A 1981 expert narrative by O'Donoghue on diagnosing and treating ACL injury. It reviews knee ligament anatomy, the mechanism of ACL rupture, examination findings, and open surgical repair techniques. It outlines a staged casting and isometric rehabilitation protocol from the pre-reconstruction era.
This paper is a window into pre-reconstruction ACL management and the origin of the eponymous triad you will be tested on. The enduring board point is biomechanical: the ACL is the primary restraint to anterior tibial translation, and an intact MCL can compensate enough to give a falsely stable drawer. When you examine an acute knee, always compare to the contralateral side.
O'Donoghue's triad (MCL, medial meniscus, ACL) remains a high-yield association from a cutting injury with medial-side instability. Recognize that his core recommendation, early open primary suture repair within 2 weeks, has been largely supplanted by reconstruction because midsubstance tears heal poorly. Modern data showed primary repair of the intrasubstance ACL fails.
The useful clinical instinct that survives is diagnostic: a pop plus acute hemarthrosis after a pivot injury means ACL until proven otherwise.
A 1981 expert narrative by O'Donoghue on diagnosing and treating ACL injury. It reviews knee ligament anatomy, the mechanism of ACL rupture, examination findings, and open surgical repair techniques. It outlines a staged casting and isometric rehabilitation protocol from the pre-reconstruction era.
This paper is a window into pre-reconstruction ACL management and the origin of the eponymous triad you will be tested on. The enduring board point is biomechanical: the ACL is the primary restraint to anterior tibial translation, and an intact MCL can compensate enough to give a falsely stable drawer. When you examine an acute knee, always compare to the contralateral side.
O'Donoghue's triad (MCL, medial meniscus, ACL) remains a high-yield association from a cutting injury with medial-side instability. Recognize that his core recommendation, early open primary suture repair within 2 weeks, has been largely supplanted by reconstruction because midsubstance tears heal poorly. Modern data showed primary repair of the intrasubstance ACL fails.
The useful clinical instinct that survives is diagnostic: a pop plus acute hemarthrosis after a pivot injury means ACL until proven otherwise.