Draper D O, Schulthies S S
Department of Physical Education, Brigham Young University, Provo, UT 84602, USA.
J Orthop Sports Phys Ther. 1995 Dec;22(6):263-6. doi: 10.2519/jospt.1995.22.6.263.
The anterior drawer and Lachman tests are frequently used for determining anterior cruciate ligament (ACL) instability. The Lachman test is considered to be the most accurate, yet it is difficult to perform on a large person, especially by an examiner with small hands. One procedure, the alternate Lachman test, has been used with some success by examiners who have difficulty performing the Lachman test. The purpose of this study was to compare these three manual tests with respect to predicting ACL stability. These findings were compared with those of the KT-1000 knee arthrometer. Seventy-four subjects (mean age = 22 years) volunteered for the study. Girth measurements were recorded for each subject at 8 cm above and below the midpoint of the patella. An examiner with small hands (21-cm span) performed each of the three tests on both knees of the subjects and then recorded which knee he believed was the most lax of the two with respect to each test. Another examiner then tested each subject's knees with the KT-1000. A log-linear model with terms for manual test type, category, and thigh girth was used for statistical analysis. The alternate Lachman test significantly outperformed the other two tests. Subjects with > 2.5 mm bilateral laxity difference were correctly evaluated 100% of the time using the alternate Lachman test. In subjects with large thigh girth (> 43 cm), 1) the alternate Lachman test was correct 78% of the time; 2) the anterior drawer test was correct 59% of the time; and 3) the Lachman test produced only 28% correct examinations. Based upon these results, the alternate Lachman test should be included in the regimen of manual ACL tests, especially for athletes with large thigh circumference or when performed by examiners with small hands.
前抽屉试验和拉赫曼试验常用于确定前交叉韧带（ACL）的稳定性。拉赫曼试验被认为是最准确的，但对于体型较大的人来说很难操作，尤其是手小的检查者。有一种方法，即交替拉赫曼试验，对于难以进行拉赫曼试验的检查者来说使用起来有一定成效。本研究的目的是比较这三种手法检查在预测ACL稳定性方面的情况。将这些结果与KT-1000膝关节测压仪的结果进行比较。74名受试者（平均年龄=22岁）自愿参与本研究。记录了每位受试者髌骨中点上下8厘米处的周长。一名手小（指距21厘米）的检查者对受试者的双膝进行了这三种检查中的每一项，然后记录他认为在每项检查中双膝中最松弛的是哪一侧。另一名检查者随后用KT-1000对每位受试者的膝盖进行检测。采用包含手法检查类型、类别和大腿周长项的对数线性模型进行统计分析。交替拉赫曼试验明显优于其他两种检查。使用交替拉赫曼试验时，双侧松弛度差异>2.5毫米的受试者被正确评估的比例为100%。在大腿周长较大（>43厘米）的受试者中，1）交替拉赫曼试验的正确率为78%；2）前抽屉试验的正确率为59%；3）拉赫曼试验的正确检查率仅为28%。基于这些结果，交替拉赫曼试验应纳入ACL手法检查方案中，尤其是对于大腿周长较大的运动员或由手小的检查者进行检查时。
