Ultrasound in Emergency Medicine
Diagnosis of Simultaneous Acute Ruptures of the Anterior Cruciate Ligament and Posterior Cruciate Ligament Using Point-of-Care Ultrasound in the Emergency Department
Abstract
Background
Patients with acute
anterior cruciate ligament(ACL) and posterior cruciate ligament (PCL) injuries from sport-related activities are frequently seen in the emergency department (ED). However, knee instability tests are known to show variable sensitivity and specificity. These tests would also have limited functionality in patients with severe pain and swelling in the knee.
Case Report
A 19-year-old female judo player presented to the ED with severe left knee pain. She had abruptly twisted her left knee while she was shoulder-throwing her opponent. She complained of severe pain and refused physical examination of the knee injury; as a result, evaluation of knee instability could not be performed. However, a point-of-care ultrasound helped in making a prompt and accurate diagnosis of simultaneous, complete rupture and partial ruptures of the ACL and PCL, respectively. The ultrasound findings correlated well with the
magnetic resonance imagingimages in the assessment of the combined ACL-PCL ruptures. The patient underwent simultaneous arthroscopic ACL and PCL reconstruction with a hamstring tendon autograft and was discharged.
Why Should an Emergency Physician Be Aware of This?
Point-of-care
ultrasound imaging of the knee in trauma patients may be helpful for diagnosis of ACL and PCL injuries by augmenting findings of physical examinations in patients with severe pain and swelling in the knee. Ultimately, it may lead to more accurate diagnosis and treatment plans in knee trauma patients.
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