Static rotational knee laxity in anterior cruciate ligament injuries
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The purpose was to provide an overview of the non-invasive devices measuring static rotational knee laxity in order to formulate recommendations for the future.
Early cadaver studies provided evidence that sectioning the anterior cruciate ligament (ACL) led to an increase of static rotational knee laxity of approximately 10–20% between full extension and 30° of knee flexion. Sections of the menisci or of the peripheral structures induced a much higher increase in rotation. This supported the hypothesis that static rotation measurements might be useful for the diagnosis of ACL or associated injuries. In vivo evaluations with measurement devices are relatively new. Several articles were published during the last decade with many different devices and important differences were seen in absolute rotational knee laxity between them. This was due to the varying precision of the devices, the variability in patient positioning, the different methods of measurement, examination protocols and data analysis. As a consequence, comparison of the available results should be performed with caution. Nevertheless, it has been established that rotational knee laxity was greater in females as compared to males and that the inter-subject variability was high. For this reason, it will probably be difficult to categorise injured patients preoperatively, and the interpretation of the results should probably be limited to side-to-side differences.
Future studies will show whether rotational laxity measurements alone will be sufficient to provide clinically relevant data or if they should be combined to static sagittal laxity measurements.
KeywordsKnee joint Measuring device Instrumented Laxity Tibiofemoral rotation Anterior cruciate ligament
The present project is supported by the National Research Fund, Luxembourg.
Conflict of interest
The authors declare that they have no conflict of interest.
- 4.Branch TP, Browne JE, Campbell JD, Siebold R, Freedberg HI, Arendt EA, Lavoie F, Neyret P, Jacobs CA (2010) Rotational laxity greater in patients with contralateral anterior cruciate ligament injury than healthy volunteers. Knee Surg Sports Traumatol Arthrosc 18(10):1379–1384PubMedCrossRefGoogle Scholar
- 6.Branch TP, Siebold R, Freedberg HI, Jacobs CA (2011) Double-bundle ACL reconstruction demonstrated superior clinical stability to single-bundle ACL reconstruction: a matched-pairs analysis of instrumented tests of tibial anterior translation and internal rotation laxity. Knee Surg Sports Traumatol Arthrosc 19(3):432–440PubMedCrossRefGoogle Scholar
- 8.Butler DL, Noyes FR, Grood ES (1980) Ligamentous restraints to anterior-posterior drawer in the human knee. A biomechanical study. J Bone Jt Surg Am 62(2):259–270Google Scholar
- 9.Cooper DE (1991) Tests for posterolateral instability of the knee in normal subjects. Results of examination under anesthesia. J Bone Jt Surg Am 73(1):30–36Google Scholar
- 10.Daniel DM, Malcom LL, Losse G, Stone ML, Sachs R, Burks R (1985) Instrumented measurement of anterior laxity of the knee. J Bone Jt Surg Am 67(5):720–726Google Scholar
- 12.Fukubayashi T, Torzilli PA, Sherman MF, Warren RF (1982) An in vitro biomechanical evaluation of anterior-posterior motion of the knee. Tibial displacement, rotation, and torque. J Bone Jt Surg Am 64(2):258–264Google Scholar
- 15.Hsieh HH, Walker PS (1976) Stabilizing mechanisms of the loaded and unloaded knee joint. J Bone Jt Surg Am 58(1):87–93Google Scholar
- 17.Isberg J, Faxen E, Laxdal G, Eriksson BI, Karrholm J, Karlsson J (2011) Will early reconstruction prevent abnormal kinematics after ACL injury? Two-year follow-up using dynamic radiostereometry in 14 patients operated with hamstring autografts. Knee Surg Sports Traumatol Arthrosc 19(10):1634–1642PubMedCrossRefGoogle Scholar
- 18.Jakob RP, Staubli HU, Deland JT (1987) Grading the pivot shift. Objective tests with implications for treatment. J Bone Jt Surg Br 69(2):294–299Google Scholar
- 20.Lipke JM, Janecki CJ, Nelson CL, McLeod P, Thompson C, Thompson J, Haynes DW (1981) The role of incompetence of the anterior cruciate and lateral ligaments in anterolateral and anteromedial instability. A biomechanical study of cadaver knees. J Bone Jt Surg Am 63(6):954–960Google Scholar
- 21.Lorbach O, Kieb M, Brogard P, Maas S, Pape D, Seil R (2011) Static rotational and sagittal knee laxity measurements after reconstruction of the anterior cruciate ligament. Knee Surg Sports Traumatol Arthrosc. doi: 10.1007/s00167-011-1635-5
- 26.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 Jt Surg Am 66(2):242–252Google Scholar
- 28.Mouton C, Seil R, Agostinis H, Maas S, Theisen D (2012) Influence of individual characteristics on static rotational knee laxity using the Rotameter. Knee Surg Sports Traumatol Arthrosc. doi: 10.1007/s00167-011-1877-2
- 35.Shoemaker SC, Markolf KL (1982) In vivo rotatory knee stability. Ligamentous and muscular contributions. J Bone Jt Surg Am 64(2):208–216Google Scholar
- 36.Shoemaker SC, Markolf KL (1985) Effects of joint load on the stiffness and laxity of ligament-deficient knees. An in vitro study of the anterior cruciate and medial collateral ligaments. J Bone Jt Surg Am 67(1):136–146Google Scholar
- 39.Shultz SJ, Shimokochi Y, Nguyen AD, Schmitz RJ, Beynnon BD, Perrin DH (2007) Measurement of varus-valgus and internal-external rotational knee laxities in vivo—Part II: relationship with anterior-posterior and general joint laxity in males and females. J Orthop Res 25(8):989–996PubMedCrossRefGoogle Scholar