Relationships Between Objective Assessment of Ligament Stability and Subjective Assessment of Symptoms and Function After Anterior Cruciate Ligament Reconstruction
Restricted accessResearch articleFirst published online April, 2004
Relationships Between Objective Assessment of Ligament Stability and Subjective Assessment of Symptoms and Function After Anterior Cruciate Ligament Reconstruction
Background: Relationships between objective assessment of ligament stability and subjective assessment of symptoms and function after anterior cruciate ligament reconstruction have not been established.
Hypothesis: Relationships exist between objective and subjective assessments after anterior cruciate ligament reconstruction.
Study Design: Case series.
Methods: Patients (N = 202) undergoing anterior cruciate ligament reconstruction with 2-year minimum follow-up were studied. Objective variables of ligament stability at follow-up included instrumented laxity, Lachman examination, and pivot-shift examination. Subjective variables of symptoms at follow-up included pain, swelling, giving way, locking, crepitus, stiffness, and limping. Subjective function at follow-up included walking, squatting, stair climbing, running, cutting, jumping, twisting, activity limitation, sports level, activities of daily living level, work level, knee function, sports participation, Lysholm score, and satisfaction with outcome.
Results: Instrumented knee laxity and Lachman examination had no significant (P> .05) relationships with any subjective variables of symptoms and function. Pivot-shift examination had significant associations with satisfaction (P= .03), partial giving way (P= .01), full giving way (P= .01), difficulty cutting (P= .01), difficulty twisting (P= .01), activity limitation (P= .01), overall knee function (P= .03), sports participation (P= .02), and Lysholm score (P= .01).
Conclusions: The pivot-shift examination may be a better measure of “functional instability” than instrumented knee laxity or Lachman examination after anterior cruciate ligament reconstruction.
1. Anderson AF, Lipscomb AB. Preoperative instrumented testing of anterior and posterior knee laxity. Am J Sports Med.1989;17:387-392.
2.
2. Anderson AF, Snyder RB, Federspiel CF, et al. Instrumented evaluation of knee laxity: a comparison of five arthrometers. Am J Sports Med.1992;20:135-140.
3.
3. Andersson C, Gillquist J. Instrumented testing for evaluation of sagittal knee laxity. Clin Orthop.1990;256:178-184.
4.
4. Borsa PA, Lephart SM, Irrgang JJ. Comparison of performancebased and patient-reported measures of function in anterior-cruciateligament-deficient individuals. J Orthop Sports Phys Ther.1998;28:392-399.
5.
5. Bull AM, Andersen HN, Basso O, et al. Incidence and mechanism of the pivot shift: an in vitro study. Clin Orthop.1999;363:219-231.
6.
6. Cross MJ, Wootton JR, Bokor DJ, et al. Acute repair of injury to the anterior cruciate ligament: a long-term followup. Am J Sports Med.1993;21:128-131.
7.
7. Dahlstedt LJ, Dalen N. Knee laxity in cruciate ligament injury: value of examination under anesthesia. Acta Orthop Scand.1989;60:181-184.
8.
8. Daniel DM, Malcom LL, Losse G, et al. Instrumented measurement of anterior laxity of the knee. J Bone Joint Surg Am.1985;67:720-726.
9.
9. Daniel DM, Stone ML, Sachs R, et al. Instrumented measurement of anterior knee laxity in patients with acute anterior cruciate ligament disruption. Am J Sports Med.1985;13:401-407.
10.
10. Donaldson WF III, Warren RF, Wickiewicz T. A comparison of acute anterior cruciate ligament examinations: initial versus examination under anesthesia. Am J Sports Med.1985;13:5-10.
11.
11. Eastlack ME, Axe MJ, Snyder-Mackler L. Laxity, instability, and functional outcome after ACL injury: copers versus noncopers. Med Sci Sports Exerc.1999;31:210-215.
12.
12. Engstrom B, Gornitzka J, Johansson C, et al. Knee function after anterior cruciate ligament ruptures treated conservatively. Int Orthop.1993;17:208-213.
13.
13. Fetto JF, Marshall JL. Injury to the anterior cruciate ligament producing the pivot-shift sign. J Bone Joint Surg Am.1979;61:710-714.
14.
14. Galway HR, MacIntosh DL. The lateral pivot shift: a symptom and sign of anterior cruciate ligament insufficiency. Clin Orthop.1980;147:45-50.
15.
15. Giannotti BF, Fanelli GC, Barrett TA, et al. The predictive value of intraoperative KT-1000 arthrometer measurements in single incision anterior cruciate ligament reconstruction. Arthroscopy.1996;12:660-666.
16.
16. Gillquist J, Messner K. Instrumented analysis of the pivot shift phenomenon after reconstruction of the anterior cruciate ligament. Int J Sports Med.1995;16:484-488.
17.
17. Harter RA, Osternig LR, Singer KM. Instrumented Lachman tests for the evaluation of anterior laxity after reconstruction of the anterior ligament. J Bone Joint Surg Am.1989;71:975-983.
18.
18. Hefti F, Muller W, Jakob RP, et al. Evaluation of knee ligament injuries with the IKDC form. Knee Surg Sports Traumatol Arthrosc.1993;1:226-234.
19.
19. Hrubesch R, Rangger C, Reichkendler M, et al. Comparison of score evaluations and instrumented measurement after anterior cruciate ligament reconstruction. Am J Sports Med.2000;28:850-856.
20.
20. Jakob RP, Hassler H, Staeubli HU. Observations on rotatory instability of the lateral compartment of the knee: experimental studies on the functional anatomy and the pathomechanism of the true and the reversed pivot shift sign. Acta Orthop Scand.1981;191:1-32.
21.
21. Jakob RP, Noesberger B, Saxer U. Value of the pivot-shift phenomenon and lateral reconstruction: diagnosis and therapy of anterior cruciate ligament rupture. Schweiz Z Sportmed.1977;25:69-84.
22.
22. Jonsson T, Althoff B, Peterson L, et al. Clinical diagnosis of ruptures of the anterior cruciate ligament: a comparative study of the Lachman test and the anterior drawer sign. Am J Sports Med.1982;10:100-102.
23.
23. Kanamori A, Woo SL, Ma CB, et al. The forces in the anterior cruciate ligament and knee kinematics during a simulated pivot shift test: a human cadaveric study using robotic technology. Arthroscopy.2000;16:633-639.
24.
24. Katz JW, Fingeroth RJ. The diagnostic accuracy of ruptures of the anterior cruciate ligament comparing the Lachman test, the anterior drawer sign, and the pivot shift test in acute and chronic knee injuries. Am J Sports Med.1986;14:88-91.
25.
25. Kim SJ, Kim HK. Reliability of the anterior drawer test, the pivot shift test, and the Lachman test. Clin Orthop.1995;317:237-242.
26.
26. Lephart SM, Perrin DH, Fu FH, et al. Relationship between selected physical characteristics and functional capacity in the anterior cruciate ligament–insufficient athlete. J Orthop Sports Phys Ther.1992;16:174-181.
27.
27. Liu SH, Osti L, Henry M, et al. The diagnosis of acute complete tears of the anterior cruciate ligament: comparison of MRI, arthrometry and clinical examination. J Bone Joint Surg Br.1995;77:586-588.
28.
28. Losee RE. Concepts of the pivot shift. Clin Orthop.1983;172:45-51.
29.
29. Lucie RS, Wiedel JD, Messner DG. The acute pivot shift: clinical correlation. Am J Sports Med.1984;12:189-191.
30.
30. Malcom LL, Daniel DM, Stone ML, et al. The measurement of anterior knee laxity after ACL reconstructive surgery. Clin Orthop.1985;196:35-41.
31.
31. Mitsou A, Vallianatos P. Clinical diagnosis of ruptures of the anterior cruciate ligament: a comparison between the Lachman test and the anterior drawer sign. Injury.1988;19:427-428.
32.
32. Muneta T, Sekiya I, Ogiuchi T, et al. Objective factors affecting overall subjective evaluation of recovery after anterior cruciate ligament reconstruction. Scand J Med Sci Sports.1998;8:283-289.
33.
33. Noyes FR, Grood ES, Cummings JF, et al. An analysis of the pivot shift phenomenon: the knee motions and subluxations induced by different examiners. Am J Sports Med.1991;19:148-155.
34.
34. Rangger C, Daniel DM, Stone ML, et al. Diagnosis of an ACL disruption with KT-1000 arthrometer measurements. Knee Surg Sports Traumatol Arthrosc.1993;1:60-66.
35.
35. Risberg MA, Holm I, Tjomsland O, et al. Prospective study of changes in impairments and disabilities after anterior cruciate ligament reconstruction. J Orthop Sports Phys Ther.1999;29:400-412.
36.
36. Sernert N, Kartus J, Kohler K, et al. Analysis of subjective, objective and functional examination tests after anterior cruciate ligament reconstruction: a follow-up of 527 patients. Knee Surg Sports Traumatol Arthrosc.1999;7:160-165.
37.
37. Seto JL, Orofino AS, Morrissey MC, et al. Assessment of quadriceps/ hamstring strength, knee ligament stability, functional and sports activity levels five years after anterior cruciate ligament reconstruction. Am J Sports Med.1988;16:170-180.
38.
38. Sherman OH, Markolf KL, Ferkel RD. Measurements of anterior laxity in normal and anterior cruciate absent knees with two instrumented test devices. Clin Orthop.1987;215:156-161.
39.
39. Snyder-Mackler L, Fitzgerald GK, Bartolozzi AR III, et al. The relationship between passive joint laxity and functional outcome after anterior cruciate ligament injury. Am J Sports Med.1997;25:191-195.
40.
40. Strand T, Solheim E. Clinical tests versus KT-1000 instrumented laxity test in acute anterior cruciate ligament tears. Int J Sports Med.1995;16:51-53.
41.
41. Tyler TF, McHugh MP, Gleim GW, et al. Association of KT-1000 measurements with clinical tests of knee stability 1 year following anterior cruciate ligament reconstruction. J Orthop Sports Phys Ther.1999;29:540-545.
42.
42. Walla DJ, Albright JP, McAuley E, et al. Hamstring control and the unstable anterior cruciate ligament–deficient knee. Am J Sports Med.1985;13:34-39.
