(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 two of the four LIMP index features should warrant a follow-up with a specialist to confirm (or rule out) an anterior cruciate ligament (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), minimizing 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 of 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 (see table 1).

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Instability episodes following an anterior cruciate ligament (ACL) rupture can lead to secondary meniscus or cartilage injuries.
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This paper shows us how important taking a good subjective history is; like any other clinical skill, taking a history is something that requires practice.

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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