Topic Overview

The bones and ligaments of the knee

What is an anterior cruciate ligament (ACL) injury?

An anterior cruciate ligament, or ACL, injury is a tear in one of the
knee
ligaments that joins the upper leg bone with the lower
leg bone
. The ACL keeps the knee stable.

Injuries range from mild, such as a small tear, to
severe, such as when the ligament tears completely or when the ligament and
part of the bone separate from the rest of the bone.

Without
treatment, the injured ACL is less able to control knee movement, and the bones
are more likely to rub against each other. This is called chronic ACL
deficiency. The abnormal bone movement can also damage the tissue (cartilage) that covers
the ends of the bones and can trap and tear the pads (menisci) that
cushion the knee joints. This damage can lead to
osteoarthritis.

Sometimes other knee
ligaments or parts of the knee are also injured. This includes cartilage such
as the menisci, or bones in the knee joint, which can be
broken.

What causes an ACL injury?

Your ACL can be injured
if your knee joint is bent backward, twisted, or bent side to side. The chance
of injury is higher if more than one of these movements occurs at the same
time. Contact (being hit by another person or object) also can cause an ACL
injury.

An ACL injury often occurs during sports. The injury can
happen when your foot is firmly planted on the ground and a sudden force hits
your knee while your leg is straight or slightly bent. This can happen when you
are changing direction rapidly, slowing down when running, or landing from a
jump. This type of injury is common in soccer, skiing, football, and other
sports with lots of stop-and-go movements, jumping, or weaving. Falling off a
ladder or missing a step on a staircase are other likely causes. Like any other
body part, the ACL becomes weaker with age. So a tear happens more easily in
people older than age 40.

What are the symptoms?

Symptoms of an acute ACL
injury include:

  • Feeling or hearing a pop in the knee at the
    time of injury.
  • Pain on the outside and back of the
    knee.
  • The knee swelling within the first few hours of the injury.
    This may be a sign of bleeding inside the knee joint. Swelling that occurs
    suddenly is usually a sign of a serious knee injury.
  • Limited knee
    movement because of pain or swelling or both.
  • The knee feeling
    unstable, buckling, or giving out.

After an acute injury, you will probably have to stop
whatever you are doing because of the pain, but you may be able to walk.

The main symptom of chronic ACL deficiency is the knee buckling or
giving out, sometimes with pain and swelling. This can happen when an ACL
injury is not treated.

How is an ACL injury diagnosed?

Your doctor can
tell whether you have an ACL injury by asking questions about your past health
and examining your knee. The doctor may ask: How did you injure your knee? Have
you had any other knee injuries? Your doctor will check for stability,
movement, and tenderness in both the injured and uninjured knee.

You may need
X-rays, which can show damage to the knee bones. Or
you may need other imaging tests, such as an
MRI. An MRI can show damage to ligaments,
tendons, muscles, and knee cartilage.
Arthroscopy may also be done. During arthroscopy, your
doctor inserts surgical tools through one or more small cuts (incisions) in the
knee to look at the inside of the knee.

How is it treated?

Start first aid right away.
These first-aid tips will reduce swelling and pain. Use the RICE method. The
letters stand for Rest the knee, put Ice on it, use an elastic bandage to give gentle
Compression to the knee, and Elevate the leg by propping it up above the level of your
heart. And at first it’s also important to move your leg as little as possible.

Take
over-the-counter pain medicine. Be safe with medicines. Read and follow all instructions on the label.

You may need to walk with
crutches and use a knee immobilizer to keep your knee still for the first few
days after the injury.

Your knee will need to be checked by your
doctor. It’s important to get treatment. If you don’t, the injury may become a
long-lasting problem. There are two ways to treat the injury:

  • Exercises and training, also called rehab. It
    takes several months of rehab for your knee to get better.
  • Surgery. You and your doctor can decide if rehab is enough or if surgery is
    right for you.

If you have surgery, you will also have several months of
rehab afterward.

Your treatment will depend on how much of the
ACL is torn, whether other parts of the knee are injured, how active you are,
your age, your overall health, and how long ago the injury occurred.

There are three main treatment goals:

  • Make the knee stable if it is unsteady, or at
    least make it stable enough to do your daily activities.
  • Make your
    knee strong enough to do all the activities you used to do.
  • Reduce
    the chance that your knee will be damaged more.

How can you prevent ACL injuries?

The best way to
prevent ACL injuries is to stretch and strengthen the leg muscles, especially
the front and back muscles of the thigh (quadriceps and hamstrings).

Here are other things you can do that may help prevent ACL injuries:

  • Avoid wearing shoes with cleats in contact
    sports.
  • Avoid wearing high-heeled shoes.
  • Avoid sports
    that involve lots of twisting and contact.

Frequently Asked Questions

Learning about anterior cruciate ligament (ACL) injuries:

Being diagnosed:

Getting treatment:

Living with an ACL injury:

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Cause

Anterior cruciate ligament (ACL) injuries are caused when the knee is straightened beyond
its normal limits (hyperextended), twisted, or bent side to side.

Typical situations that can lead to ACL injuries include:

  • Changing direction quickly or cutting around an
    obstacle or another player with one foot solidly planted on the ground. (This can
    happen in
    sports that put high demand on the ACL, such as
    basketball, football, soccer, skiing, and gymnastics.)
  • Landing
    after a jump with a sudden slowing down, especially if the leg is straight or slightly bent
    (such as in basketball).
  • Falling off a ladder, stepping off a curb,
    jumping from a moderate or extreme height, stepping into a hole, or missing a
    step when walking down a staircase. Injuries like these tend to be
    caused by stopping suddenly, with the leg straight or slightly bent.

Inactive people and some older adults who have weak leg
muscles may injure their knees during normal daily activities. But they usually
injure bones, not ligaments.

When contact causes an ACL injury, it
can be from playing a sport, from a sudden and severe accident, or from less
obvious contact injuries.

Symptoms

Symptoms of a severe and sudden (acute)
anterior cruciate ligament (ACL) injury
include:

  • Feeling or hearing a “pop” in the knee at the
    time of injury.
  • Sudden instability in the knee. (The knee feels
    wobbly, buckles, or gives out.) This may happen after a jump or change in direction or after a
    direct blow to the side of the knee.
  • Pain on the outside and back
    of the knee.
  • Knee swelling within the first few hours of the
    injury. This may be a sign of bleeding inside the joint. Swelling that occurs suddenly is
    usually a sign of a serious knee injury.
  • Limited knee movement
    because of swelling and/or pain.

After an acute injury, you will almost always have to stop
the activity you are doing, but you may be able to walk.

Other health problems can cause symptoms like those of an ACL injury. They include a bone break or injuries to the knee cushions (menisci) or to other ligaments in the knee.

For more information on knee injuries, see:

Chronic ACL deficiency

The main
symptom of chronic (long-lasting and recurrent)
ACL deficiency is an unstable knee joint. The knee buckles or gives out,
sometimes with pain and swelling. This happens more often over time. But not
everyone with an ACL injury develops a chronic ACL deficiency.

What Happens

If you have a sudden (acute) anterior cruciate ligament (ACL) injury, you typically know when it happens. You may feel or hear a pop, and the knee may give out, causing you to fall. The knee swells and often is too painful or unstable for you to continue any activity.

An ACL injury can cause small or medium tears of the ligament, a complete tear of the ligament (rupture), a separation of the ligament from the upper or lower leg bone (avulsion), or a separation of the ligament and part of the bone from the rest of the bone (avulsion fracture). When any of these occur, the lower leg bone moves abnormally forward on the upper bone, with a sense of the knee giving out or buckling.

How an anterior cruciate ligament (ACL) injury
is treated and how it heals depends on:

  • The condition of the ACL before the injury. This includes prior injuries, partial tears, ACL deficiency, and changes due to age.
  • The general condition and health of the rest of your
    knee before this injury.
  • The amount of damage or
    injury to the ACL. Injuries are usually grouped into
    grade I, II, or III sprains (tears) according to the
    amount of damage.
  • Other injuries to the knee joint, such as to
    the
    cartilage or
    menisci, or to bones in the knee.
  • Your
    age, how active you are, and how committed you are to treatment and
    rehabilitation (rehab).
  • The time of diagnosis. If the ACL diagnosis is not
    made soon after the injury, the knee may be further damaged with use.

An ACL injury may develop into long-lasting and
recurrent (chronic)
ACL deficiency that leads to an unstable knee-the knee buckles or gives out,
sometimes with pain and swelling. This can occur if you had an ACL injury in the
past and didn’t know it or if your ACL has not been
treated or has been treated unsuccessfully. ACL deficiency can cause damage to the joint,
including
osteoarthritis. But not everyone with an ACL injury
gets ACL deficiency.

People with minor ACL injuries usually begin treatment with
a physical rehab program. Rehab exercises build strength and
flexibility in the muscles on the front of the thigh (quadriceps) and
strengthen and tighten the muscles in the back of the thigh (hamstrings). Most people return to their normal activities after a few weeks of
rehab.

More serious ACL injuries may need several
months of rehab or surgery followed by several months of
rehab to regain your knee strength, knee stability, and range of
motion.

Not all ACL injuries require surgery. But whether you have
surgery or not, you need to start strengthening your knee and regaining motion
soon after you injure it. This prepares you for your rehab program if
you choose not to have surgery. It also helps prepare the knee for surgery if
you choose to have it.

What Increases Your Risk

Things that increase your
risk of
anterior cruciate ligament (ACL) injuries
include:

  • Playing
    sports that involve sudden changes in direction or
    cutting around other players or obstacles, such as skiing, football, soccer,
    basketball, baseball, and tennis.
  • Making accidental movements that
    may twist your knee. Examples include falling off a ladder, jumping from an extreme
    height, stepping into a hole, or missing a step on a
    staircase.
  • Losing muscle tone in legs (from aging or
    inactivity).
  • Having unbalanced leg muscle strength, such as if the
    muscles in the front of your thigh (quadriceps) are stronger than the muscles
    at the back of your thigh (hamstrings).
  • Previous ACL injuries,
    especially if your knee sometimes gives out or buckles (chronic ACL deficiency).

Women have more ACL injuries than men.footnote 1

When To Call a Doctor

Call your doctor immediately if you have an injury to your knee and:

  • You have severe pain in your
    knee.
  • Your knee appears to be deformed.
  • You have signs
    of damage to the nerves or blood vessels. Signs include numbness, tingling, a
    “pins-and-needles” sensation below the injury, an inability to move your leg
    below the injury, pale or bluish skin, or your leg feels cold.
  • You have severe swelling in your knee right after the injury.

Call your doctor today if:

  • Your knee begins to swell within 2 hours of the
    injury.
  • You hear or feel a pop in your knee during an
    injury.
  • Your knee won’t bear weight.
  • You are unable to
    straighten your leg completely.
  • Your knee is unstable, buckles, or
    gives out.
  • Your knee “locks” in one position.
  • You have
    had an
    anterior cruciate ligament (ACL) injury in the past,
    and you have reinjured your knee.

Before your appointment, don’t put weight on the injured
knee. Use crutches if you need to.
Apply ice and wrap your knee in an elastic bandage or
neoprene (synthetic rubber) sleeve. Rest and elevate the knee. Take a
nonsteroidal anti-inflammatory drug, such as ibuprofen (Advil) or naproxen (Aleve), to reduce
swelling. For more information on first aid steps, see Home Treatment.

Watchful waiting

Watchful waiting is a period of time during
which you and your doctor observe your symptoms or condition without using
medical treatment. Watchful waiting is not appropriate if knee pain is severe;
if your knee is deformed, swells, or has limited movement immediately after an injury; or if you are unable
to bear any weight because of either pain or instability.

Serious
knee injuries need to be checked for possible broken bones as well as
ligament or
cartilage damage. Whenever immediate swelling follows
an injury, there also may be torn blood vessels or damaged nerves in the knee.
Your doctor will check your knee to make sure the blood supply to your leg is
normal and the nerves are intact.

If you have occasional pain in
your knee or your knee sometimes gives way or buckles, have your doctor check
it. If you have damaged your ACL, it is important to get treatment so that your
knee is appropriately managed. This may reduce the chance that you will get
osteoarthritis in your knee.

Who to see

Knee problems can be diagnosed by:

If surgery is considered, you may be referred to an
orthopedic surgeon (possibly a sports medicine
specialist) who is experienced in knee surgery.

To prepare for your appointment, see the topic Making the Most of Your Appointment.

Exams and Tests

An
anterior cruciate ligament (ACL) injury is diagnosed
through a medical history and a physical exam. A doctor who specializes
in knee injuries (for example, an
orthopedic surgeon or
sports medicine specialist) will usually be able to
accurately diagnose an ACL injury after:

  • Taking your
    medical history. You will be asked how you injured
    your knee, about your symptoms at the time of injury, whether you have had any
    other knee injuries, and general questions about your health.
  • Checking your knees for stability, strength, range of
    movement, swelling, and tenderness. Tests for stability include a Lachman test
    and a pivot shift test. The Lachman test compares the degree of looseness
    (laxity) in your knees.
  • Looking at an
    X-ray, which is usually done for any knee injury if there is pain, swelling, or you cannot put your weight on the leg.
    Although an ACL injury cannot be directly diagnosed by an X-ray, an X-ray can
    show whether a bone is broken, any bone fragments are in the knee, the ACL
    is torn from the bone along with a little piece of the bone (avulsion fracture), or blood is present in the knee
    (effusion).

If you see your doctor soon after your injury, the pain
and the degree of swelling and muscle tenseness may make it difficult for your
doctor to accurately diagnose the condition.

More imaging tests

Other tests that may
help your doctor see how badly the knee is injured include:

  • An MRI. It can identify an ACL tear or other problems, such as meniscus tears or other ligament
    injuries.
  • A CT scan. It can be
    done to see any small breaks in the bones.

Looking at fluid in the knee

If your knee looks red, feels warm to the touch, or is very swollen, a
knee joint aspiration (arthrocentesis) may be done. This involves removing fluid from the knee joint with a needle. It
is done to:

  • Help relieve pain and pressure. This may make
    the physical exam easier and make you more comfortable.
  • Check joint
    fluid for possible infection or inflammation.
  • Look for blood, which
    may mean there is a tear.
  • Look for drops of fat, which may mean there is a
    broken bone.

Local anesthetic may be injected to reduce
pain and make the knee easier to examine.

Other tests

  • Arthrometric testing: In this test, your doctor uses a tool to
    measure the looseness of your knee. This test is especially useful in people
    whose pain or size makes a physical exam difficult. An arthrometer has
    two sensor pads and a pressure handle that allows your doctor to put force on
    the knee.
  • Arthroscopy: This can be used
    to diagnose an ACL injury and as a method of
    surgery. It involves inserting tools through one or more small
    incisions in the knee, which allows your doctor to examine the structures inside
    the knee joint, including the ACL.

Before arthroscopy, you and
your doctor will decide what will be done if certain conditions are found. For
example, you may decide in advance that if a complete tear of the ACL is found,
it will be reconstructed during the arthroscopy. Or if a more severe condition
is found, you and your doctor may agree to discuss the condition rather than
proceeding with surgery at that time.

Treatment Overview

The goals of treatment for an anterior cruciate ligament (ACL) injury are to:

  • Restore normal or almost normal stability in
    the knee.
  • Restore the level of function you had before the knee
    injury.
  • Limit loss of function in the knee.
  • Prevent
    injury or more damage to other knee structures.
  • Reduce pain.

You’ll need to work with your doctor to decide whether you should have several months of
rehabilitation (rehab) or surgery with rehab. Not all ACL tears need
surgery.

Treatment right after an injury

If you know you have
injured your ACL, the first treatment consists
of:

  • First aid to reduce swelling and pain.
    This may include resting the knee,
    applying ice, using gentle compression with an elastic
    bandage, elevating the leg, and taking pain medicines, such as
    acetaminophen or
    nonsteroidal anti-inflammatory drugs (NSAIDs).
  • Using crutches and/or splints in the
    first few days. If crutches or splints are used for too long,
    the muscles will become weaker from too little activity. Then movement of the
    knee will become stiff and restricted.
  • Strength and motion
    exercises to help prepare you for treatment.

For more information on first aid, see Home Treatment.

Further treatment

What type of other treatment you have depends on:

  • How much of your ACL is torn (whether it is
    a grade I, II, or III sprain).
  • When the
    injury occurred and how stable your knee is.
  • Whether other parts of
    the knee are injured. If they are, it will be
    harder for the strong parts of your knee to compensate and protect the injured
    parts.
  • Whether you had other knee problems before, such as injuries
    that caused long-term (chronic)
    ACL deficiency, or
    osteoarthritis.
  • How active you
    are.
  • Your age and overall health.
  • Your
    willingness and ability to complete a long and rigorous rehab.

Treatment options include:

Recovery from an ACL injury varies for each person.
Your treatment should continue until your knee is stable and strong rather than for a
certain length of time.

Treatment in children and teens

Treatment of ACL injuries in children and teens involves special concerns, because children’s bones are still growing. Talk to your doctor about treatment choices for your child.

Prevention

The best way to prevent
anterior cruciate ligament (ACL) injuries is to
stretch and strengthen the leg muscles, especially the front and back muscles
of the thigh (quadriceps and hamstrings).

You
may help prevent ACL injuries if you:

  • Avoid wearing shoes with cleats in contact
    sports.
  • Avoid wearing high-heeled shoes.
  • Avoid sports
    that involve lots of twisting and contact.

If you have already had an ACL injury, you can avoid
another one by:

  • Strengthening the injured knee through
    rehabilitation (rehab) exercises.
  • Changing your sports techniques to avoid
    motions that might stress the injured knee.
  • Changing your lifestyle
    to avoid
    sports that have a high risk of injuring your knee
    further, such as skiing, football, soccer, or basketball.
  • Wearing a
    knee brace during high-risk activities. But braces should be used only if
    rehab is also being done. Wearing a brace alone may be of little
    benefit and may give you a false sense of security.

Programs to prevent ACL injuries are available. These
programs typically emphasize injury awareness, avoidance techniques, and
stretching, strengthening, and jumping exercises to help reduce ACL
injuries.

You can help prevent ACL injuries by practicing
landing with the knees bent after jumps and crouching when pivoting and
turning.

Home Treatment

If you have an acute (sudden)
anterior cruciate ligament (ACL) injury, use the
following first aid steps to reduce pain and swelling:

  • Rest and reduce your activity level.
    If it hurts to put weight on your knee, use crutches until you can see your
    doctor. Crutches can be rented from most drugstores. Crutches should not
    be used for long, because a lack of activity can cause muscle tissue to waste
    away and cause restricted movement of the knee.
  • Ice your knee. To avoid a freeze-burn, don’t put the ice directly on your skin.
    Put a cloth or towel between the ice and your knee.
  • Elevate your
    knee while applying ice or anytime you are sitting or lying
    down.
  • Wrap your knee with an elastic bandage or neoprene sleeve
    (available at a drugstore). This may help ease pain during movement and reduce
    fluid inside the knee. Don’t wrap your knee too tightly, as this may cause
    swelling below the bandage. Loosen the bandage if it is too tight. Signs of an
    overly tight bandage include numbness, tingling, increased pain, and coolness
    in the foot.
  • Take medicine such as acetaminophen or
    nonsteroidal anti-inflammatory drugs (NSAIDs) to
    reduce your pain. Be safe with medicines. Read and follow all instructions on the label.

After diagnosis of an ACL injury, your doctor may suggest
exercises that help strengthen your leg and increase your range of motion. They
may be the start of your nonsurgical treatment program or be used to help
prepare your knee for surgery.

Medications

Medicine is used to:

Nonprescription pain
medicines such as acetaminophen (Tylenol, for example) or
nonsteroidal anti-inflammatory drugs (NSAIDs), such as
ibuprofen and naproxen, are commonly used. Be safe with medicines. Read and follow all instructions on the label.

Surgery

Most surgery for
anterior cruciate ligament (ACL) injuries involves
replacing the ACL with tissue called a
graft. Usually an autograft (tendon tissue
taken from another part of the body) is used.

Repair surgery
typically is used only in the case of an avulsion fracture (a separation of the
ligament and a piece of the bone from the rest of the bone). In this case, the
bone fragment connected to the ACL is reattached to the bone.

Most ACL surgery is done by
making small incisions in the knee and inserting surgical tools
through these incisions (arthroscopic surgery). Open surgery
(cutting a large incision in the knee) is sometimes required.

Goals of surgery

The
goals of surgical treatment for ACL injuries are
to:

  • Restore normal or almost normal stability in
    the knee.
  • Restore the level of function you had before the knee
    injury.
  • Limit loss of function in the knee.
  • Prevent
    injury or degeneration to other knee structures.
  • Reduce pain.

Most people who have ACL surgery
have favorable results, with reduced pain, good knee function and stability,
and a return to normal levels of activity. But some still have knee pain
and instability. Athletes and those who take part
in sports typically can return to their sports within months. But this may depend on how
intense and sports-focused the rehab was.

Exercises before surgery

Before ACL surgery, strength and motion exercises are often
done to help get the knee ready for surgery and for rehab after surgery. Surgery is followed by a short period of home exercises,
increased activity, and the use of crutches for walking.

An intensive
rehab program to strengthen the knee then begins. The rehab
program often lasts up to a year.

Surgery in children and teens

Surgery for ACL injuries in children and teens involves special concerns, because children’s bones are still growing. Talk to your doctor about the benefits and risks of surgery.

What to think about

Depending on how bad your injury is, surgery with
rehab may offer the best chance of making your knee stable again. It also may help you return to an active lifestyle without further pain, injury, or loss of
strength and movement in your knee.

If your injured knee gives out now and then (chronic ACL deficiency) and you continue to do activities that
require a stable knee, you may injure your knee again.
That may be another reason to consider surgery.

You will need to follow a rehab program whether or not
you have surgery. If you don’t complete a rehab program, even with
surgery you may not regain full stability and function in your knee.

Other Treatment

Other treatment for
anterior cruciate ligament (ACL) injuries includes
physical rehabilitation (rehab) to:

  • Restore function and stability in the
    knee.
  • Strengthen muscles around the knee.
  • Protect the
    ACL and your knee joint from further injury.
  • Allow you to return to
    most activities that you did before the injury. If rehab is done
    without surgery, the knee might not be stable during some
    movements.

You may choose to treat an ACL injury with rehab
alone. If you have surgery, rehab will also be part of your
treatment.

Other Places To Get Help

Organizations

American Academy of Orthopaedic Surgeons
www.orthoinfo.aaos.org

National Institute of Arthritis and Musculoskeletal and Skin Diseases (U.S.)
www.niams.nih.gov

References

Citations

  1. Honkamp NJ, et al. (2010). Anterior cruciate ligament injuries in adults. In JC DeLee et al., eds., Delee and Drez’s Orthopaedic Sports Medicine: Principles and Practice, 3rd ed., vol. 2, pp. 1644-1676. Philadelphia: Saunders Elsevier.

Other Works Consulted

  • American Academy of Orthopaedic Surgeons (2014). Management of Anterior Cruciate Ligament Injuries: Evidence-Based Clinical Practice Guideline. Rosemont, IL: American Academy of Orthopaedic Surgeons. https://www.aaos.org/research/guidelines/ACLGuidelineFINAL.pdf. Accessed June 12, 2015.
  • American Academy of Orthopaedic Surgeons and American Academy of Pediatrics (2010). Anterior cruciate ligament tear. In JF Sarwark, ed., Essentials of Musculoskeletal Care, 4th ed., pp. 640-646. Rosemont, IL: American Academy of Orthopaedic Surgeons.
  • American College of Radiology (2011). ACR Appropriateness Criteria: Acute Trauma to the Knee. Available online: https://www.acr.org/SecondaryMainMenuCategories/quality_safety/app_criteria/pdf/ExpertPanelonMusculoskeletalImaging/AcuteTraumatotheKNEEDoc2.aspx.
  • Bernhardt DT (2010). Acute injuries of the knee. In SJ Anderson, SS Harris, eds., Care of the Young Athlete, 2nd ed., pp. 409-420. Elk Grove Village, IL: American Academy of Pediatrics.
  • Biau DJ, et al. (2007). ACL reconstruction: A meta-analysis of functional scores. Clinical Orthopaedics and Related Research, 458: 180-187.
  • Gilchrist J, et al. (2008). A randomized controlled trial to prevent noncontact anterior cruciate ligament injury in female collegiate soccer players. American Journal of Sports Medicine, 36(8): 1476-1483.
  • Micheo W, et al. (2015). Anterior cruciate
    ligament tear. In WR Frontera et al., eds., Essentials of Physical Medicine and Rehabilitation, 3rd ed., pp. 324-330. Philadelphia: Saunders.

Credits

ByHealthwise Staff
Primary Medical Reviewer William H. Blahd, Jr., MD, FACEP – Emergency Medicine
Adam Husney, MD – Family Medicine
E. Gregory Thompson, MD – Internal Medicine
Specialist Medical Reviewer Patrick J. McMahon, MD – Orthopedic Surgery
Freddie H. Fu, MD – Orthopedic Surgery

Current as ofMarch 21, 2017