Complete Anterior Cruciate Ligament Rupture with a Nondisplaced Lateral Tibial Plateau Fracture in a Recreational Skier: A Case Report

A 28-year-old male recreational skier presented to a chiropractic office one week after a sudden twisting injury to his right knee while skiing downhill. He reported hearing a “pop” with immediate pain, followed by swelling, stiffness, a sense of instability with the knee giving way, and inability to bear weight; he rated his pain 9 on a 0 to 10 scale. Examination showed an antalgic limp, right knee effusion and reduced passive range of motion. Lachman’s test, the anterior drawer test, Apley’s compression test and the Lever sign were positive, McMurray’s test was negative, and lower extremity reflexes and sensation were normal. Magnetic resonance imaging (MRI) confirmed complete disruption of the anterior cruciate ligament (ACL), with bone marrow edema and a nondisplaced fracture of the posterior lateral tibial plateau and a small cartilage defect of the lateral femoral condyle; the menisci and the remaining ligaments and tendons were intact. Palliative care with electrical stimulation, ice and myofascial release was provided, and, given his age, activity level and goals, the patient was referred to an orthopedic surgeon, who recommended surgical reconstruction using a semitendinosus autograft. This case report outlines the common mechanism of injury, clinical presentation, diagnostic process and management options for ACL tears in young, active patients, and the roles of clinical examination and MRI in guiding timely referral.