| HOME | HELP | CONTACT US | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
Sign In to gain access to subscriptions and/or personal tools.
|
|
|
|||||||
Sign In to gain access to subscriptions and/or personal tools. |
|||||||||
Sports Medicine Service, The Hospital for Special Surgery, New York, New York
Sports Medicine Service, The Hospital for Special Surgery, New York, New York
Sports Medicine Service, The Hospital for Special Surgery, New York, New York
The preoperative examination, the examination under anesthesia, and the findings at surgery were compared for acutely injured knees that were found at surgery to have anterior cruciate ligament (ACL) tears.
The pivot shift was initially positive in only 35% of the knees; however, under anesthesia 98% were pos itive. The Lachman test was initially positive in 99% of the knees, and under anesthesia, 100%. The anterior drawer sign was present initially in 70% of the knees, and under anesthesia this increased to 91 %.
Of the 37 patients with isolated ACL tears, only 20 (54%) had initially positive anterior drawer signs. In the knees in which secondary restraints to anterior-poste rior motion were injured, this percentage increased to 69% in medial meniscus injury, 82% in lateral meniscus injury and 89.5% in rupture of the medial collateral ligament (MCL). The Lachman test seems relatively unaffected by associated ligamentous or meniscal in juries, but the end point in the Lachman test is absent in all complete ACL tears. The pivot shift phenomenon, which was demonstrable in 98% of patients when tested under anesthesia, may be diminished when there is a MCL injury or absent in partial ACL tears.
Experience in performing the Lachman test and in appreciating the quality of the end point will give the examiner a high degree of accuracy in making the diagnosis of an ACL tear without resorting to anesthe sia, arthroscopy, or arthrography in most patients.
This article has been cited by other articles:
|
|
 |
|
  C. G. Lane, R. Warren, and A. D. Pearle The Pivot Shift J. Am. Acad. Ortho. Surg., December 1, 2008; 16(12): 679 - 688. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. H. Lubowitz, B. J. Bernardini, and J. B. Reid III Current Concepts Review: Comprehensive Physical Examination for Instability of the Knee Am. J. Sports Med., March 1, 2008; 36(3): 577 - 594. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W. J. Hurd, M. J. Axe, and L. Snyder-Mackler A 10-Year Prospective Trial of a Patient Management Algorithm and Screening Examination for Highly Active Individuals With Anterior Cruciate Ligament Injury: Part 2, Determinants of Dynamic Knee Stability Am. J. Sports Med., January 1, 2008; 36(1): 48 - 56. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. H. P. Kilger, J. Stehle, J. A. Fisk, M. Thomas, K. Miura, and S. L-Y. Woo Anatomical Double-Bundle Anterior Cruciate Ligament Reconstruction After Valgus High Tibial Osteotomy: A Biomechanical Study Am. J. Sports Med., June 1, 2006; 34(6): 961 - 967. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Miura, S. L-Y. Woo, R. Brinkley, Y.-C. Fu, and S. Noorani Effects of Knee Flexion Angles for Graft Fixation on Force Distribution in Double-Bundle Anterior Cruciate Ligament Grafts Am. J. Sports Med., April 1, 2006; 34(4): 577 - 585. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Y. Yamamoto, W.-H. Hsu, S. L-Y. Woo, A. H. Van Scyoc, Y. Takakura, and R. E. Debski Knee Stability and Graft Function After Anterior Cruciate Ligament Reconstruction: A Comparison of a Lateral and an Anatomical Femoral Tunnel Placement Am. J. Sports Med., December 1, 2004; 32(8): 1825 - 1832. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. Coady, D. Walker, and L. Kay Regional Examination of the Musculoskeletal System (REMS): a core set of clinical skills for medical students Rheumatology, May 1, 2004; 43(5): 633 - 639. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. S. Kocher, J. R. Steadman, K. K. Briggs, W. I. Sterett, and R. J. Hawkins Relationships Between Objective Assessment of Ligament Stability and Subjective Assessment of Symptoms and Function After Anterior Cruciate Ligament Reconstruction Am. J. Sports Med., April 1, 2004; 32(3): 629 - 634. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. L. Jackson, P. G. O'Malley, and K. Kroenke Evaluation of Acute Knee Pain in Primary Care Ann Intern Med, October 7, 2003; 139(7): 575 - 588. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. Davis Clinical examination of the knee following trauma: an evidence-based perspective Trauma, July 1, 2002; 4(3): 135 - 145. [Abstract] [PDF]
|
|
|
|
 |
|
 D. H. Solomon, D. L. Simel, D. W. Bates, J. N. Katz, and J. L. Schaffer Does This Patient Have a Torn Meniscus or Ligament of the Knee?: Value of the Physical Examination JAMA, October 3, 2001; 286(13): 1610 - 1620. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. G. Ciccotti, J. Perry, and M. Pink Authors' Response Am. J. Sports Med., July 1, 1995; 23(4): 515 - 516. [PDF]
|
|
|
|
|
|
J. B. Duncan, R. Hunter, M. Purnell, and J. Freeman Meniscal Injuries Associated With Acute Anterior Cruciate Ligament Tears in Alpine Skiers Am. J. Sports Med., March 1, 1995; 23(2): 170 - 172. [Abstract] [PDF]
|
|
|
|
|
|
D. M. Daniel, M. L. Stone, B. E. Dobson, D. C. Fithian, D. J. Rossman, and K. R. Kaufman Fate of the ACL-injured Patient: A Prospective Outcome Study Am. J. Sports Med., September 1, 1994; 22(5): 632 - 644. [Abstract] [PDF]
|
|
|
|
|
|
R. A. Rubinstein JR, K. D. Shelbourne, J. R. McCarroll, C. D. VanMeter, and A. C. Rettig The Accuracy of the Clinical Examination in the Setting of Posterior Cruciate Ligament Injuries Am. J. Sports Med., July 1, 1994; 22(4): 550 - 557. [Abstract] [PDF]
|
|
|
|
|
|
M. F. Sherman, L. Lieber, J. R. Bonamo, L. Podesta, and I. Reiter The long-term followup of primary anterior cruciate ligament repair: Defining a rationale for augmentation Am. J. Sports Med., June 1, 1991; 19(3): 243 - 255. [Abstract] [PDF]
|
|
|
|
|
|
D. M. Daniel Assessing the limits of knee motion Am. J. Sports Med., March 1, 1991; 19(2): 139 - 147. [Abstract] [PDF]
|
|
| HOME | HELP | CONTACT US | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
