• What it is:
• ACL failure from excessive anterior tibial translation — basically the tibia tries to run off and the ACL can’t hold the line.
• Classic signs:
• Pop
• Immediate swelling (1–2 hours)
• Pivot / cutting mechanism
• Instability
• Difficulty weight-bearing
• Rule-in test:
• Lachman test — NPTE’s #1.
• Rule-out clues:
• Slow swelling → Meniscus
• Posterior sag → PCL
• Medial pain → MCL
• NPTE trap:
• Delayed swelling means NOT ACL.
• Best treatment:
• Early ROM, quads, swelling control, gait normalized.
• Mock question included: Yes — test yourself before you move on.

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