Skip to main content
Log in

Quantitative stress radiography for diagnosis of anterior cruciate ligament deficiency

Comparison between manual and instrumental techniques and between methods with knee flexed at 20° and at 90°

  • Original Articles
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript


A portable stress-applying device for stress radiography was developed for daily clinical use. Using this device, stress radiography for the diagnosis of the anterior cruciate ligament (ACL) deficiency was performed with the knee flexed at 20° and at 90°. A 100-N force was chosen as a standardized stress. The subjects were classified into four groups: the manually tested ACL-deficient group (32 knees), the manually tested control group (80 knees), the instrumentally tested ACL-deficient group (14 knees), and the instrumentally tested control group (34 knees). There was no statistical difference in the reliability (sensitivity, specificity, and accuracy) of stress radiography between the manual technique and the instrumental technique. When stress radiography with the knee flexed at 20° and that at 90° were compared, the former was more reliable than the latter. As the manual technique is compromised by a lack of standardization in applied force, a mechanical device is required in quantitative stress radiography. The reliability of stress radiography with the knee flexed at 20° is considered high enough to warrant dispensing with further stress radiography with the knee flexed at 90° for diagnosing ACL deficiency.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others


  1. Andersson C, Gillquist J (1990) Instrumented testing for evaluation of sagittal knee laxity. Clin Orthop 256:178–184

    Google Scholar 

  2. Daniel DM, Stone ML, Barnett P, Sachs R (1988) Use of the quadriceps active test to diagnose posterior cruciate-ligament disruption and measure posterior laxity of the knee. J Bone Joint Surg [Am] 70:386–391

    Google Scholar 

  3. Edixhoven P, Huiskes R, de Graaf R (1989) Anteroposterior drawer measurements in the knee using an instrumented test device. Clin Orthop 247:232–242

    Google Scholar 

  4. Fukubayashi T, Torzilli PA, Sherman MF, Warren RE (1982) An in vitro biomechanical evaluation of anterior-posterior motion of the knee. Tibial displacement, rotation, and torque. J Bone Joint Surg [Am] 64:258–264

    Google Scholar 

  5. Harilainen A, Myllynen P, Rauste J, Silvennoinen E (1986) Diagnosis of acute knee ligament injuries: the value of stress radiography compared with clinical examination, stability under anaesthesia and arthroscopic or operative findings. Ann Chir Gynaecol 75:37–43

    Google Scholar 

  6. Hede A, Hejgaard N, Sandberg H, Jacobsen K (1985) Sports injuries of the knee ligaments. A prospective stress radiographic study. Br J Sports Med 19:8–10

    Google Scholar 

  7. Hooper GJ (1986) Radiological assessment of anterior cruciate ligament deficiency. A new technique. J Bone Joint Surg [Br] 68:292–296

    Google Scholar 

  8. Jacobsen K (1981) Gonylaxometry. Acta Orthop Scand 52 [Suppl] 194:1–263

    Google Scholar 

  9. Jakob RP, Staubli HU, Deland JT (1987) Grading the pivot shift. Objective tests with implications for treatment. J Bone Joint Surg [Br] 69:294–299

    Google Scholar 

  10. Jonsson T, Althoff B, Peterson L, Renström P (1982) Clinical diagnosis of ruptures of the anterior cruciate ligament. A comparative study of the Lachman test and the anterior drawer sign. Am J Sports Med 10:100–102

    Google Scholar 

  11. Kennedy JC, Fowler PJ (1971) Medial and anterior instability of the knee: an anatomical and clinical study using stress machines. J Bone Joint Surg [Am] 53:1257–1270

    Google Scholar 

  12. Markolf KL, Kochan A, Amstutz HC (1984) Measurement of knee stiffness and laxity in patients with documented absence of the anterior cruciate ligament. J Bone Joint Surg [Am] 66:242–253

    Google Scholar 

  13. Murase K, Kumano K, Bannoji T, Yokoe K, Kaneko K, Irie K (1983) Radiographical measurement of anteroposterior instability of the knee joint. Tokyo Knee Society 4:179–186 (in Japanese)

    Google Scholar 

  14. Noyes FR, Bassett RW, Grood ES, Butler DL (1980) Arthroscopy in acute traumatic hemarthrosis of the knee. Incidence of anterior cruciate tears and other injuries. J Bone Joint Surg [Am] 62:687–695

    Google Scholar 

  15. Rijke AM, Tegtmeyer CJ, Weiland DJ, McCue FC III (1987) Stress examination of the cruciate ligaments: a radiologic Lachman test. Radiology 165:867–869

    Google Scholar 

  16. Sommerlath K, Gillquist J (1991) Instrumented testing of sagittal knee laxity in stable and unstable knees. A clinical comparison of simple and computerized devices. Am J Knee Surg 4:70–78

    Google Scholar 

  17. Staubli HU (1990) Stressradiography. Measurements of knee motion limits. In: Daniel DM, Akeson WH, O'Connor JJ (eds) Knee ligaments: structure, function, injury, and repair. Raven Press, New York, pp 449–459

    Google Scholar 

  18. Strobel M, Stedtfeld H-W (1990) Diagnostic evaluation of the knee. Springer, Berlin Heidelberg New York

    Google Scholar 

  19. Torzilli PA, Greenberg RL, Insall J (1981) An in vivo biomechanical evaluation of anterior-posterior motion of the knee. Roentgenographic measurement technique, stress machine, and stable population. J Bone Joint Surg [Am] 63:960–968

    Google Scholar 

  20. Torzilli PA, Greenberg RL, Hood RW, Pavlov H, Insall JN (1984) Measurement of anterior-posterior motion of the knee in injured patients using a biomechanical stress technique. J Bone Joint Surg [Am] 66:1438–1442

    Google Scholar 

Download references

Author information

Authors and Affiliations


Rights and permissions

Reprints and permissions

About this article

Cite this article

Kobayashi, S., Terayama, K. Quantitative stress radiography for diagnosis of anterior cruciate ligament deficiency. Arch Orthop Trauma Surg 112, 109–112 (1993).

Download citation

  • Received:

  • Issue Date:

  • DOI: