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Instrumented Measurement of the Multiple-Ligament Injured Knee: Arthrometers, Stress Radiography, and Laxiometer

  • Lucas Teske
  • Donald D. Johnson
  • Brian R. WatermanEmail author
Chapter

Abstract

The laxity within a multiple-ligament injured knee has been a conundrum for the clinician and researcher to be able to reliably and reproducibly quantify. Furthermore, once a method of quantification has been established, there needs to be a defined degree of laxity for which physiologic and pathologic laxity can be differentiated. When these goals are accomplished, the clinician is then equipped with the information necessary to determine how and when to intervene, and the researcher is capable of utilizing this data to study outcomes. There are numerous methods available to provide quantification of laxity including stress radiography, a multitude of arthrometry devices, and laxiometers. The current literature has extensively examined the evaluation of the ACL and to a certain extent, PCL laxity. However, the MCL, LCL, and posterolateral corner remain relatively understudied in regard to quantifiable measurements. The ACL may be reliably assessed with stress radiographs utilizing the Telos device to apply force to the anterior tibia, or with KT-1000 and GNRB arthrometers. Exam of choice for the PCL, MCL, and LCL remains the stress radiograph employing various stress techniques and instruments such as the Telos device and S-type load cells. Rotatory instability such as in the case of PLC injuries may be assessed using rotationometers such as the LARS device or with stress radiography. There are promising new devices for examining the multiple-ligament injured knee such as MRI-compatible devices like the Porto Knee Testing Device, computer-assisted devices as well as quantifiable computer-based visual tracking of the pivot-shift maneuver with KiRA. These newer methods have yet to achieve widespread usage, but may be on the precipice of expansion. Overall, these devices to measure laxity remain an adjunct in the diagnosis and treatment of the multiple-ligament injured knee. The physical exam and MRI remain mainstays in diagnosis and treatment plan algorithms.

Keywords

Arthrometer Stress radiograph Telos Multi-ligament Knee laxity Instrumented knee testing Stress MRI Accelerometer Rotational instability 

List of Abbreviations

ACL

Anterior cruciate ligament

AP

Anterior–posterior

BAT

Blumensaat’s line-anterior tibia

CAS

Computer-assisted surgery

GNRB

Genourob

KiRA

Kinematic Rapid Assessment

LARS

Ligament augmentation and reconstruction system

LCL

Lateral collateral ligament

MCL

Medial collateral ligament

MRI

Magnetic resonance imaging

N

Newton

PCL

Posterior cruciate ligament

PCL

Posterolateral corner

PKTD

Porto Knee Testing Device

SSD

Side-to-side difference

VKLD

Vermont Knee Laxity Device

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Lucas Teske
    • 1
  • Donald D. Johnson
    • 2
  • Brian R. Waterman
    • 3
    Email author
  1. 1.Department of Orthopaedic SurgeryWake Forest University School of MedicineWinston-SalemUSA
  2. 2.Sports Medicine ClinicOrthopaedics, Carleton UniversityOttawaCanada
  3. 3.Department of Orthopaedic SurgeryWake Forest University School of MedicineWinston-SalemUSA

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