Validation of a Measurement Device for Instrumented Quantification of Anterior Translation and Rotational Assessment of the Knee

Mayr, Hermann O.; Hoell, Anna; Bernstein, Anke; Hube, Robert; Zeiler, C.; Kalteis, T.; Suedkamp, Norbert P.; Stoehr, Amelie

doi:10.1016/j.arthro.2011.02.034

Cited by 33 publications

(58 citation statements)

References 21 publications

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“…Unfortunately, current clinical assessments of knee stability are limited in their ability to quantify these complex motions. They consist of single degree of freedom measures of AP translation 11 (e.g., KT-1000) or axial rotation 30, 34, 39 , and subjective assessment of rotational stability (i.e., pivot shift) 23 .…”

Section: Discussionmentioning

confidence: 99%

Abnormal Tibiofemoral Contact Stress and Its Association With Altered Kinematics After Center-Center Anterior Cruciate Ligament Reconstruction

et al. 2013

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Background Abnormal tibiofemoral contact stress and aberrant kinematics may influence the progression of osteoarthritis in the ACL-deficient and the ACL-reconstructed knee. However, relationships between contact stress and kinematics following ACL reconstruction are poorly understood. Therefore, we posed the following research questions: (1) How do ACL deficiency and reconstruction affect kinematics of and contact stress in the tibiofemoral joint? (2) What kinematic differences are associated with abnormal contact stress following ACL reconstruction? Hypothesis/Purpose Center-center ACL reconstruction will not restore knee kinematics and contact stress. Correlations will exist between abnormal contact stress and aberrant kinematics following ACL reconstruction will exist. Study Design Controlled laboratory study Methods Clinical tests of anterior and rotational stability were simulated on eleven cadaveric knees using an industrial robot. Tests were conducted with the ACL intact, sectioned, and after single bundle ACL reconstruction using a quadrupled hamstring autograft with tunnels drilled through the center of the native footprints. Kinematics were recorded during the tests. Contact stress was continuously recorded from a stress transducer fixed to the tibial plateau and mean contact stress was calculated regionally. Results ACL deficiency resulted in increased mean contact stress in the posterior sectors of the medial and lateral compartments under anterior and rotational loads, respectively. Reconstruction reduced stress in these locations; however contact stress abnormalities remained. On average, kinematics were overconstrained following ACL reconstruction (≤1.8mm and ≤2.6° in all directions). However, combinations of overconstrained and underconstrained motions in ab/adduction and medial-lateral translation in response to combined moments, and axial rotation, anterior-posterior and medial-lateral translation in response to an anterior load were associated with abnormal mean contact stress. Conclusions ACL reconstruction reduces high stresses generated in the posterior compartment of the ACL-deficient knee. Abnormal contact stress following ACL reconstruction is related to multiplanar variations in knee kinematics. Clinical Relevance Clinical measures of multiplanar kinematics may help to better characterize the quality of ACL reconstruction. Such measures may help identify those at increased risk of long-term joint degeneration following this surgery.

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Section: Discussionmentioning

confidence: 99%

Abnormal Tibiofemoral Contact Stress and Its Association With Altered Kinematics After Center-Center Anterior Cruciate Ligament Reconstruction

et al. 2013

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“…All examinations of external and internal rotation were performed in comparison with the contralateral side. The Laxitester® for quantitative measurement evaluation of rotational laxity of the knee joint has already been used in patients with ruptures of the anterior cruciate ligament and is clinically validated [6,7]. In the present measurements, the pre-operative valgus aligned knees achieved an average difference of external rotation of 3.9°± 6.7°, and internal rotation of 1.2°±2.5°compared to the healthy contralateral knee.…”

Section: Discussionmentioning

confidence: 50%

“…The device was tested and validated on stable knee joints and knee joints with ligamentous damage [6,7]. As big interindividual differences exist reagarding rotational laxity, measurements are compared to the contralateral side.…”

Section: Measurement Of Rotational Knee Laxitymentioning

confidence: 99%

Rotational laxity and collateral ligament laxity following total knee arthroplasty with rotating platform

Mayr

Reinhold²,

Hube³

et al. 2014

International Orthopaedics (SICOT)

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Purpose The aim of this study was to evaluate laxity in knees with pre-operative (preop) valgus alignment compared to knees with pre-operative varus alignment after total knee arthroplasty (TKA). Methods This was a retrospective study including 81 patients, with six years follow-up, for pre-operative valgus-or varus alignment of the leg. All patients had been supplied with the same cruciate retaining (CR) TKA with rotating platform. Clinical findings were assessed by KSS, OKS and IKDC 2000 score. Rotational knee laxity was evaluated by a validated instrument (Laxitester®) with 2 Nm torque in 30°flex-ion. Collateral ligament laxity was tested manually in 30°f lexion with a bending moment of approximately5 Nm. Biomechanical results were compared to the contralateral side. Results Thirty-one patients had a preop valgus alignment of 8.96°and 50 patients a varus leg axis of 4.99°in the mean. In the preop valgus knees rotational analysis showed an increased laxity of 10.7°compared to preop varus knees (p=0.001). There was no significant difference in medial (valgus 2.6 mm, varus 2.5 mm) and lateral (valgus 2.8 mm, varus 2.7 mm) laxity. KSS and OKS showed no significant differences in the follow-up results. In the IKDC 2000 objective score 50 % of the preop varus knees and 25.8 % of the preop valgus knees were classified as nearly normal. The difference in the IKDC objective was highly significant (p<0.001). Conclusion Preop valgus knees show a significantly increased rotational laxity but no increased collateral ligament laxity compared to pre-operative varus knees six years after TKA with rotating platform. There is a significant difference in IKDC objective.

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“…Robotic systems have promised to overcome bias inherent to manual force application by means of comprising mechanical methods to apply load or torque in a controlled mode (magnitude, direction, rate) (Lob et al 2006;Park et al 2008;Tsai et al 2008;Robert et al 2009;Woo and Fisher 2009;Branch et al 2010a;Musahl et al 2010;Citak et al 2011;Mayr et al 2011).…”

Section: Robotic Systemsmentioning

confidence: 99%

“…Another method (Mayr et al 2011) was tested in the awake and non-anesthetized patient measuring anteroposterior translation and rotation of the knee joint. Tibial external/internal rotation was imposed with a torque of 2 Nm on the footrest with the ankle locked in dorsiflexion.…”

Section: Robotic Systemsmentioning

confidence: 99%

ACL Injuries Identifiable for Pre-participation Imagiological Analysis: Risk Factors

et al. 2013

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Identification of pre-participation risk factors for noncontact anterior cruciate ligament (ACL) injuries has been attracting a great deal of interest in the sports medicine and traumatology communities. Appropriate methods that enable predicting which patients could benefit from preventive strategies are most welcome. This would enable athlete-specific training and conditioning or tailored equipment in order to develop appropriate strategies to reduce incidence of injury. In order to accomplish these goals, the ideal system should be able to assess both anatomic and functional features. Complementarily, the screening method must be cost-effective and suited for widespread application. Anatomic study protocol requiring only standard X rays could answer some of such demands. Dynamic MRI/CT evaluation and electronically assisted pivot-shift evaluation can be powerful tools providing complementary information. These upcoming insights, when validated and properly combined, envision changing pre-participation knee examination in the near future. Herein different methods (validated or under research) aiming to improve the capacity to identify persons/athletes with higher risk for ACL injury are overviewed.

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Validation of a Measurement Device for Instrumented Quantification of Anterior Translation and Rotational Assessment of the Knee

Cited by 33 publications

References 21 publications

Abnormal Tibiofemoral Contact Stress and Its Association With Altered Kinematics After Center-Center Anterior Cruciate Ligament Reconstruction

Abnormal Tibiofemoral Contact Stress and Its Association With Altered Kinematics After Center-Center Anterior Cruciate Ligament Reconstruction

Rotational laxity and collateral ligament laxity following total knee arthroplasty with rotating platform

ACL Injuries Identifiable for Pre-participation Imagiological Analysis: Risk Factors

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