[Surgicalcric]

Well since it does not appear anyone else is going to give it a shot.

1. Three main noncontact MOI's are: planting and cutting or twisting, straight-knee landing, and one-step stop landing with the knee hyperextended. Of the three listed planting and cutting is most common.

2a. Examine injured knee after uninjured side has been examined and use this as a guide. Acute swelling with position of comfort flexed. Limited active range of motion will be present in the majority of cases. This can be caused by effusion, miniscal tear, entrapment of torn ACL, and/or hamstring spasm. Intra-articular effusion is readily apparent and results in symmetrical swelling of the entire knee. Tenderness on palpation should be present over the medial and lateral joint lines (for meniscal injury) and the medial and lateral femoral epicondyles, adductor tubercle, and proximal medial tibia (for ligament attachments). Major tendons of the knee (patellar, quadriceps, popliteal, and hamstring) should also be palpated for tenderness and swelling.

2b. Lachman's test is the most reliable indicator of ACL integrity and the Anterior Drawer test to a lesser degree. It should be noted though Anterior Drawer is rarely used in the acute setting do to effusion and guarding by patient. It is considered positive if excursion is larger on the injured side, or if no end point is reached. False negatives can occur with spasms or a displaced bucket-handle tear of the meniscus.

Posterior subluxation of the tibia with the knee in 90° of flexion (a positive sag sign) indicates PCL tear.

The MCL and LCL are commonly evaluated by applying varus and valgus forces to each knee at 0° and 30° of flexion. Significant displacement or "opening up" of the joint under stress or loss of a distinct end point denotes a positive test. In full extension, a positive test indicates a severe capsular injury in association with collateral ligament disruption.

McMurray's and Apley's tests are performed to detect or exclude meniscal injury. Both tests are considered positive if a painful pop is felt during manipulation and palpation of the knee.

3. Splint leg in the position of comfort, ice, MS for pain.

4. I do not have an informed opinion as to which method is best but I will note the surgical intervention I am aware of.

Patellar Tendon Allograft
Achilles Tendon Allograft
Gortex Implant
Double Loop Hamstring Graft- I have heard this is the new thing for ACL reconstruction as it is 2x stronger than original ACL and 1.3x stronger than Patellar Grafts. I would suppose I would have to go with this one.