Lesson 1Interpretation and clinical reasoning: integrating findings to plan prehab, immediate priorities, and referralsThis section explains how to synthesise subjective and objective findings into a clear problem list, set short-term priorities, decide on prehabilitation focus, and determine when to refer urgently to orthopedic or medical specialists, considering local healthcare access in Botswana.
Formulating a prioritized problem listLinking findings to tissue irritabilitySetting early functional and pain goalsDeciding on prehabilitation focus areasCriteria for urgent orthopedic referralCommunicating the plan to the athleteLesson 2Subjective history: mechanism, onset, prior injuries, sports demands, locking/instability, pain pattern, swelling timeline, footwear and playing surfaceThis section outlines how to take a focused subjective history for acute ACL injury, exploring mechanism, onset, previous injuries, sport demands, instability, pain and swelling patterns, footwear, and surface factors to inform risk profile and rehab planning, adapted to Botswana's playing fields.
Clarifying injury mechanism and onsetPrevious knee injuries and surgeriesSport, position, and seasonal demandsInstability, locking, and giving-way historyPain location, intensity, and irritabilitySwelling onset, footwear, and surface detailsLesson 3Range of motion and joint mobility testing: active/passive knee flexion-extension, hamstring/quad length tests, patellofemoral mobilityThis section explains how to assess active and passive knee range of motion, patellofemoral mobility, and key muscle length tests, while respecting irritability and protection, to identify motion loss patterns and guide early manual therapy and exercise choices suitable for local resources.
Active and passive knee flexion testingActive and passive knee extension testingHamstring length and neural tension testsQuadriceps length and prone knee bendPatellofemoral glide and tilt assessmentDocumenting motion loss and end-feelLesson 4Strength and muscle activation assessment: isometric quad/hamstring testing, single-leg rise, calf and hip strength screenThis section covers practical methods to assess quadriceps, hamstring, calf, and hip strength after acute ACL injury, emphasising safe isometric testing, limb symmetry, activation failure, and how to use findings to guide early loading and protection strategies in Botswana clinics.
Safe isometric quadriceps testingHamstring strength and co-contractionSingle-leg rise and endurance measuresHip abductor and external rotator screenCalf strength and heel-rise assessmentIdentifying arthrogenic muscle inhibitionLesson 5Objective inspection and palpation: swelling quantification, joint effusion tests, wound/incision check, gait and limb alignment observationsThis section focuses on systematic inspection and palpation of the injured limb, including swelling grading, effusion tests, wound or incision review, and observation of gait and alignment to detect complications and guide protection and compression strategies using available tools.
Visual inspection and swelling gradingPatellar tap and sweep tests for effusionPalpation of joint line and periarticular tissuesAssessment of surgical wounds or incisionsGait pattern and weight-bearing toleranceStatic limb alignment and posture reviewLesson 6Stability and ligament tests: Lachman test, anterior drawer, pivot shift basics, collateral ligament screeningThis section details safe performance and interpretation of ACL and collateral ligament tests, including Lachman, anterior drawer, and pivot shift basics, emphasising timing, guarding, and how to integrate findings with imaging and overall clinical picture in resource-limited settings.
Principles of acute ligament testingLachman test technique and gradingAnterior drawer test performanceScreening medial and lateral collateralsBasics of pivot shift in acute settingsIntegrating laxity with imaging findingsLesson 7Functional and sport-specific observation: single-leg balance, step-down, squatting symmetry, stair negotiationThis section details how to observe functional tasks relevant to sport, including single-leg balance and squatting, to identify compensations, asymmetries, and movement strategies that inform load tolerance, neuromuscular control, and early rehab targets for Botswana athletes.
Single-leg balance and postural controlStep-down mechanics and dynamic valgusSquat depth, symmetry, and weight shiftStair negotiation and gait transitionsSport-specific stance and cutting patternsVideo analysis for movement feedbackLesson 8Outcome measures and baseline patient-reported tools: IKDC, KOOS, Tegner activity scale, visual analog scale for painThis section introduces validated outcome measures for ACL injury, including IKDC, KOOS, Tegner, and pain scales, and explains how to select, administer, and interpret them to establish baselines, track progress, and support shared decision-making in local practices.
Selecting appropriate knee outcome toolsAdministering IKDC and scoring basicsUsing KOOS subscales in acute ACL careTegner activity scale and sport demandsVisual analog and numeric pain scalesTracking change and minimal important differenceLesson 9Red flags and medical screening: vascular compromise, compartment syndrome, infection signs, fracture suspicion, neurovascular deficitsThis section teaches recognition of red flags in acute knee trauma, including vascular compromise, suspected fracture, compartment syndrome, infection, and significant neurovascular deficits, and defines clear pathways for urgent referral and emergency action within Botswana's system.
Screening for vascular compromiseRecognizing acute compartment syndromeFracture suspicion and Ottawa knee rulesInfection signs after trauma or surgeryNeurovascular deficit assessmentCriteria for emergency referral pathways
