Skip to main content
SpringerLink
Log in

Static rotational knee laxity in anterior cruciate ligament injuries

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

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.

Results

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.

Conclusion

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.

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

Access this article

Log in via an institution

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

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Alam M, Bull AM, Thomas RD, Amis AA (2011) Measurement of rotational laxity of the knee: in vitro comparison of accuracy between the tibia, overlying skin, and foot. Am J Sports Med 39(12):2575–2581

    Article  PubMed  Google Scholar 

  2. Almquist PO, Arnbjornsson A, Zatterstrom R, Ryd L, Ekdahl C, Friden T (2002) Evaluation of an external device measuring knee joint rotation: an in vivo study with simultaneous Roentgen stereometric analysis. J Orthop Res 20(3):427–432

    Article  PubMed  Google Scholar 

  3. Andersen HN, Dyhre-Poulsen P (1997) The anterior cruciate ligament does play a role in controlling axial rotation in the knee. Knee Surg Sports Traumatol Arthrosc 5(3):145–149

    Article  PubMed  CAS  Google Scholar 

  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):1379–1384

    Article  PubMed  CAS  Google Scholar 

  5. Branch TP, Mayr HO, Browne JE, Campbell JC, Stoehr A, Jacobs CA (2010) Instrumented examination of anterior cruciate ligament injuries: minimizing flaws of the manual clinical examination. Arthroscopy 26(7):997–1004

    Article  PubMed  Google 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):432–440

    Article  PubMed  CAS  Google Scholar 

  7. Bull AM, Earnshaw PH, Smith A, Katchburian MV, Hassan AN, Amis AA (2002) Intraoperative measurement of knee kinematics in reconstruction of the anterior cruciate ligament. J Bone Jt Surg Br 84(7):1075–1081

    Article  CAS  Google 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):259–270

    CAS  Google 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):30–36

    CAS  Google 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):720–726

    CAS  Google Scholar 

  11. Favre J, Luthi F, Jolles BM, Siegrist O, Najafi B, Aminian K (2006) A new ambulatory system for comparative evaluation of the three-dimensional knee kinematics, applied to anterior cruciate ligament injuries. Knee Surg Sports Traumatol Arthrosc 14(7):592–604

    Article  PubMed  CAS  Google 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):258–264

    CAS  Google Scholar 

  13. Georgoulis AD, Ristanis S, Chouliaras V, Moraiti C, Stergiou N (2007) Tibial rotation is not restored after ACL reconstruction with a hamstring graft. Clin Orthop Relat Res 454:89–94

    Article  PubMed  Google Scholar 

  14. Gross SM, Carcia CR, Gansneder BM, Shultz SJ (2004) Rate of force application during knee arthrometer testing affects stiffness but not displacement measurements. J Orthop Sports Phys Ther 34(3):132–139

    PubMed  Google Scholar 

  15. Hsieh HH, Walker PS (1976) Stabilizing mechanisms of the loaded and unloaded knee joint. J Bone Jt Surg Am 58(1):87–93

    CAS  Google Scholar 

  16. Hsu WH, Fisk JA, Yamamoto Y, Debski RE, Woo SL (2006) Differences in torsional joint stiffness of the knee between genders: a human cadaveric study. Am J Sports Med 34(5):765–770

    Article  PubMed  Google 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):1634–1642

    Article  PubMed  Google 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):294–299

    CAS  Google Scholar 

  19. Lane JG, Irby SE, Kaufman K, Rangger C, Daniel DM (1994) The anterior cruciate ligament in controlling axial rotation. An evaluation of its effect. Am J Sports Med 22(2):289–293

    Article  PubMed  CAS  Google 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):954–960

    CAS  Google 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

  22. Lorbach O, Pape D, Maas S, Zerbe T, Busch L, Kohn D, Seil R (2010) Influence of the anteromedial and posterolateral bundles of the anterior cruciate ligament on external and internal tibiofemoral rotation. Am J Sports Med 38(4):721–727

    Article  PubMed  Google Scholar 

  23. Lorbach O, Wilmes P, Maas S, Zerbe T, Busch L, Kohn D, Seil R (2009) A non-invasive device to objectively measure tibial rotation: verification of the device. Knee Surg Sports Traumatol Arthrosc 17(7):756–762

    Article  PubMed  Google Scholar 

  24. Lorbach O, Wilmes P, Theisen D, Brockmeyer M, Maas S, Kohn D, Seil R (2009) Reliability testing of a new device to measure tibial rotation. Knee Surg Sports Traumatol Arthrosc 17(8):920–926

    Article  PubMed  Google Scholar 

  25. Lubowitz JH, Bernardini BJ, Reid JB 3rd (2008) Current concepts review: comprehensive physical examination for instability of the knee. Am J Sports Med 36(3):577–594

    Article  PubMed  Google Scholar 

  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):242–252

    CAS  Google Scholar 

  27. McQuade KJ, Crutcher JP, Sidles JA, Larson RV (1989) Tibial rotation in anterior cruciate deficient knees: an in vitro study. J Orthop Sports Phys Ther 11(4):146–149

    PubMed  CAS  Google 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

  29. Musahl V, Bell KM, Tsai AG, Costic RS, Allaire R, Zantop T, Irrgang JJ, Fu FH (2007) Development of a simple device for measurement of rotational knee laxity. Knee Surg Sports Traumatol Arthrosc 15(8):1009–1012

    Article  PubMed  Google Scholar 

  30. Myklebust G, Bahr R (2005) Return to play guidelines after anterior cruciate ligament surgery. Br J Sports Med 39(3):127–131

    Article  PubMed  CAS  Google Scholar 

  31. Nielsen S, Ovesen J, Rasmussen O (1984) The anterior cruciate ligament of the knee: an experimental study of its importance in rotatory knee instability. Arch Orthop Trauma Surg 103(3):170–174

    Article  PubMed  CAS  Google Scholar 

  32. Park HS, Wilson NA, Zhang LQ (2008) Gender differences in passive knee biomechanical properties in tibial rotation. J Orthop Res 26(7):937–944

    Article  PubMed  Google Scholar 

  33. Robert H, Nouveau S, Gageot S, Gagniere B (2009) A new knee arthrometer, the GNRB: experience in ACL complete and partial tears. Orthop Traumatol Surg Res 95(3):171–176

    Article  PubMed  CAS  Google Scholar 

  34. Schmitz RJ, Ficklin TK, Shimokochi Y, Nguyen AD, Beynnon BD, Perrin DH, Shultz SJ (2008) Varus/valgus and internal/external torsional knee joint stiffness differs between sexes. Am J Sports Med 36(7):1380–1388

    Article  PubMed  Google Scholar 

  35. Shoemaker SC, Markolf KL (1982) In vivo rotatory knee stability. Ligamentous and muscular contributions. J Bone Jt Surg Am 64(2):208–216

    CAS  Google 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):136–146

    CAS  Google Scholar 

  37. Shultz SJ, Schmitz RJ, Beynnon BD (2011) Variations in varus/valgus and internal/external rotational knee laxity and stiffness across the menstrual cycle. J Orthop Res 29(3):318–325

    Article  PubMed  Google Scholar 

  38. 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 I: assessment of measurement reliability and bilateral asymmetry. J Orthop Res 25(8):981–988

    Article  PubMed  Google 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):989–996

    Article  PubMed  Google Scholar 

  40. Tsai AG, Musahl V, Steckel H, Bell KM, Zantop T, Irrgang JJ, Fu FH (2008) Rotational knee laxity: reliability of a simple measurement device in vivo. BMC Musculoskelet Disord 9:35

    Article  PubMed  Google Scholar 

  41. Uh BS, Beynnon BD, Churchill DL, Haugh LD, Risberg MA, Fleming BC (2001) A new device to measure knee laxity during weightbearing and non-weightbearing conditions. J Orthop Res 19(6):1185–1191

    Article  PubMed  CAS  Google Scholar 

  42. van der Hart CP, van den Bekerom MP, Patt TW (2008) The occurrence of osteoarthritis at a minimum of ten years after reconstruction of the anterior cruciate ligament. J Orthop Surg Res 3:24

    Article  PubMed  Google Scholar 

  43. Wang CJ, Walker PS (1974) Rotatory laxity of the human knee joint. J Bone Joint Surg Am 56(1):161–170

    PubMed  CAS  Google Scholar 

  44. Weir JP (2005) Quantifying test-retest reliability using the intraclass correlation coefficient and the SEM. J Strength Cond Res 19(1):231–240

    PubMed  Google Scholar 

  45. Zarins B, Rowe CR, Harris BA, Watkins MP (1983) Rotational motion of the knee. Am J Sports Med 11(3):152–156

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

The present project is supported by the National Research Fund, Luxembourg.

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Sports Medicine Research Laboratory, Public Research Center for Health, 1460, Luxembourg, Luxembourg

    Caroline Mouton, Daniel Theisen & Romain Seil

  2. Department of Orthopedic Surgery, Centre-Hospitalier—Clinique d’Eich, 1460, Luxembourg, Luxembourg

    Dietrich Pape, Christian Nührenbörger & Romain Seil

Authors
  1. Caroline Mouton
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Daniel Theisen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Dietrich Pape
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Christian Nührenbörger
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Romain Seil
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Caroline Mouton.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Mouton, C., Theisen, D., Pape, D. et al. Static rotational knee laxity in anterior cruciate ligament injuries. Knee Surg Sports Traumatol Arthrosc 20, 652–662 (2012). https://doi.org/10.1007/s00167-011-1878-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-011-1878-1

Keywords

Search

Navigation