Arthroscopic Assessment

Arthroscopic assessment of the anterior cruciate ligament tear is difficult for two reasons. First, it is hard to see the ligament without removing the synovium and fat pad. Second, it is only an estimate of the degree of tearing of the ligament. It seems to be best to try to estimate

Figure 3.2. The MRI imaging of the ACL tear.
Figure 3.3. The laxity of the ACL is demonstrated with a probe.

whether the tear is less than or greater than 50%. A hook probe must be used to examine the ligament proximally to see where the ligament is attached—to the side wall, the roof, or the posterior cruciate ligament. The best position is the side wall at the normal site of the anterior cruciate ligament. The most common situation is to see the ligament attached to the posterior cruciate ligament.

Figure 3.3 shows the appearance of the ligament proximally. It has attenuated to a small band attached to the side wall. This may give a 1+ Lachman test and a negative pivot-shift test, but would not stand up to vigorous pivoting activities. Figure 3.3 also shows the use of the probe to examine the ligament proximally. This example is lax, but is less than 50% tear. This amount of ligament laxity should allow a return to sports without a reconstruction.

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