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[Music] this this is a case of an acl injury where there was an isolated acl complete tear acl injuries occur with a pivot shift event they can be associated with isolated twisting injury with non-contact or with contact in the scenario of the pivot shift the thigh bone rotates one direction and the leg bone rotates in a different direction acl injuries present on a spectrum dependent upon the amount of energy involved in the injury event that energy can be at different levels and represents and presents different levels of injury isolated acls on one side of the spectrum and acls with two meniscus tears and cartilage injury on the other end of the spectrum and in between individual injuries of all types including acl injuries with one meniscus tear acl injuries with two meniscus tears and all are individual in terms of their injury pattern but there are some trends that we see we always start with the story of the injury and it typically involves a twisting invent a pop and patients