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ANTERIOR CRUCIATE LIGAMENT (ACL) INJURIES
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–For prevention of primary ACL injuries, use training programs designed to prevent injury in athletes participating in high-risk sports.
–Obtain a relevant history and focused musculoskeletal exam of the lower extremities to assess for an ACL injury.
–When surgery is indicated for an acute isolated ACL tear, arrange early reconstruction surgery, as the risk of additional cartilage/meniscal injuries occurs at 3 mo.
–Consider aspiration of painful, tense knee effusions after ACL injury.
–Functional knee braces do not confer any clinical benefit in patients who have received isolated ACL reconstruction surgery.
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Practice Pearl
Although MRI should not be the initial imaging study, it is considered a highly sensitive option in diagnosing soft tissue injuries in those with negative plain radiographs. An accurate diagnosis can then guide surgical treatment, if indicated.
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Practice Pearls
There is insufficient evidence to support physical activity for primary prevention of low back pain. (J Sci Med Sport. 2024;27:257–265)
To prevent patients with acute low back pain who are at high risk of progressing to chronic low back pain, implement the STarT Back program. (Am Fam Physician. 2024;109(3):233–244)
Screening tools to assess the risk of progression from acute to chronic low back pain include the PICKUP score, the Orebro Musculoskeletal Pain Screening Questionnaire, and STarT Back calculator.
Exercise alone or exercise in combination with education is effective for secondary prevention of low back pain. Education alone, back belts, ergonomic interventions, and shoe insoles are likely not effective for both primary and secondary prevention. (JAMA Intern Med. 2016;176(2):199–208)
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►ACP 2017, ICSI 2018, NICE 2020, ACR 2021, WHO 2023
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–Exclude other specific causes of back pain such as cancer, infection, trauma, and inflammatory disease.
–Avoid routine imaging (X-ray, CT, MRI) in patients with nonspecific or radicular low back pain (LBP) without red flag symptoms.
–Obtain imaging in the following situations:
Persistent or progressive symptoms after 6 wk of optimal medical management.
History of prior lumbar surgery with new or worsening symptoms.
Presence of red flag symptoms.
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–For first-line management of acute and chronic LBP, consider nonpharmacologic treatments:
–For second-line management of chronic LBP, consider pharmacologic treatments:
–Offer pharmacologic treatments at the ...