The patient was a 27-year-old man with an acute onset of right knee pain, subsequent to a twisting injury that occurred while playing soccer earlier in the day. He was evaluated via direct-access physical therapy 5 hours after the injury. He did not report giving way and locking, but did report feeling a "pop" upon injury. Based on the patient's history and physical examination findings, the therapist was concerned about the possibility of anterior cruciate ligament disruption and medial meniscus tear. The physical therapist ordered conventional radiographs to rule out bony pathology and magnetic resonance imaging of the right knee to assess for internal derangement. The conventional radiographs of the knee were interpreted as normal, while the radiologist's report from the magnetic resonance imaging was significant for an anterior cruciate ligament tear and bucket handle tear of the medial meniscus. The patient was referred to an orthopaedic surgeon and subsequently underwent surgical reconstruction of the anterior cruciate ligament.

J Orthop Sports Phys Ther 2009;39(10):766. doi:10.2519/jospt.2009.0412

KEY WORDS: knee, magnetic resonance imaging, radiograph