are the next most common. Tibial plateau fractures make up about 22% of acute knee injuries in skiers, so be sure to look carefully at the plateau on your plain films. Often a CT or MRI is needed to diagnose the plateau fractures and it should be considered if no ligament injury is found in an acutely swollen knee.
Yes, the patient age, mechanism and exam warrant further evaluation. An ACL tear with an avulsion of the ACL off the tibia or femur should be repaired early to allow bone to bone healing to occur and possibly avoid the need for an ACL graft.
Knee immobilizer for stability and comfort, ice, short term use of NSAIDs will reduce swelling. Orthopedic consultation should be ordered as well.
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