Human knee laxity in ACL-deficient and physiological contralateral joints: intra-operative measurements using a navigation system

BioMedical Engineering OnLine

Pierre Imbert¹  Claudio Belvedere²  Alberto Leardini² 

[1] Department of Knee Surgery, Clinique Notre Dame de la Merci, Saint-Raphaël, France

[2] Movement Analysis Laboratory, Centro di Ricerca Codivilla-Putti, Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy

关键词: Knee biomechanics;    Knee surgical navigation;    Contralateral healthy knee;    ACL-deficiency knee;    Knee instability tests;    Knee joint laxity;   

Others  :  1084808
DOI  :  10.1186/1475-925X-13-86

 received in 2014-02-20, accepted in 2014-06-11,  发布年份 2014

【 摘 要 】

Background

The comprehension of human knee laxity and of the failures of relevant surgical reconstructions of the anterior cruciate ligament (ACL) can be enhanced by the knowledge of the laximetric status of the contralateral healthy knee (CHK). Rarely this is available in patients, directly from the skeletal structures, and for a number of the standard clinical tests. The general aim of this study was to measure the extent to which laxity occurs immediately before surgery in the ACL deficient knee (ADK) with respect to CHK, in a number of standard clinical evaluation tests.

Method

Thirty-two patients with ACL deficiency were analyzed at ADK and at CHK by a navigation system immediately before reconstructions. Knee laxity was assessed based on digitized anatomical references during the antero-posterior drawer, Lachman, internal-external rotation, varus-valgus, and pivot-shift tests. Antero-posterior laxity was normalized based on patient-specific length of the tibial plateau.

Results

In the drawer test, statistical significance (p < 0.05) was found for the larger antero-posterior laxity in ADK than in CHK, on average, of 54' in the medial and 47' in the lateral compartments, when measured in normalized translations. In the Lachman test, these were about 106' and 68'. The pivot-shift test revealed a significant 70' larger antero-posterior central laxity and a 32' larger rotational laxity. No statistically relevant differences were observed in the other tests.

Conclusion

The first conclusion is that it is important to measure also the antero-posterior and rotational laxity of the uninjured contralateral knee in assessing the laxity of the injured knee. A second is that the Lachman test shows knee laxity better than the AP drawer, and that the pivot-shift test was the only one able to reveal rotational instability. The present original measurements and analyses contribute to the knowledge of knee joint mechanics, with possible relevant applications in biomedical and clinical research.

【 授权许可】

   
2014 Imbert et al.; licensee BioMed Central Ltd.

【 图 表 】

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