Factors Associated With High-Grade Lachman, Pivot Shift, and Anterior Drawer at the Time of Anterior Cruciate Ligament Reconstruction

Magnussen, Robert A.; Reinke, Emily K.; Huston, Laura J.; Hewett, Timothy E.; Spindler, Kurt P.

doi:10.1016/j.arthro.2015.11.018

Cited by 77 publications

(94 citation statements)

References 23 publications

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“…19 Prior work has demonstrated that patients with lateral meniscus injury are more likely to demonstrate a higher-grade pivot shift, while medial meniscus injury is associated with increased anterior laxity. 24 In addition to meniscal injury, increased laxity may also be associated with increased risk of capsular injury, particularly in the anterolateral aspect of the knee.…”

Section: Introductionmentioning

confidence: 99%

Effect of High-Grade Preoperative Knee Laxity on Anterior Cruciate Ligament Reconstruction Outcomes

et al. 2016

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Background Knee laxity in the setting of suspected ACL injury is frequently assessed through physical examination using the Lachman, pivot-shift, and anterior drawer tests. The degree of laxity noted on these examinations may influence treatment decisions and prognosis. Hypothesis We hypothesized that increased pre-operative knee laxity would be associated with increased risk of subsequent revision ACL reconstruction and poorer patient-reported outcomes two years postoperatively. Study design Cohort study. Methods From an ongoing prospective cohort study, 2333 patients who underwent primary isolated ACL reconstruction without collateral or posterior cruciate ligament injury were identified. Patients reported by the operating surgeons as having an International Knee Documentation Committee Grade D Lachman, anterior drawer, or pivot-shift examination were classified as having a high-grade laxity. Multiple logistic regression modeling was used to evaluate whether having high-grade pre-operative laxity was associated with increased odds of undergoing revision ACL reconstruction within two years of the index procedure, controlling for patient age, sex, Marx activity level, level of competition, and graft type. Multiple linear regression modeling was used to evaluate whether having high-grade pre-operative laxity was associated with poorer IKDC or KOOS-QOL scores at a minimum 2 years postoperative, controlling for baseline score, patient age, ethnicity, sex, BMI, marital status, smoking status, sport participation, competition level, Marx activity rating score, graft type, and articular cartilage and meniscus status. Results Pre-reconstruction laxity data were available for 2325 patients (99.7%). Two year revision data were available for 2259 patients (96.8%) and patient-reported outcomes were available for 1979 patients (84.8%). High-grade pre-operative laxity was noted in 743 patients (31.9%). The mean postoperative IKDC score was 81.8 ± 15.9 and the mean KOOS-QOL score was 72.0 ± 22.0. The presence of high-grade pre-reconstruction laxity was associated with significantly increased odds of ACL graft revision (OR=1.87, 95% CI: 1.19 – 2.95, p = 0.007). The presence of high-grade pre-reconstruction laxity was not associated with any difference in postoperative IKDC (β = −0.56, p = 0.44) or KOOS-QOL (β = 0.04, p = 0.97). Conclusion The presence of high-grade pre-reconstruction knee laxity as assessed by manual physical examination under anesthesia is associated with significantly increased odds of revision ACL surgery, but has no association with patient-reported outcome scores at 2 years following ACL reconstruction.

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Section: Introductionmentioning

confidence: 99%

Effect of High-Grade Preoperative Knee Laxity on Anterior Cruciate Ligament Reconstruction Outcomes

et al. 2016

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“…Early detection of complete rupture of ACL and adequate surgical treatment are mandatory to restore knee stability because neglecting ACL rupture will make knee instability worse. Results of delayed surgical treatment may be dissatisfying [25][26][27][28]. However, muscle guarding due to pain or apprehension can make physical examination or radiographic test for instability less sensitive.…”

Section: Discussionmentioning

confidence: 99%

Anterior tibial displacement on preoperative stress radiography of ACL-injured knee depending on knee flexion angle

Noh

Nam

Roh

2019

Knee Surg & Relat Res

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Purpose: To compare side-to-side difference (SSD) of anterior tibial translation in instrumented stress radiography for each series of anterior cruciate ligament (ACL)-injured subjects according to knee flexion angle. Methods: Forty subjects who were suspected of having significant ACL injury by manual Lachman test and MRI were recruited for this prospective study. These subjects took stress radiographs for both knees with corresponding knee flexion of 10°(series M1) and 30°(series M2) using Telos stress device. Mean SSDs of M1 and M2 were compared. Sensitivities of M1 and M2 were assessed using the SSD ≥ 3 mm or ≥ 5 mm as a cutoff value. Results: Mean SSDs in series M1 and M2 were 4.22 ± 3.72 mm and 3.25 ± 3.30 mm, respectively (p < 0.001). When 3 mm of SSD was used as a cutoff value, sensitivities of series M1 and M2 were 47.5% (19/40) and 32.5% (13/40), respectively (p = 0.171). When 5 mm of SSD was used as a cutoff value, sensitivities of series M1 and M2 were 45.0% (18/40) and 22.5% (9/40), respectively (p = 0.033). Conclusions: Anterior tibial translation on stress radiographs using a Telos device is more prominent when knee flexion angle is 10°compared to that when knee flexion angle is 30°. However, stress radiography using Telos device, either at 10°or 30°of knee flexion, might not be suitable to make decision on surgical treatment due to relatively low sensitivities.

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“…Clinical examination is an important diagnostic procedure for detection of anterior cruciate ligament injury to establish the correct diagnosis Literature review and subsequent decision making on the choice of a particular treatment protocol. The accuracy of the examination findings is usually evaluated by comparing the positive and negative results of clinical tests, which with a certain degree of probability correspond to one or another type of damage to the anterior cruciate ligament [37][38][39].…”

Section: Diagnosis Of the Anterior Cruciate Ligament Injuriesmentioning

confidence: 99%

“…The test is considered positive when there is no clear end point with significant anteroposterior shift of the lower leg relative to the femur. Moreover, the final point of motion, described as "soft", is important [38]. The test has high sensitivity and specificity for acute and chronic injuries of the anterior cruciate ligament, but is not sensitive to partial tear of the anterior cruciate ligament.…”

Section: Diagnosis Of the Anterior Cruciate Ligament Injuriesmentioning

confidence: 99%

Surgical treatment of anterior cruciate ligament injury (review)

Anastasieva¹,

Simagaev²,

Кирилова³

2020

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The anterior cruciate ligament (ACL) is the key stabilizer of the knee joint, which prevents the anterior displacement of the tibia relative the femur and rotational instability of the knee joint. Proper understanding of its complex anatomy, function and biomechanics, mechanism and the type of ACL injury is of great importance in choosing a treatment strategy. Findings of clinical tests and imaging methods have a significant value in the diagnosis of anterior knee joint instability. Considering all the variety of currently existing techniques and implants for operative treatment of anterior knee instability, the clinical practitioner should make the right choice of a method or combination of methods for surgical ACL reconstruction in a specific patient, taking into account individual risks of gonarthrosis. The goal is to ensure knee joint stability with the least invasiveness to allow the patient to return to the preoperative level of physical activity as soon as possible.

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Factors Associated With High-Grade Lachman, Pivot Shift, and Anterior Drawer at the Time of Anterior Cruciate Ligament Reconstruction

Cited by 77 publications

References 23 publications

Effect of High-Grade Preoperative Knee Laxity on Anterior Cruciate Ligament Reconstruction Outcomes

Effect of High-Grade Preoperative Knee Laxity on Anterior Cruciate Ligament Reconstruction Outcomes

Anterior tibial displacement on preoperative stress radiography of ACL-injured knee depending on knee flexion angle

Surgical treatment of anterior cruciate ligament injury (review)

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