Delay in diagnosis of anterior cruciate ligament injury in sport.
OBJECTIVE
To determine the rate and timing of diagnosis of anterior cruciate ligament (ACL) injuries and to identify the diagnostic features.


METHODS
70 patients injured in sport with isolated ACL tears, who had received or were awaiting reconstruction, answered a telephone questionnaire about the history of injury and timing of diagnosis.


RESULTS
55 (79%) presented to a doctor within 24 hours of their injury. Eleven (16%) reported that their ACL injury was diagnosed correctly at initial presentation by the first doctor they saw. 34 (49%) saw two doctors, and 25 (36%) saw three or more doctors before the diagnosis was made. The mean time to correct diagnosis was two months after the injury. Specific questioning revealed that at the moment of injury 54 (77%) felt that the knee had been disrupted, 30 (43%) sensed a snap, and 26 (37%) a pop. 41 (59%) reported that when correctly diagnosed, little or no advice had been given to them about modifying their sport.


CONCLUSIONS
Despite the injured athletes presenting early, diagnosis was usually made late. Most often, multiple doctors were consulted. Even when correctly diagnosed, patients were usually not given clear advice about sports modification to prevent recurrent ACL instability. The history of injury was commonly strongly suggestive of ACL tear. Popping and snapping are known to be commonly associated, and a sense of knee disruption was even more common than either in this series. These characteristic sensations should be sought by doctors by specific questioning to increase diagnosis rates.
Wellington School of Medicine.
N
N
Hartnett
R J
RJ
Tregonning
D000293:Adolescent; D000328:Adult; D000070598:Anterior Cruciate Ligament Injuries; D001265:Athletic Injuries / Q000175:diagnosis*; D002983:Clinical Competence; D003951:Diagnostic Errors; D005260:Female; D006801:Humans; D008297:Male; D011795:Surveys and Questionnaires; D013997:Time Factors