The diagnostic accuracy of ruptures of the anterior cruciate ligament comparing the Lachman test, the anterior drawer sign, and the pivot shift test in acute and chronic knee injuries

Abstract Objective This study was aimed to utilize a modified anterior drawer test (MADT) to detect the anterior cruciate ligament (ACL) ruptures and investigate its accuracy compares with three traditional tests. Methods Four hundred patients were prospectively enrolled between January 2015 and September 2017 preoperatively to undergo knee arthroscopic surgeries. The MADT, anterior drawer test, Lachman test, and pivot shift test were used in the outpatient clinical setting and were compared statistically for their accuracy in terms of ACL ruptures, with arthroscopic findings as the gold standard. Results The prevalence of ACL ruptures in this study was 37.0%. The MADT demonstrated the highest sensitivity (0.89) and accuracy (0.92) among the four tests and had comparable specificity (0.94) and a positive predictive value (0.90) compared with the anterior drawer test, Lachman test, and pivot shift test. The diagnostic odds ratio (DOR) of MADT was 122.92, with other test values of no more than 55.45. The area under the receiver operating characteristic curve (AUC) for the MADT was 0.92 ± 0.01, with a significant difference compared with that for the anterior drawer test (z = 17.00, p < 0.001), Lachman test (z = 9.66, p = 0.002), and pivot shift test (z = 16.39, p < 0.001). The interobserver reproducibility of the MADT was good, with a kappa coefficient of 0.86. When diagnosing partial tears of ACL, the MADT was significantly more sensitive than the anterior drawer test (p < 0.001), Lachman test (p = 0.026), and pivot shift test (p = 0.013). The MADT showed similar sensitivity in detecting anteromedial and posterolateral bundle tears (p = 0.113) and no difference in diagnosing acute and chronic ACL ruptures (χ2 = 1.682, p = 0.195). Conclusions The MADT is also an alternative diagnostic test to detect ACL tear, which is equally superior to the anterior drawer test, Lachman test, and pivot shifting test. It could improve the diagnosis of ACL ruptures combined with other clinical information including injury history, clinical examination, and radiological findings. Levels of evidence Level II/observational diagnostic studies Trial registration Chinese Clinical Trial Registry. ChiCTR1900022945 /retrospectively registered

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Association Between Psychological Readiness and Knee Laxity and Their Predictive Value for Return to Sport in Patients With Anterior Cruciate Ligament Reconstruction

The American Journal of Sports Medicine ◽

10.1177/03635465211021831 ◽

2021 ◽

pp. 036354652110218

Author(s):

Anne Gro Heyn Faleide ◽

Liv Heide Magnussen ◽

Bård Erik Bogen ◽

Torbjørn Strand ◽

Ingunn Fleten Mo ◽

...

Keyword(s):

Anterior Cruciate Ligament ◽

Pivot Shift ◽

Cruciate Ligament ◽

Return To Sport ◽

Knee Laxity ◽

Pivot Shift Test ◽

Lachman Test ◽

Anterior Tibial ◽

Kt 1000 ◽

Anterior Cruciate

Background: Deciding when patients are ready to return to sport (RTS) after an anterior cruciate ligament (ACL) reconstruction (ACLR) is challenging. The understanding of which factors affect readiness and how they may be related is limited. Therefore, despite widespread use of RTS testing, there is a lack of knowledge about which tests are informative on the ability to resume sports. Purpose: To examine whether there is an association between knee laxity and psychological readiness to RTS after ACLR and to evaluate the predictive value of these measures on sports resumption. Study Design: Cohort study; Level of evidence, 2. Methods: Patients aged ≥16 years engaged in physical activity/sports before injury were recruited at routine clinical assessment 9-12 months after ACLR. Exclusion criteria were concomitant ligament surgery at ACLR and/or previous ACL injury in the contralateral knee. At baseline, a project-specific activity questionnaire and the ACL–Return to Sport After Injury (ACL-RSI) scale were completed. Knee laxity was assessed by use of the Lachman test, KT-1000 arthrometer, and pivot-shift test. Two years after surgery, knee reinjuries and RTS status (the project-specific questionnaire) were registered. Associations between psychological readiness and knee laxity were evaluated with the Spearman rho test, and predictive ability of the ACL-RSI and knee laxity tests were examined using regression analyses. Results: Of 171 patients screened for eligibility, 132 were included in the study. There were small but significant associations between the ACL-RSI score and the Lachman test (rho = −0.18; P = .046) and KT-1000 arthrometer measurement (rho = −0.18; P = .040) but no association between the ACL-RSI and the pivot-shift test at the time of recruitment. Of the total patients, 36% returned to preinjury sport level by 2 years after surgery. Higher age, better psychological readiness, and less anterior tibial displacement (KT-1000 arthrometer measurement) were significant predictors of 2-year RTS (explained variance, 33%). Conclusion: Small but significant associations were found between measurements of psychological readiness and anterior tibial displacement, indicating that patients with less knee laxity after ACLR feel more ready to RTS. ACL-RSI and KT-1000 arthrometer measurements were independent predictors of 2-year RTS and should be considered in RTS assessments after ACLR.

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EVALUATE THE RESULTS OF ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION WITH THE USE OF AUTOGENOUS PATELLAR LIGAMENT AT HUE UNIVERSITY HOSPITAL

Journal of Medicine and Pharmacy ◽

10.34071/jmp.2011.5.14 ◽

2011 ◽

pp. 105-115

Author(s):

Nghi Thanh Nhan Le ◽

Huu Toan Bui

Keyword(s):

Anterior Cruciate Ligament ◽

Ligament Reconstruction ◽

Pivot Shift ◽

Cruciate Ligament ◽

University Hospital ◽

Patellar Ligament ◽

Pivot Shift Test ◽

Cruciate Ligament Reconstruction ◽

Lachman Test ◽

Anterior Cruciate

Background: Anterior cruciate ligament (ACL) play the importance role in stability of knee. Our purpose was to report the stability and functional outcomes for a prospective series of patients with ACL injuries treated with reconstruction of use of autogenous patellar ligament. Methods: A prospective study of 30 patients with ACL ruptures treated with arthroscopically assisted reconstruction with autogenous patellar ligament was initiated from May 2008 to December 2010 at Hue University Hospital. Lachman test, anterior draw test, pivot shift test, functional Lysholm scores were obtained at each visit, including preoperatively and at the third and sixth month of follow-up visit. Results: Thirty patients (male : female = 2.3; with a mean age of thirty years) enrolled in the study. Twenty one knees had an isolated ACL tear, nine also had an associated PCL tear and/or meniscus injuries. Lachman test was positive in 100% of cases, draw test was positive in 86% and pivot-shift test was positive in 93%. Mean value of knee function according to Lysholm score was 56 points. Twenty-six patients were followed-up in six months. Lachman test was positive in 15% of all cases, draw test was positive in 7% and pivot-shift test was positive in 7%. Lysholm outcomes scores were improved to 89 points. Conclusions: Bone patellar tendon bone graft was a useful and safety technique for anterior cruciate ligament reconstruction.

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Comparison between functional outcome of arthroscopic anterior cruciate ligament reconstruction using single bundle six fold and four fold semitendinosus and gracilis graft

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20180441 ◽

2018 ◽

Vol 4 (2) ◽

pp. 220

Author(s):

Rahul G. Jaju ◽

Jeevan B. Tonde

Keyword(s):

Anterior Cruciate Ligament ◽

Functional Outcome ◽

Acl Reconstruction ◽

Pivot Shift ◽

Cruciate Ligament ◽

Pivot Shift Test ◽

Single Bundle ◽

Lachman Test ◽

Anterior Drawer Test ◽

Anterior Cruciate

Background: With increase participation in sports activities, anterior cruciate ligament (ACL) tear is a common and functionally disabling injury. Hamstring tendon as autografts for arthroscopic ACL reconstructions have shown good clinical and functional outcome in patients. The purpose of present study was to compare the functional outcome of arthroscopic Anterior Cruciate ligament (ACL) reconstruction using single bundle six fold and four fold ST and G graft.Methods: This was a prospective study conducted between period June 2008 to December 2010.181 patients undergoing ACL reconstruction were screened and 113 patients fulfilling the inclusion exclusion criteria were selected for the study.Results: All patients completed a minimum of 1 years follow up. In 4 fold group 27.50% were having grade 1 anterior drawer test 22.50% were having grade 1 Lachman test and 17.50% had grade 1 pivot shift test as compared to 6 fold group 6.66% had grade 1 anterior drawer test, 11.66% had grade 1 Lachman test, and 3.33% had grade 1 pivot shift test respectively which was statistically significant (p<0.05). Conclusions: Arthroscopic ACL reconstruction using six fold graft is effective modality of treatment in patient with ACL deficient knee. Six fold graft is thicker in diameter and cross sectional area as compared to four fold graft which occupies more surface area of normal ACL foot print and gives better stability of knee joint in both AP and rotational plane.

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Do scarring of the anterior cruciate ligament rupture to posterior cruciate ligament influences anterior drawer, lachman and pivot shift test results?

Jurnal Orthopaedi dan Traumatologi Indonesia ◽

10.31282/joti.v2n2.42 ◽

2019 ◽

Vol 2 (2) ◽

Author(s):

John Butarbutar ◽

Nyoman Aditya Sindunata ◽

Prettysia Suvarli ◽

Rio Aditya

Keyword(s):

Anterior Cruciate Ligament ◽

Posterior Cruciate Ligament ◽

Pivot Shift ◽

Cruciate Ligament ◽

Anterior Cruciate Ligament Rupture ◽

Pivot Shift Test ◽

Test Results ◽

Anterior Drawer ◽

Ligament Rupture ◽

Anterior Cruciate

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The Anterolateral Structure of the Knee Does Not Affect Anterior and Dynamic Rotatory Stability in Anterior Cruciate Ligament Injury: Quantitative Evaluation With the Electromagnetic Measurement System

The American Journal of Sports Medicine ◽

10.1177/0363546519879692 ◽

2019 ◽

Vol 47 (14) ◽

pp. 3381-3388 ◽

Cited By ~ 4

Author(s):

Daisuke Araki ◽

Takehiko Matsushita ◽

Yuichi Hoshino ◽

Kanto Nagai ◽

Kyohei Nishida ◽

...

Keyword(s):

Pivot Shift ◽

Cruciate Ligament ◽

Pivot Shift Test ◽

Lachman Test ◽

Electromagnetic Measurement System ◽

The Mean ◽

Anterior Cruciate ◽

Electromagnetic Measurement ◽

Tibial Translation ◽

Acl Deficient

Background: The biomechanical function of the anterolateral structure (ALS), which includes the anterolateral joint capsule and anterolateral ligament (ALL), remains a topic of debate. Hypothesis: The ALS contributes to knee joint stability during the Lachman test and the pivot-shift test in anterior cruciate ligament (ACL)–deficient knees. Study Design: Controlled laboratory study. Methods: Fourteen fresh-frozen hemipelvis lower limbs were used. For 7 specimens, the anterior one-third of the ALS and the residual ALS were cut intra-articularly with a radiofrequency device. Subsequently, the ACL was cut arthroscopically. For the other 7 specimens, the ACL was cut first, followed by the anterior one-third of the ALS and the residual ALS intra-articularly. During the procedures, the iliotibial band (ITB) was kept intact. At each condition, the anterior tibial translation (ATT) during the manual Lachman test and the acceleration of posterior tibial translation (APT) and the posterior tibial translation (PTT) during the manual pivot-shift test were measured quantitatively with an electromagnetic measurement system. The mean values of those parameters were compared among 6 groups (ACL intact, one-third ALS cut, all ALS cut, ACL cut, ACL/one-third ALS cut, and ACL/all ALS cut). Results: The mean ATTs during the Lachman test and the mean APTs and PTTs in the ACL-cut conditions (ACL cut, ACL/one-third ALS cut, and ACL/all ALS cut) were significantly larger than those under the ACL-intact conditions (ACL intact, one-third ALS cut, all ALS cut) ( P < .01). However, no statistically significant differences were observed among the intact, one-third ALS–cut, and all ALS–cut conditions, within the ACL-intact or ACL-cut conditions. Conclusion: Intra-articular dissection of the ALS did not increase the ATT during the Lachman test or the APT and PTT during the pivot-shift test under the intact condition of the ITB, regardless of the integrity of the ACL. When the ITB is intact, the ALS does not have a significant role in either anterior or dynamic rotatory knee stability, while the ACL does. Clinical Relevance: Recent growing interest about ALL reconstruction or ALS augmentation may not have a large role in controlling either anterior or dynamic rotatory knee instability in isolated ACL-deficient knees.

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Augmentation of Anatomic Anterior Cruciate Ligament Reconstruction With Lateral Extra-articular Tenodesis Does Not Significantly Affect Rotatory Knee Laxity: A Time Zero, In Vivo Kinematic Analysis

The American Journal of Sports Medicine ◽

10.1177/0363546520966624 ◽

2020 ◽

Vol 48 (14) ◽

pp. 3495-3502

Author(s):

Andrew J. Sheean ◽

Jayson Lian ◽

Robert Tisherman ◽

Sean J. Meredith ◽

Darren de SA ◽

...

Keyword(s):

Anterior Cruciate Ligament ◽

Pivot Shift ◽

Cruciate Ligament ◽

Knee Laxity ◽

Lateral Compartment ◽

Categorical Variables ◽

Pivot Shift Test ◽

Contralateral Knee ◽

Rotatory Knee Laxity ◽

Anterior Cruciate

Background: The pivot-shift test is used to assess for rotatory knee laxity in the anterior cruciate ligament (ACL)-deficient knee and ACL-reconstructed knee; however, the pivot shift uses a subjective grading system that is limited by variability between examiners. Consequently, quantified pivot shift (QPS) test software (PIVOT iPad application) has been developed and validated to measure the magnitude of rotatory knee laxity during the positive pivot-shift test. Purpose: To employ intraoperative QPS (iQPS) to assess for differences in residual rotatory knee laxity after ACL reconstruction (ACLR) versus ACLR augmented with lateral extra-articular tenodesis (ACLR + LET), and to employ iQPS to determine if ACLR and/or ACLR + LET result in overconstrained knee kinematics when compared with the contralateral knee. Study Design: Cohort study; Level of evidence, 2. Methods: iQPS was performed in 20 patients by a single surgeon on both the operative and contralateral knees before ACLR. ACLR was augmented with a LET if the lateral compartment tibial translation measured during QPS was greater than or equal to double the amount of lateral tibial compartment translation measured for the contralateral knee. After each reconstruction (ACLR or ACLR + LET), iQPS measurements were performed. iQPS data were compared with the preoperative QPS measurements of the operative and contralateral knees. Postoperative iQPS data were compared with both the preoperative QPS measurements of the operative and contralateral knees with paired samples t tests. Categorical variables were compared using the Fisher exact test. Results: The mean age in the cohort was 17.3 years (range, 15-24 years). There were no significant differences between the groups in terms of the proportion of male patients (ACLR: 5 male, 5 female vs ACLR + LET: 4 male, 6 female) or age (ACLR: 17.7 ± 3.3 years; 95% CI, 15.4-24.0 vs ACLR + LET: 16.8 ± 2.8 years, 95% CI, 14.8-22.0; P = .999). There were no significant differences between the groups with respect to preoperative QPS performed during examination under anesthesia (ACLR: 4.7 ± 2.0 mm; 95% CI, 3.3-6.1 vs ACLR + LET: 3.6 ± 1.8 mm; 95% CI, 2.3-4.9; P = .2). Both ACLR and ACLR + LET resulted in significant decreases in rotatory knee laxity when compared with preoperative QPS measurements (ACLR: –3.4 ± 1.7 mm; 95% CI, −4.6 to −2.2; P < .001: ACLR + LET: –2.6 ± 1.9 mm; 95% CI, −3.9 to −1.3; P < .002). Moreover, when compared with isolated ACLR, ACLR + LET did not result in a significantly smaller magnitude of change in iQPS between the pre- and postoperative states ( P = .3). Conclusion: Both ACLR and ACLR + LET resulted in significant decreases in rotatory knee laxity. The augmentation of ACLR with LET did not change the constraint of the knee with respect to lateral compartment translation as measured during iQPS.

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