Abstract
Purpose
The goal of the present study was to evaluate static anteroposterior and rotational knee laxity after ACL reconstructions with two noninvasive measurement devices by comparing the measured results of the operated with the contralateral healthy knees of the patients.
Methods
Fifty-two consecutive patients were reviewed after isolated single-bundle transtibial ACL reconstruction using a BPTB graft. At a mean follow-up of 27 months, sagittal AP laxity was tested using a noninvasive knee measurement system (Genourob) with an applied pressure of 67 N, 89 N and 134 N. Rotational laxity was measured using a noninvasive rotational knee laxity device (Rotameter) with an applied torque of 5, 8 and 10 Nm. The results were compared with the measurements of the patients’ healthy contralateral knees. Tegner, Lysholm and IKDC score were used in order to evaluate the clinical outcome.
Results
Pivot shift was negative (33) or glide (16) in 49 patients with 12 of 16 (75%) patients having also a pivot glide on the healthy contralateral side; Lachman tests were negative in 50 cases. Subjective assessment of the IKDC score was classified according to category A in 44 patients, B in 5 patients and C in 3 patients. Mean Lysholm score was 94.5 ± 9.5, median Tegner score was 7 (3–9) preoperative and 6 (3–9) at follow-up (n.s.). Anteroposterior knee laxity measurements revealed mean side-to-side differences of 0.6–1.3 mm (P < 0.0001). Rotational laxity measurements revealed no statistical significant differences between the operated and the contralateral knee (n.s.). The measured differences in the entire rotational range varied from 0.2° to 1° depending on the applied torque. In those 3 patients with a positive pivot shift, differences in the entire rotational range of 4.5° at 5 N, 4.6° at 8 N and 4.1° at 10 N were found.
Conclusion
Static knee laxity was quantified after ACL surgery using the introduced noninvasive measurement systems by comparing the measured results of the operated with the contralateral healthy knees. Significant differences were found in AP laxity although they were defined as clinically successful according to the IKDC classification. No significant differences were found in rotational knee laxity measurements. Therefore, the used noninvasive masurement devices might offer a high potential for objective quality control in knee ligament injuries and their treatment.
Level of evidence
Retrospective case series, Level IV.
Similar content being viewed by others
References
Aglietti P, Giron F, Cuomo P et al (2007) Single-and double-incision double-bundle ACL reconstruction. Clin Orthop Relat Res 454:108–113
Aglietti P, Giron F, Losco M et al (2010) Comparison between single-and double-bundle anterior cruciate ligament reconstruction: a prospective, randomized, single-blinded clinical trial. Am J Sports Med 38:25–34
Bignozzi S, Zaffagnini S, Lopomo N et al (2010) Clinical relevance of static and dynamic tests after anatomical double-bundle ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 18:37–42
Boyer P, Djian P, Christel P et al (2004) Reliability of the KT-1000 arthrometer (Medmetric) for measuring anterior knee laxity: comparison with Telos in 147 knees. Rev Chir Orthop Reparatrice Appar Mot 90:757–764
Branch TP, Browne JE, Campbell JD et al (2010) Rotational laxity greater in patients with contralateral anterior cruciate ligament injury than healthy volunteers. Knee Surg Sports Traumatol Arthrosc 18:1379–1384
Bull AM, Andersen HN, Basso O et al (1999) Incidence and mechanism of the pivot shift. An in vitro study. Clin Orthop Relat Res 363:219–231
Colombet P, Robinson J, Christel P et al (2007) Using navigation to measure rotation kinematics during ACL reconstruction. Clin Orthop Relat Res 454:59–65
Daniel DM, Malcom LL, Losse G et al (1985) Instrumented measurement of anterior laxity of the knee. J Bone Joint Surg Am 67:720–726
Forster IW, Warren-Smith CD, Tew M (1989) Is the KT1000 knee ligament arthrometer reliable? J Bone Joint Surg Br 71:843–847
Georgoulis AD, Papadonikolakis A, Papageorgiou CD et al (2003) Three-dimensional tibiofemoral kinematics of the anterior cruciate ligament-deficient and reconstructed knee during walking. Am J Sports Med 31:75–79
Hatcher J, Hatcher A, Arbuthnot J, McNicholas M (2005) An investigation to examine the inter-tester and intra-tester reliability of the Rolimeter knee tester, and its sensitivity in identifying knee joint laxity. J Orthop Res 23:1399–1403
Hefti F, Muller W, Jakob RP, Staubli HU (1993) Evaluation of knee ligament injuries with the IKDC form. Knee Surg Sports Traumatol Arthrosc 1:226–234
Ho JY, Gardiner A, Shah V, Steiner ME (2009) Equal kinematics between central anatomic single-bundle and double-bundle anterior cruciate ligament reconstructions. Arthroscopy 25:464–472
Hofbauer M, Valentin P, Kdolsky R et al (2010) Rotational and translational laxity after computer-navigated single- and double-bundle anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 18:1201–1207
Järvelä T (2007) Double-bundle versus single-bundle anterior cruciate ligament reconstruction: a prospective, randomize clinical study. Knee Surg Sports Traumatol Arthrosc 15:500–507
Kanaya A, Ochi M, Deie M et al (2009) Intraoperative evaluation of anteroposterior and rotational stabilities in anterior cruciate ligament reconstruction: lower femoral tunnel placed single-bundle versus double-bundle reconstruction. Knee Surg Sports Traumatol Arthrosc 17:907–913
Kato Y, Ingham SJ, Kramer S et al (2010) Effect of tunnel position for anatomic single-bundle ACL reconstruction on knee biomechanics in a porcine model. Knee Surg Sports Traumatol Arthrosc 18:2–10
Lorbach O, Pape D, Maas S et al (2010) The influence of the anteromedial and posterolateral bundles of the anterior cruciate ligament on external and internal tibiofemoral rotation. Am J Sports Med 38:721–727
Lorbach O, Wilmes P, Maas S et al (2009) A non-invasive device to objectively measure tibial rotation: verification of the device. Knee Surg Sports Traumatol Arthrosc 17:756–762
Lorbach O, Wilmes P, Theisen D et al (2009) Reliability testing of a new device to measure tibial rotation. Knee Surg Sports Traumatol Arthrosc 17:920–926
Markolf KL, Park S, Jackson SR, McAllister DR (2008) Simulated pivot-shift testing with single and double-bundle anterior cruciate ligament reconstructions. J Bone Joint Surg Am 90:1681–1689
Meredick RB, Vance KJ, Appleby D, Lubowitz JH (2008) Outcome of single-bundle versus double-bundle reconstruction of the anterior cruciate ligament: a meta-analysis. Am J Sports Med 36:1414–1421
Muellner T, Bugge W, Johansen S et al (2001) Inter- and intratester comparison of the Rolimeter knee tester: effect of tester’s experience and the examination technique. Knee Surg Sports Traumatol Arthrosc 9:302–306
Muneta T, Koga H, Mochizuki T et al (2007) A prospective randomized study of 4-strand semitendinosus tendon anterior cruciate ligament reconstruction comparing single-bundle and double-bundle techniques. Arthroscopy 23:618–628
Noyes FR, Grood ES, Cummings JF, Wroble RR (1991) An analysis of the pivot shift phenomenon. The knee motions and subluxations induced by different examiners. Am J Sports Med 19:148–155
Papandreou MG, Antonogiannakis E, Karabalis C, Karliaftis K (2005) Inter-rater reliability of Rolimeter measurements between anterior cruciate ligament injured and normal contra lateral knees. Knee Surg Sports Traumatol Arthrosc 13:592–597
Park SJ, Jung YB, Jung HJ et al (2010) Outcome of arthroscopic single-bundle versus double-bundle reconstruction of the anterior cruciate ligament: a preliminary 2-year prospective study. Arthroscopy 26:630–636
Ristanis S, Giakas G, Papageorgiou CD et al (2003) The effects of anterior cruciate ligament reconstruction on tibial rotation during pivoting after descending stairs. Knee Surg Sports Traumatol Arthrosc 11:360–365
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 95:171–176
Robinson J, Carrat L, Granchi C, Colombet P (2007) Influence of anterior cruciate ligament bundles on knee kinematics: clinical assessment using computer-assisted navigation. Am J Sports Med 35:2006–2013
Sastre S, Popescu D, Nunez M et al (2010) Double-bundle versus single-bundle ACL reconstruction using the horizontal femoral position: a prospective, randomized study. Knee Surg Sports Traumatol Arthrosc 18:32–36
Schuster AJ, McNicholas MJ, Wachtl SW et al (2004) A new mechanical testing device for measuring anteroposterior knee laxity. Am J Sports Med 32:1731–1735
Siebold R, Dehler C, Ellert T (2008) Prospective randomized comparison of double-bundle versus single-bundle anterior cruciate ligament reconstruction. Arthroscopy 24:137–145
Streich NA, Friedrich K, Gotterbarm T, Schmitt H (2008) Reconstruction of the ACL with a semitendinosus tendon graft: a prospective randomized single blinded comparison of double-bundle versus single-bundle technique in male athletes. Knee Surg Sports Traumatol Arthrosc 16:232–238
Tashman S, Collon D, Anderson K et al (2004) Abnormal rotational knee motion during running after anterior cruciate ligament reconstruction. Am J Sports Med 32:975–983
Tsai AG, Wijdicks CA, Walsh MP, Laprade RF (2010) Comparative kinematic evaluation of all-inside single-bundle and double-bundle anterior cruciate ligament reconstruction: a biomechanical study. Am J Sports Med 38:263–272
Wiertsema SH, van Hooff HJ, Migchelsen LA, Steultjens MP (2008) Reliability of the KT1000 arthrometer and the Lachman test in patients with an ACL rupture. Knee 15:107–110
Woo SL, Kanamori A, Zeminski J et al (2002) The effectiveness of reconstruction of the anterior cruciate ligament with hamstrings and patellar tendon. A cadaveric study comparing anterior tibial and rotational loads. J Bone Joint Surg Am 84-A:907–914
Conflict of interest
No potential conflicts of interests are declared.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Lorbach, O., Kieb, M., Brogard, P. et al. Static rotational and sagittal knee laxity measurements after reconstruction of the anterior cruciate ligament. Knee Surg Sports Traumatol Arthrosc 20, 844–850 (2012). https://doi.org/10.1007/s00167-011-1635-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00167-011-1635-5