athlete. The knee joint will be instate and the athlete will have joint pain on the inner (medial) side of the knee. With most injuries the type of movement will help to determine the injury: "I twisted to the right." etc. An experienced clinician can diagnose an ACL tear with relative accuracy by a manual examination. X-ray examination and Magnetic Response Imaging (MRI) are also used in diagnosing ACL injuries. Doctors or trainers can use three different types of physical examination to test for ACL injuries: Lechman's test, Anterior drawer test, and Pivot shift test of MacIntosh. Lechman's test is performed by having the athlete lay on his/her back, then passively flexing the knee of the athlete to between 20 degrees and 30 degrees. The hamstring has to be relaxed or it can produce false test result. Holding the lower part of the athlete's thigh in one hand and the upper part of the calf in the other, then slowly pulling the tibia forward. Increased looseness in the knee joint is indicative of an ACL injury. During the Anterior drawer test the athlete lies on his/her back with the knee bent to 90 degrees and the foot resting on the table. Stabilizing the foot by either sitting on it or having someone else hold it down, the examiner will place his /her hands around the upper part of the calf with thumbs on the end of the thigh bone (tibial condyles), slowly applying pressure on the posterior side of the tibia. Any looseness in the joint could indicate ACL injury.The Pivot shift test of MacIntosh is done by having the athlete lay on his/her back. The foot of the injured side is lifted with the leg straight and the foot turned inward. Pressure is applied to the outside of the knee while the knee joint is slowly bent. An ACL injury is detected if the tibia moves out of joint at 30-40 degrees or if a clunk is felt. One should note that this test can be very painful for the athlete. All three of these tests are very similar, however, the...
