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The American Journal of Sports Medicine 32:369-375 (2004)
© 2004 American Orthopaedic Society for Sports Medicine

What Really Happens During the Lachman Test?

A Dynamic MRI Analysis of Tibiofemoral Motion

Martin Charles Logan, BSc, MBChB, MRCS*,{dagger}, Andrew Williams, MBBS, FRCS{ddagger}, Jonathon Lavelle, MBBS, FRCS{ddagger}, Wady Gedroyc, MBBS, FRCR{dagger} and Michael Freeman, MD, FRCS{dagger}

From the {dagger} Interventional MR Unit, St. Mary’s Hospital, London, and the {ddagger} Department of Orthopaedics and Trauma Surgery at the Chelsea and Westminster Hospital, London.

* Address correspondence to Martin Logan, 73 Simpson Court, Dundee, Scotland DD2 1UT (e-mail: mlogan100{at}hotmail.com).

Background: The Lachman test is the most reliable clinical test for diagnosing rupture of the anterior cruciate ligament (ACL). It is generally believed that the lateral side contributes more than the medial side to anterior tibial translation, but this has never been convincingly proven. The MRI study presented in this article addresses this issue.

Hypothesis: The lateral side of the ACL-deficient knee contributes more than the medial side to anterior tibial translation.

Study Design: Prospective cohort study.

Methods: The Lachman test and the radiologic Lachman test were performed on 10 patients with isolated rupture of the ACL while the knee was scanned dynamically using open-access magnetic resonance imaging. The amount of movement in the midmedial and midlateral compartments of both the contralateral normal knee and the ACL-deficient knee was measured.

Results: In both normal and ACL-deficient knees, the lateral compartment contributes more than the medial to anterior translation of the tibia. Rupture of the ACL leads to increased laxity in both medial and lateral compartments with a statistically significant greater contribution from the lateral side.

Conclusion: Rupture of the ACL leads to increased anterior tibial translation coupled with tibial internal rotation.

Key Words: anterior cruciate ligament • Lachman test • MRI • tibiofemoral motion




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