Clinical diagnosis and instrumented measurement of anterior knee laxity. A comparative study of the Lachman test, KT 1000 knee ligament arthrometer and the sonographic Lachman test

Abstract

We reviewed 45 patients on average 14.7 years after surgery for rupture of the anterior cruciate ligament. The aim of the study was to compare the reliability of the Lachman test to evaluation of knee laxity with the KT 1000 arthrometer and the ultrasound-assisted Lachman test. Forty-five knees were examined with the Lachman test: 12 knees showed no sign of instability; 20 had a + positive Lachman test with a hard end point; 6 with a + positive test had no end point and were rated as unstable; a +2 Lachman test was found in 7 knees. With the KT 1000 Arthrometer 44 knees were examined: 30 knees were graded as stable according to the criteria of Daniel; 14 knees were unstable. We used the ultrasound-guided Lachman test in 44 knees. Taking only the side-to-side difference into account, 37 knees were stable and 7 unstable. According to Gruber, a single translation greater than 4 mm is also a sign of instability. Therefore, 12 knees were unstable, although 6 of these knees were rated as stable, taking the side-to-side difference into account. Comparing the two instrument measurements, all knees with ultrasound-rated instability on the basis of side-to-side measurements were also rated as unstable with the KT 1000 arthrometer. Only half of the knees rated as unstable because of a single translation greater than 4 mm with the ultrasound technique were rated as unstable with the KT 1000 arthrometer. Our results show that the accuracy of the Lachman test is as good as the instrument evaluation if the end point is taken into consideration. A positive Lachman test indicating anterior knee laxity is one where the soft end point is as described by Torg et al. Both instrument measurements are accurate in indicating anterior knee laxity, but only if they are used by an experienced examiner. Using the side-to-side measurements, the sensitivity of the KT 1000 arthrometer is higher. If only single translations greater than 4 mm without a significant side-to-side difference with the ultrasound technique are interpreted as anterior knee instability, then some knees will be rated as unstable, although both the clinical and KT 1000 arthrometer examinations prove them to be stable. We believe that only a side-to-side difference with the instrument techniques should be interpreted as knee laxity. Borderline positive measurements should only be used together with the clinical findings. Both instrument measurements can help to improve the quality of the clinical examination if the examiners are inexperienced. If instrument measurements are required, we believe that the ultrasound technique is easy and cheap to perform. Nevertheless, we believe that instrument measurements of anterior knee laxity are not necessary if a thorough clinical examination is performed, taking the end point of the Lachman test into consideration.

Clinical Diagnosis of an Anterior Cruciate Ligament Rupture: A Meta-analysis

“…45,62,67 Eight additional studies did not fulfill the inclusion criteria. 21,25,37,41,43,46,65,66 One study, 55 that was not indexed in 1 of the databases but was identified through personal communication, was added to the included studies. Two articles pertained to the same study.…”

Inter- and intratester comparison of the Rolimeter knee tester: effect of tester's experience and the examination technique

“…The objective measurement of sagittal laxity of the knee is imperative for scientific comparisons of the results of anterior cruciate ligament (ACL) surgery. The most commonly used tools are the KT-1000, KT-2000 (MEDmetric, San Diego, Calif., USA), and the Stryker knee laxity testers [1,5,12,14,19]. The diagnostic efficiency of these devices has been confirmed in several investigations [9,14].…”

Prone Lachman with Ultrasound: A Literature Review and Description of the Technique

“…Dynamic ultrasonography overcomes the limitations of needing to directly visualize the entirety of the ACL by indirectly measuring its function. Previous literature has described several dynamic ultrasound variations for assessing ACL integrity by measuring tibial translation relative to the femur (10,(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24). The primary differences among these techniques are patient positioning (prone or supine), transducer placement (anterior or posterior), and force application method (manual, gravity-induced, or device-generated).…”

“…In contrast to MRI, musculoskeletal ultrasound (MSKUS) is more cost-effective, portable, and offers the ability to image structures dynamically. As the use of MSKUS has become more prevalent, an increasing number of studies have documented the efficacy of using this modality to diagnose ACL tears (10–12,14–36). However, tremendous heterogeneity exists between approaches, and optimal technique has not been clearly described in the literature.…”