Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
Department of Human and Artificial Intelligent Systems, Graduate School of Engineering, University of Fukui, Fukui, Japan.
Orthop J Sports Med. 2013 May 2;1(1):2325967113487855. doi: 10.1177/2325967113487855. eCollection 2013 Jan-Jun.
The Lachman and pivot-shift tests have been widely used for detecting anterior cruciate ligament (ACL) deficiency. However, it still remains unclear whether these manual tests can be quantified accurately while patients are awake.
To assess the differences in knee kinematics of awake and anesthetized patients.
Case series; Level of evidence, 4.
A total of 50 patients with unilateral ACL rupture were examined. Anteroposterior tibial translation was assessed using a KT-1000 arthrometer at maximal manual power. Anterior tibial translations during the manual Lachman test and the acceleration of tibial posterior translation (APT) during the pivot-shift test were also measured using an electromagnetic measurement system (EMS). All 3 measurements were performed on the day previous to surgery while the patients were awake and on the operative day before the surgery while the patients were under general anesthesia.
The mean side-to-side difference in anteroposterior tibial translation was 5.6 ± 2.6 mm in the awake state and 5.9 ± 3.5 mm under anesthesia, indicating a nonsignificant difference. According to the EMS, the mean side-to-side difference in anteroposterior tibial translation during the Lachman test was 4.6 ± 3.6 mm in the awake state and 6.9 ± 4.3 mm under anesthesia, indicating a significant difference (P < .01). The mean APT during the pivot-shift test was -0.8 ± 0.3 m/s(2) in intact knees and -1.1 ± 0.4 m/s(2) in ACL-deficient knees when the patients were awake and was -0.7 ± 0.2 m/s(2) and -1.7 ± 1.0 m/s(2), respectively, when the patients were under anesthesia. In ACL-deficient knees, the APT pivot-shift test result was significantly higher when the patients were under anesthesia than when they were awake (P < .01).
In ACL-deficient knees, the knee kinematics during the Lachman and pivot-shift tests is significantly affected by patient consciousness, and caution is needed in quantifying anterior knee laxity during these tests when the patients are awake.
Lachman 试验和枢轴转移试验已被广泛用于检测前交叉韧带（ACL）缺陷。然而，在患者清醒时，这些手动测试是否可以准确地定量，目前仍不清楚。
评估清醒和麻醉患者膝关节运动学的差异。
病例系列；证据水平，4 级。
共 50 例单侧 ACL 断裂患者接受检查。使用 KT-1000 关节测量仪在最大手动力量下评估胫骨前后平移。还使用电磁测量系统（EMS）测量手动 Lachman 试验中的胫骨前平移和枢轴转移试验中胫骨后平移的加速（APT）。所有 3 项测量均在手术前一天患者清醒时和手术当天患者全身麻醉前进行。
在清醒状态下，胫骨前后平移的侧间差异平均值为 5.6 ± 2.6mm，在麻醉状态下为 5.9 ± 3.5mm，差异无统计学意义。根据 EMS，Lachman 试验中胫骨前平移的侧间差异平均值在清醒状态下为 4.6 ± 3.6mm，在麻醉状态下为 6.9 ± 4.3mm，差异有统计学意义（P<.01）。在清醒状态下，枢轴转移试验中的平均 APT 为-0.8 ± 0.3m/s2，在 ACL 缺失膝关节中为-1.1 ± 0.4m/s2，在麻醉状态下，分别为-0.7 ± 0.2m/s2和-1.7 ± 1.0m/s2。在 ACL 缺失膝关节中，患者在麻醉状态下进行枢轴转移试验时 APT 的结果明显高于清醒状态（P<.01）。
在 ACL 缺失膝关节中，Lachman 试验和枢轴转移试验中的膝关节运动学受患者意识的显著影响，在患者清醒时进行这些试验时，量化前膝松弛度需要谨慎。
