Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Kaufman Medical Building, Suite 1011, 3941 Fifth Avenue, Pittsburgh, PA 15203, USA; Department of Orthopaedic Surgery, Trauma Surgery, and Sports Medicine, Cologne Merheim Medical Center, Ostmerheimer Str. 200, 51109, Cologne, Germany.
Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Kaufman Medical Building, Suite 1011, 3941 Fifth Avenue, Pittsburgh, PA 15203, USA.
Knee. 2020 Dec;27(6):1866-1873. doi: 10.1016/j.knee.2020.07.093. Epub 2020 Nov 14.
Anterior drawer test, Lachman test including evaluation of the endpoint, and pivot shift test have been commonly applied clinically in diagnosing anterior cruciate ligament (ACL) injury but how they function in the appraisal of partial ACL tears is less known. The aims of this study were to examine the diagnostic values of the commonly used knee function tests on patients in detecting ACL injury including partial injury patterns, to assess each of the test's predictive values on the specific ACL injury pattern, and to assess if using multiple tests collectively for the diagnosis of the injury could improve diagnostic accuracy.
We evaluated 36 consecutive patients who underwent ACL single bundle augmentation surgery. Those patients were matched by gender and age to 36 patients with a complete rupture of the ACL. Data was obtained from the patients' records. The rupture pattern was confirmed by arthroscopy. An examination under anesthesia was routinely performed by two surgeons who were blinded to the rupture pattern prior to surgery.
Collectively using both Lachman test and pivot shift test increases ability to distinguish between partial tears and complete ruptures. When comparing partial PL tears and complete ruptures the pivot shift test is more important than the Lachman test. In diagnosing a complete rupture, the evaluation of the endpoint during the Lachman test is more sensitive than the evaluation of the anterior tibial translation during the Lachman test.
Based on the findings of this study, a diagnostic algorithm has been implemented and is presented in this manuscript.
前抽屉试验、包括终点评估的 Lachman 试验和枢轴转移试验已在临床上广泛应用于诊断前交叉韧带（ACL）损伤，但它们在评估部分 ACL 撕裂中的作用知之甚少。本研究的目的是检查临床上常用的膝关节功能检查在检测 ACL 损伤（包括部分损伤模式）中的诊断价值，评估每项检查对特定 ACL 损伤模式的预测价值，并评估是否可以通过联合使用多种检查来提高诊断准确性。
我们评估了 36 例接受 ACL 单束增强手术的连续患者。这些患者按性别和年龄与 36 例 ACL 完全撕裂的患者相匹配。数据来自患者的记录。通过关节镜检查确认撕裂模式。在手术前，由两位对撕裂模式不知情的外科医生对麻醉下的检查进行常规评估。
联合使用 Lachman 试验和枢轴转移试验可提高区分部分撕裂和完全撕裂的能力。当比较部分 PL 撕裂和完全撕裂时，枢轴转移试验比 Lachman 试验更重要。在诊断完全撕裂时，Lachman 试验中终点的评估比 Lachman 试验中胫骨前移位的评估更敏感。
基于本研究的发现，已实施了一种诊断算法，并在本文档中提出。
