Bates Brandon, Albright Jay, Methenitis Allison, Dibbern Kevin, Losee Ronald, Albright John
The University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, Iowa, USA.
Children's Hospital Colorado, Aurora, Colorado, USA.
Video J Sports Med. 2022 Nov 15;2(6):26350254221122557. doi: 10.1177/26350254221122557. eCollection 2022 Nov-Dec.
Pivot shift test results have demonstrated widely inconsistent sensitivities when used on awake clinic patients. We believe the painful valgus force applied during traditional pivot shift techniques is the primary culprit and can be circumvented with our novel examination technique.
The reason for publishing this examination technique is to maximize the sensitivity and accuracy of the pivot shift examination in the awake patient.
Four major modifications of Ronald Losee's original valgus-based examination technique are introduced. These are the 4 general modifications: minimizing the sagittal plane arc of motion, avoiding applying valgus force to the knee, application of gentle anteriorly directed force to the lateral tibia, and performing the examination on the patient's noninjured knee first. We also provide detailed description of the hand placement during the Albright-Losee pivot shift test. (1) Once the patient is relaxed, the examiner's hands are placed as follows: (1) the ulnar side of the examiner's thumb is applied to the posterior aspect of the fibular head. The fingers are placed above the patella on the distal femur as shown in the video. (2) With the examiner's hands in the correct position, the knee is flexed to 20° to 30°. One-to-3 pounds of anterior translatory force is then applied by the side of the thumb to the fibular head while the knee is taken slowly toward extension. Pathological anterior tibial translation can be expected to begin in a 20° to 30° range short of the patient's complete knee extension. The examiner must be conscious not to provide any valgus or additional internal or external rotation of the leg.
This examination is useful for reproducing the subluxation phenomenon in anterior cruciate ligament (ACL)-deficient knees. Our work has shown that these modifications yield an accuracy of 95.51% and a sensitivity of 94.7% in 353 knees examined by 71 clinicians.
DISCUSSION/CONCLUSION: The Albright-Losee pivot shift test is an easy to perform, highly sensitive, and highly specific test. In our recently submitted manuscript, the Albright-Losee pivot shift test suggested to be of greater value than Lachman test.The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
在清醒的门诊患者中使用轴移试验时，其结果显示出广泛不一致的敏感性。我们认为，传统轴移技术中施加的疼痛性外翻力是主要原因，而我们的新型检查技术可以避免这一问题。
公布这项检查技术的目的是最大限度地提高清醒患者轴移检查的敏感性和准确性。
介绍了对罗纳德·洛西最初基于外翻的检查技术的四项主要改进。这四项一般改进是：最小化矢状面运动弧，避免对膝关节施加外翻力，对胫骨外侧施加轻柔的向前力，以及首先在患者未受伤的膝关节上进行检查。我们还提供了奥尔布赖特-洛西轴移试验中手部放置的详细描述。（1） 患者放松后，检查者的手按以下方式放置：（1）检查者拇指的尺侧放在腓骨头的后侧。手指如图像中所示放在股骨远端的髌骨上方。（2） 检查者的手位置正确后，膝关节屈曲至20°至30°。然后，在膝关节缓慢伸展时，拇指一侧对腓骨头施加1至3磅的前向平移力。预计病理性胫骨前移会在患者膝关节完全伸展前20°至30°的范围内开始。检查者必须注意不要对腿部施加任何外翻力或额外的内旋或外旋力。
这项检查有助于重现前交叉韧带（ACL）损伤膝关节的半脱位现象。我们的研究表明，在71名临床医生检查的353个膝关节中，这些改进的准确率为95.51%，敏感性为94.7%。
讨论/结论：奥尔布赖特-洛西轴移试验是一项易于执行、高度敏感且高度特异的检查。在我们最近提交的手稿中，奥尔布赖特-洛西轴移试验被认为比拉赫曼试验更有价值。作者证明已获得本出版物中出现的任何患者的同意。如果个体可能被识别，作者在提交发表时已包含患者的豁免声明或其他书面批准形式。
