The loss of extension test (LOE test): a new clinical sign for the anterior cruciate ligament insufficient knee

Abstract

BackgroundThis prospective study was created to evaluate the reliability of a new clinical test, which we termed the “loss of extension test” (LOE test). The LOE test investigates the loss of normal maximum passive extension (MPE) of the knee due to an anterior cruciate ligament tear in comparison to the normal MPE of the healthy knee.Materials and methodsThe study was divided into two consecutive parts. Part 1 was designed to assess the side-to-side difference in normal MPE in a healthy population. In part 1, 100 healthy adults were enrolled. Part 2 was designed to evaluate the LOE test reliability in injured knees. In part 2, we included 196 selected patients.ResultsIn part 1, the average side-to-side difference in MPE in the healthy population was not statistically significant. In part 2, the overall average side-to-side difference in MPE of the injured group was 10.1 mm ± 14.1 (min −20; max 60), which was not statistically significant (p = 0.52). An anterior cruciate ligament (ACL) tear was found in 121 knees among 196 patients. The average side-to-side difference in MPE in the ACL-insufficient group was 16.9 mm ± 13.4 (min −20; max 60), which was statistically significant (p < 0.0001). The accuracy of the loss of extension test was 83.7 %, its specificity was 93.3 %, its sensitivity was 77.7 %, its positive predictive value was 95 %, and its negative predictive value was 72.2 %.ConclusionsThe reliability of the LOE test is comparable to those reported in the literature for the Lachman test and dynamic tests, so the LOE test could represent a useful tool for the diagnosis of the anterior cruciate ligament insufficient knee.

Arthroscopically assisted reduction and internal fixation (ARIF) versus open reduction and internal fixation (ORIF) for lateral tibial plateau fractures: a comparative retrospective study

“…The patients were evaluated clinically and radiologically using the modified Rasmussen score and the KSS (Knee Society Score) systems [25, 26]. Clinical knee assessment included post-operative ROM evaluation, knee stability, and meniscal tests [27]. Hospital stay and early and late complications were also recorded.…”

Late onset periprosthetic joint infection of the knee caused by Streptococcus anginosus. Case presentation and literature review

“…Body temperature was 36.8 °C and no fever was reported in the previous days. Active and passive range of motion was 0° -100°, and the knee was stable at physical examination [13]. The Knee Society Score (KSS) questionnaire was used to assess the global residual function of the knee according to pain, range of movement and its stability.…”

The Treatment of Acute Diaphyseal Long-bones Fractures with Orthobiologics and Pharmacological Interventions for Bone Healing Enhancement: A Systematic Review of Clinical Evidence

“…According to several studies cortical strut allografts represent a reliably solution in the treatment of periprosthetic femoral fractures (PFF) in patients with a hip arthroplasty [26][27][28]. Particularly, grafts have been applied in periprosthetic femoral fractures, classified as type B1 (fracture around a stable femoral stem) of the Unified Classification System (UCS), in type C (fracture below the stem) and in re-osteosynthesis of a previously failed fixation, with union rates ranging from 92% to 100% [26,[29][30][31][32][33][34][35][36]. In a systematic review reporting the outcome of B1 fractures, no significant difference in healing rates between plate fixation alone and plate fixation with strut graft were found (91% vs. 92%, p < 0.05).…”