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Anterior Cruciate Ligament ACL injury

  • Initial pre-referral workup

    Clinical history

    When did the injury occur (acute or chronic)?

    What caused the injury (e.g. direct blow, pivoting, cutting, jumping)?

    Does the knee catch, lock or give way?

    Can the patient bear weight?

    Can the leg fully straighten?

    Physical examination

    • swollen knee
    • inability to straighten
    • stiffness
    • anterior/posterior draw
    • pain on palpation


    • plain X-rays (AP, lateral, notch and skyline)
    • consider MRI if clinically suspicious

    GP management

    Rule out acute fracture.

    If fracture is identified, the patient should be assessed at the nearest ED.

    If the patient has acute injury - knee splint, use protected weight bearing with crutches and refer for urgent assessment.

    If the patient has chronic injury, assess for instability symptoms, refer to physiotherapy and for semi-urgent assessment.

    Please instruct patients to bring films to their specialist appointments at the RCH.

    Indications for specialist referral


    • acute locked knee
    • stiff knee
    • significant instability or giving way


    • chronic injury
    • intermittent instability symptoms

    Indications for Escalation

    • increased catching and locking
    • increased pain