Clinical recommendation	Evidence rating	References
The Lachman test is the most accurate test for detecting ACL injury, followed by the anterior drawer test and the pivot shift test.	C	24
Patients with ACL injury should be referred to an orthopedic surgeon if they have recurrent giving-way episodes, a strong desire to resume high-intensity activity, or concomitant meniscal or collateral ligament damage.	C	23, 27
A trial of conservative management may be considered if the patient has few giving-way episodes, near normal range of motion on knee extension, minimal or no meniscal damage on magnetic resonance imaging, strong quadriceps femoris, and no difficulty performing the crossover hop test.	C	23, 27
To prevent ACL injuries, athletes should participate in neuromuscular and proprioceptive strengthening and conditioning programs. These should include plyometric exercises and coaching regarding proper positioning while landing.	B	8, 14, 33–36