[Golden Oldie] The use of history to identify anterior cruciate ligament injuries in the acute trauma setting: the 'LIMP index'

Review written by Dr Christina Le info

Key Points

  1. Having 2 of the 4 LIMP index features should warrant a follow-up with a specialist to confirm (or rule out) an ACL injury.
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BACKGROUND & OBJECTIVE

Instability episodes following an anterior cruciate ligament (ACL) rupture can lead to secondary meniscus or cartilage injuries (1,2). Therefore, if we can diagnose an anterior cruciate ligament (ACL) injury in a timely manner, we can educate patients on what is safe and not safe to do (e.g. no running, jumping), we can minimize additional structural damage to the knee joint.

Acute ACL injuries may be difficult to assess due to pain and swelling. However, many studies have discussed a core set to subjective or history-taking questions that we could ask to make this diagnosis without needing to check one’s Lachman. This study examined the diagnostic accuracy of four injury features commonly associated with ACL injuries: _L_eg giving way, _I_nability to continue activity immediately following the injury, _M_arked swelling/effusion within 6 hours, and hearing and/or feeling a _P_op – otherwise known as the LIMP index.

Instability episodes following an anterior cruciate ligament (ACL) rupture can lead to secondary meniscus or cartilage injuries.
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As physiotherapists, we are often the first line of medical care for a sports knee injury, therefore asking patients the right questions and listening to their answers is a very important clinical skill.

METHODS

This study employed a self-designed questionnaire across multiple sites in the NHS system in the UK. Patients with ACL injuries were prospectively identified and asked to complete the survey. Patients were eligible to participate if they had attended a specialist-led

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