Tibial subluxation in anterior cruciate ligament–deficient knees

Almekinders, Louis C.; Chiavetta, John B.

doi:10.1053/jars.2001.25248

Cited by 30 publications

(35 citation statements)

References 7 publications

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“…Tibiofemoral position was measured using a similar radiographic method to that of Almekinders and Chiavetta. 25 The averaged tibial position was 7.5 mm more anterior in the ACL-injured knees than in the same subjects' uninjured knees. This displacement is considerably larger than the average relative anterior tibial positioning of the injured knees of the ACL-D subjects in the current study (3.5 mm).…”

Section: Discussionmentioning

confidence: 84%

“…24 Joint positioning in such reference configurations may itself be affected by pathology; for instance, fixed joint subluxations have been reported in ACL-deficient subjects during standing by Almekinders and Chiavetta. 25 In that study, tibiofemoral position was determined from landmarks drawn on sagittal plane radiographs. Average tibial position in ACL-injured knees was reported to be 3.9 mm anterior to the uninjured knees.…”

Section: Discussionmentioning

confidence: 99%

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Altered knee kinematics in ACL‐deficient non‐copers: A comparison using dynamic MRI

Barrance

Williams

Snyder‐Mackler

et al. 2005

Journal Orthopaedic Research

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Kinematics measured during a short arc quadriceps knee extension exercise were compared in the knees of functionally unstable ACL-deficient patients, these patients' uninjured knees, and uninjured control subjects' knees. Cine phase contrast dynamic magnetic resonance imaging, in combination with a model-based tracking algorithm developed by the authors, was used to measure tibiofemoral kinematics as the subjects performed the active, supine posture knee extension exercise in the terminal 30 degrees of motion. Two determinants of tibiofemoral motion were measured: anterior/posterior location of the tibia relative to the femur, and axial rotation of the tibia relative to the femur. We hypothesized that more anterior tibial positioning, as well as differences in axial tibial rotation patterns, would be observed in ACL-deficient (ACL-D) knees when compared to uninjured knees. Multifactor ANOVA analyses were used to determine the dependence of the kinematic variables on (i) side (injured vs. uninjured, matched by subject in the control group), (ii) flexion angle measured at five-degree increments, and (iii) subject group (ACL-injured vs. control). Statistically significant anterior translation and external tibial rotation (screw home motion) accompanying knee extension were found. The ACL-D knees of the injured group exhibited significantly more anterior tibial positioning than the uninjured knees of these subjects (average difference over extension range ¼ 3.4 AE 2.8 mm, p < 0.01 at all angles compared), as well as the matched knees of the control subjects. There was a significant effect of interaction between side and subject group on A/P tibial position. We did not find significant differences in external tibial rotation associated with ACL deficiency. The changes to active joint kinematics documented in this entirely noninvasive study may contribute to cartilage degradation in ACL-D knees, and encourage more extensive investigations using similar methodology in the future. ß

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Section: Discussionmentioning

confidence: 84%

Section: Discussionmentioning

confidence: 99%

Altered knee kinematics in ACL‐deficient non‐copers: A comparison using dynamic MRI

Barrance

Williams

Snyder‐Mackler

et al. 2005

Journal Orthopaedic Research

View full text Add to dashboard Cite

show abstract

“…In order to provide a possible explanation for this phenomenon, we assume that the tibia is anteriorly subluxated in extension in an ACL-insufficient knee, as previously reported by Almekinders and Chiavetta [31]. Should the tibia subluxate in extension, the posterior capsule could be abnormally tight and responsible for the limitation of the physiological maximum extension of the knee seen in cases of ACL tear.…”

Section: Methodsmentioning

confidence: 80%

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

Salvi

Caputo

Piu

et al. 2013

J Orthopaed Traumatol

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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.

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“…The current study demonstrated that ACL deficient patients who had anterior knee instability showed more posterior translation of the tibia compared to control subjects during walking and running. While a previous study reported that ACL deficient knees had a more anterior translation of the tibia compared to healthy knees during standing with full extension [1], other studies have also reported that ACL deficient patients showed increased hamstring muscle activity in order to reduce knee instability during walking [7,21]. Although ACL deficient patients may have abnormal neuromuscular function, it has been suggested that these adaptive functions correlate with decreased tibial anterior translation during dynamic activities such as walking and running.…”

Section: Discussionmentioning

confidence: 99%

The Relationship between Knee Biomechanics and Clinical Assessments in ACl Deficient Patients

et al. 2019

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The purpose of this study was to clarify the relationship between knee biomechanics and clinical assessments in ACL deficient patients. Subjects included 22 patients with unilateral ACL rupture and 22 healthy controls. Knee kinematics and kinetics during walking and running were examined using a 3-dimensional motion analysis system. The passive knee joint laxity, range of motion of knee joint, and knee muscle strength were also measured. Correlations between the knee kinematic and kinetic data and clinical assessments were evaluated. In the ACL deficient patients, there were no significant relationships between tibial translation during walking and running and passive knee joint laxity. The correlations between knee kinematics and kinetics and range of motion of knee joint were also not significant. Additionally, there were no significant correlations between knee kinematics during walking and knee muscle strength. However, there were several significant correlations between knee kinematics during running and knee muscle strength. The results demonstrate the importance of knee muscle strength for knee kinematics and kinetics during running in ACL deficient patients. Patients with stronger knee muscle strength may demonstrate more nearly normal knee joint movement during dynamic activities such as running.

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Tibial subluxation in anterior cruciate ligament–deficient knees

Cited by 30 publications

References 7 publications

Altered knee kinematics in ACL‐deficient non‐copers: A comparison using dynamic MRI

Altered knee kinematics in ACL‐deficient non‐copers: A comparison using dynamic MRI

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

The Relationship between Knee Biomechanics and Clinical Assessments in ACl Deficient Patients

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