Diagnosing ACL tears
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This weekend at UFC 246 there was an unusual physician call during @mayceebarber vs @roxyfighter . During the first round Barber suffered a knee injury and between rounds the physician assessed her knee and diagnosed a “small ACL tear” and that she was “fine to continue”. Barber continued the fight but ultimately lost a decision.
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After the fight MRI results were positive for a complete ACL tear and that Barber would require ACL reconstruction surgery.
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My thoughts on this exchange:
The gold standard for diagnosing ligament injuries is a MRI, however clinicians can perform orthopedic tests to see if there is a likelihood of ligament pathology. .
The physician performed two orthopedic tests: Lachman’s test and Anterior drawer. Both tests assess the amount of anterior translation of the tibia on the femur. The ACL is the primary constraint to this motion, therefore increased movement is associated with ligament pathology.
•Lachman: 77.7% Sensitivity. 95% Specificity. •Anterior drawer: 22.2% Sensitivity. 95% Specificity.
High specificity means they are good at avoiding false negatives, but the accuracy is not 100%.
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An important note is that the hamstrings are secondary stabilizers for anterior translation, the movement performed in these orthopedic tests. Hamstring guarding can cause a false negative (the injury appears negative but actually was positive). Between rounds a fighter is trying to drop their HR as quick as possible to prepare for the next round, likely she had significant muscle guarding which affected the test.
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Remember the role of a ringside physician is to decide if a fighter is fit to continue. The physician was attempting to determine how unstable the knee was. A clearly unstable knee and he may have called off the fight but in that moment the knee did not appear to have significant laxity therefore he let the fight continue. While he was wrong about the diagnosis his thought process was correct. .
I expect a 9 to 12 month recovery before we see Barber return to the Octagon after surgery.