This case has all the features of an ACL rupture except for the acute marrow edema pattern of the pivot-shift mechanism and the ever-present knee joint effusion. The patient had a history of a netball injury 12 months earlier and had suffered an ACL rupture at that time; it was not surgically repaired. The vertical tear of the anterior horn of the medial meniscus may have occurred at the time of initial injury although may be the result of instability.