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Variability in knee laxity in anterior cruciate ligament deficiency using a mechanized model

Knee Surgery, Sports Traumatology, Arthroscopy volume 21, pages 784–788 (2013)Cite this article

Abstract

Purpose

To establish normative values for the magnitude of anterior tibial translation (ATT) in the Lachman and pivot shift tests in the intact and anterior cruciate ligament (ACL)-deficient states, and to explore whether a correlation in ATT magnitude exists between the Lachman and pivot shift tests.

Methods

Twenty-six fresh frozen cadaveric hip-to-toe specimens were used. Mechanized testing was performed to simulate both a Lachman and pivot shift test with the ACL intact. Tests were repeated after sectioning the ACL. ATT was recorded using a computer navigation system. Difference in ATT after sectioning was calculated for each specimen.

Results

For the Lachman, mean lateral compartment ATT in the intact knee was 5.3 mm (SD = 2.8 mm). After sectioning the ACL, translation increased to 11.4 mm (SD = 3.9 mm; P < 0.05). For the mechanized pivot shift, mean lateral compartment ATT in the intact knee was −0.2 mm (SD = 2.6 mm). After sectioning the ACL, translation increased to 8.2 mm (SD = 3.1 mm; P < 0.05). No correlation in the magnitude of ATT was found between the intact and ACL-deficient knees for either the Lachman or pivot shift tests, or between both tests (Cronbach’s α < 0.7).

Conclusions

No correlation was found between the Lachman and pivot shift test in both the intact and ACL-deficient knee. This suggests that the Lachman cannot be used as a surrogate for the pivot shift as the magnitude of the Lachman did not predict the magnitude of the pivot shift.

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References

  1. Bach BR Jr, Warren RF, Wickiewicz TL (1988) The pivot shift phenomenon: results and description of a modified clinical test for anterior cruciate ligament insufficiency. Am J Sports Med 16(6):571–576

    PubMed  Article  Google Scholar 

  2. Bedi A, Musahl V, Lane C, Citak M, Warren RF, Pearle AD (2010) Lateral compartment translation predicts the grade of pivot shift: a cadaveric and clinical analysis. Knee Surg Sports Traumatol Arthrosc 18(9):1269–1276

    PubMed  Article  Google Scholar 

  3. Benvenuti JF, Vallotton JA, Meystre JL, Leyvraz PF (1998) Objective assessment of the anterior tibial translation in Lachman test position. Comparison between three types of measurement. Knee Surg Sports Traumatol Arthrosc 6(4):215–219

    PubMed  Article  CAS  Google Scholar 

  4. Bland JM, Altman DG (1997) Cronbach’s alpha. BMJ 314(7080):572

    PubMed  Article  CAS  Google Scholar 

  5. Citak M, Suero EM, Rozell JC, Bosscher MR, Kuestermeyer J, Pearle AD (2011) A mechanized and standardized pivot shifter: technical description and first evaluation. Knee Surg Sports Traumatol Arthrosc 19(5):707–711

    PubMed  Article  Google Scholar 

  6. Gadikota HR, Seon JK, Chen CH, Wu JL, Gill TJ, Li G (2011) In vitro and intraoperative laxities after single-bundle and double-bundle anterior cruciate ligament reconstructions. Arthroscopy 27(6):849–860

    PubMed  Article  Google Scholar 

  7. Galway HR, MacIntosh DL (1980) The lateral pivot shift: a symptom and sign of anterior cruciate ligament insufficiency. Clin Orthop Relat Res 147:45–50

    PubMed  Google Scholar 

  8. Hoshino Y, Araujo P, Ahlden M, Moore CG, Kuroda R, Zaffagnini S, Karlsson J, Fu FH, Musahl V (2012) Standardized pivot shift test improves measurement accuracy. Knee Surg Sports Traumatol Arthrosc 20(4):732–736

    PubMed  Article  Google Scholar 

  9. Hoshino Y, Kuroda R, Nagamune K, Yagi M, Mizuno K, Yamaguchi M, Muratsu H, Yoshiya S, Kurosaka M (2007) In vivo measurement of the pivot-shift test in the anterior cruciate ligament-deficient knee using an electromagnetic device. Am J Sports Med 35(7):1098–1104

    PubMed  Article  Google Scholar 

  10. Hurley WL, Boros RL, Challis JH (2004) Influences of variation in force application on tibial displacement and strain in the anterior cruciate ligament during the Lachman test. Clin Biomech (Bristol, Avon) 19(1):95–98

    Article  Google Scholar 

  11. Jakob RP, Staubli HU, Deland JT (1987) Grading the pivot shift. Objective tests with implications for treatment. J Bone Joint Surg Br 69(2):294–299

    PubMed  CAS  Google Scholar 

  12. Lane CG, Warren R, Pearle AD (2008) The pivot shift. J Am Acad Orthop Surg 16(12):679–688

    PubMed  Google Scholar 

  13. Lin HC, Chang CM, Hsu HC, Lai WH, Lu TW (2011) A new diagnostic approach using regional analysis of anterior knee laxity in patients with anterior cruciate ligament deficiency. Knee Surg Sports Traumatol Arthrosc 19(5):760–767

    PubMed  Article  Google Scholar 

  14. Logan MC, Williams A, Lavelle J, Gedroyc W, Freeman M (2004) What really happens during the Lachman test? A dynamic MRI analysis of tibiofemoral motion. Am J Sports Med 32(2):369–375

    PubMed  Article  Google Scholar 

  15. Lopomo N, Zaffagnini S, Bignozzi S, Visani A, Marcacci M (2010) Pivot-shift test: analysis and quantification of knee laxity parameters using a navigation system. J Orthop Res 28(2):164–169

    PubMed  Google Scholar 

  16. Markolf KL, Jackson SR, McAllister DR (2010) Relationship between the pivot shift and Lachman tests: a cadaver study. J Bone Soint Surg Am 92(11):2067–2075

    Article  Google Scholar 

  17. Musahl V, Citak M, O’Loughlin PF, Choi D, Bedi A, Pearle AD (2010) The effect of medial versus lateral meniscectomy on the stability of the anterior cruciate ligament-deficient knee. Am J Sports Med 38(8):1591–1597

    PubMed  Article  Google Scholar 

  18. Musahl V, Voos J, O’Loughlin PF, Stueber V, Kendoff D, Pearle AD (2010) Mechanized pivot shift test achieves greater accuracy than manual pivot shift test. Knee Surg Sports Traumatol Arthrosc 18(9):1208–1213

    PubMed  Article  Google Scholar 

  19. Suero EM, Citak M, Choi D, Bosscher MR, Pearle AD, Plaskos C (2011) Software for compartmental translation analysis and virtual three-dimensional visualization of the pivot shift phenomenon. Comput Aided Surg 16(6):298–303

    PubMed  Article  Google Scholar 

  20. Torg JS, Conrad W, Kalen V (1976) Clinical diagnosis of anterior cruciate ligament instability in the athlete. Am J Sports Med 4(2):84–93

    PubMed  Article  CAS  Google Scholar 

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Conflict of interest

The authors declare that they have no conflict of interest.

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Affiliations

  1. Hospital for Special Surgery, 535 E 70th Street, New York, NY, 10021, USA

    Courtney K. Dawson, Eduardo M. Suero & Andrew D. Pearle

Authors
  1. Courtney K. Dawson
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  2. Eduardo M. Suero
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  3. Andrew D. Pearle
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Corresponding author

Correspondence to Andrew D. Pearle.

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Dawson, C.K., Suero, E.M. & Pearle, A.D. Variability in knee laxity in anterior cruciate ligament deficiency using a mechanized model. Knee Surg Sports Traumatol Arthrosc 21, 784–788 (2013). https://doi.org/10.1007/s00167-012-2170-8

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  • DOI: https://doi.org/10.1007/s00167-012-2170-8

Keywords

  • Pivot shift
  • Anterior cruciate ligament
  • Knee laxity
  • Lachman