Similarities and Differences of Diagnostic Manual Tests for Anterior Cruciate Ligament Insufficiency

Abstract

We should recognize the limitations of these manual tests and the possibilities of their objective measurement.

Electromagnetic tracking of the pivot-shift

“…Finally, the manual execution of the pivot-shift test has a wide variation among examiners [15,16,28]. The manually applied force, the testing speed, and the position of the hip joint are potential factors affecting the knee kinematics and the quantitative measurement of the pivot-shift.…”

“…Valgus stress is always applied during the pivot-shift test, but axial rotational stress is not necessarily the same between surgeons [16]. Internal rotational stress is more important than external rotational stress, but some do not intentionally apply rotational torque [15]. Such a wide variation of the pivot-shift testing technique leads to great variability of the measurement results [15,28].…”

“…Internal rotational stress is more important than external rotational stress, but some do not intentionally apply rotational torque [15]. Such a wide variation of the pivot-shift testing technique leads to great variability of the measurement results [15,28]. However, similar pivot-shift testing techniques can reduce the variability of the measurement results to an acceptable level [18].…”

“…While a clinical exam for the pivot shift exists, there are some shortcomings in the clinically performed pivot-shift test. The pivot-shift test provides a rough four-grade evaluation, such as none (−), glide (+), clunk (++), and gross (+++), according to the magnitude of the pivot-shift phenomenon, and the clinical grading is determined in a highly subjective way based on the examiner's feeling [13][14][15][16]. In order to achieve more objective evaluation of the pivot-shift test, various measurement systems have been developed, such as an electromagnetic tracking system, a navigation system, an image analysis, and an accelerometer [17][18][19][20][21][22][23][24].…”

Dynamic knee laxity measurement devices

“…Knee kinematics measurements of the pivot shift test have shown considerable difference between examiners, because of great variation in their testing procedures [41,64]. In order to standardize the external force when measuring rotational laxity, a mechanized and standardized procedure has been developed [59].…”