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Clinically Assessed Knee Joint Laxity as a Predictor for Reconstruction After an Anterior Cruciate Ligament Injury: A Prospective Study of 100 Patients Treated With Activity Modification and Rehabilitation.

Kostogiannis, Ioannis LU ; Ageberg, Eva LU ; Neuman, Paul LU ; Dahlberg, Leif LU ; Fridén, Thomas LU and Roos, Harald LU (2008) In American Journal of Sports Medicine 36(8). p.1528-1533
Abstract
BACKGROUND: The association of early knee joint laxity with the need for later reconstruction of the anterior cruciate ligament has not been extensively studied. HYPOTHESIS: The grade of knee laxity can be used as an early predictor of the need for later reconstruction. STUDY DESIGN: Cohort study (prognosis); Level of evidence, 2. METHODS: One hundred consecutive patients with an acute arthroscopically verified total anterior cruciate ligament rupture were followed prospectively for 15 years. Lachman and pivot-shift tests were performed with the patient under general anesthesia before arthroscopy. After 3 months, the tests were repeated in an ordinary clinical setting. All patients underwent rehabilitation as the first choice of treatment.... (More)
BACKGROUND: The association of early knee joint laxity with the need for later reconstruction of the anterior cruciate ligament has not been extensively studied. HYPOTHESIS: The grade of knee laxity can be used as an early predictor of the need for later reconstruction. STUDY DESIGN: Cohort study (prognosis); Level of evidence, 2. METHODS: One hundred consecutive patients with an acute arthroscopically verified total anterior cruciate ligament rupture were followed prospectively for 15 years. Lachman and pivot-shift tests were performed with the patient under general anesthesia before arthroscopy. After 3 months, the tests were repeated in an ordinary clinical setting. All patients underwent rehabilitation as the first choice of treatment. Anterior cruciate ligament reconstruction was performed only in cases of significant reinjuries (n = 16) or reparable meniscal lesions (n = 6) at a mean of 4 years after injury (range, 4 months-11 years). After 15 years, 94 patients were available for follow-up. RESULTS: Of the later reconstructed patients (n = 18), 82% had a high-grade Lachman test under anesthesia compared with 63% of the nonreconstructed patients (n = 45; P = .048). At 3 months, 44% of the nonreconstructed patients (n = 32) had a high-grade Lachman test compared with 82% of the reconstructed patients (n = 18; P = .007). Twenty-five patients displayed a normal pivot-shift test at 3 months, of whom 1 underwent later reconstruction (P = .009). A high-grade pivot-shift test at 3 months was associated with an 11.4 relative risk for reconstruction. CONCLUSION: A positive pivot-shift test at 3 months after injury in an awake patient is the strongest predictor for the future need for reconstruction. Furthermore, a normal pivot-shift test at 3 months indicates a low risk for reconstruction and is characteristic for copers. (Less)
Please use this url to cite or link to this publication:
author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
predictorsACL, laxity, pivot-shift test, copers, long-term follow-up
in
American Journal of Sports Medicine
volume
36
issue
8
pages
1528 - 1533
publisher
American Orthopaedic Society for Sports Medicine
external identifiers
  • wos:000257985900010
  • pmid:18544668
  • scopus:47649128801
ISSN
1552-3365
DOI
10.1177/0363546508317717
language
English
LU publication?
yes
id
8b04648a-1073-4757-a1dd-c53da48e4126 (old id 1168920)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/18544668?dopt=Abstract
date added to LUP
2008-07-04 09:52:37
date last changed
2017-06-18 04:02:03
@article{8b04648a-1073-4757-a1dd-c53da48e4126,
  abstract     = {BACKGROUND: The association of early knee joint laxity with the need for later reconstruction of the anterior cruciate ligament has not been extensively studied. HYPOTHESIS: The grade of knee laxity can be used as an early predictor of the need for later reconstruction. STUDY DESIGN: Cohort study (prognosis); Level of evidence, 2. METHODS: One hundred consecutive patients with an acute arthroscopically verified total anterior cruciate ligament rupture were followed prospectively for 15 years. Lachman and pivot-shift tests were performed with the patient under general anesthesia before arthroscopy. After 3 months, the tests were repeated in an ordinary clinical setting. All patients underwent rehabilitation as the first choice of treatment. Anterior cruciate ligament reconstruction was performed only in cases of significant reinjuries (n = 16) or reparable meniscal lesions (n = 6) at a mean of 4 years after injury (range, 4 months-11 years). After 15 years, 94 patients were available for follow-up. RESULTS: Of the later reconstructed patients (n = 18), 82% had a high-grade Lachman test under anesthesia compared with 63% of the nonreconstructed patients (n = 45; P = .048). At 3 months, 44% of the nonreconstructed patients (n = 32) had a high-grade Lachman test compared with 82% of the reconstructed patients (n = 18; P = .007). Twenty-five patients displayed a normal pivot-shift test at 3 months, of whom 1 underwent later reconstruction (P = .009). A high-grade pivot-shift test at 3 months was associated with an 11.4 relative risk for reconstruction. CONCLUSION: A positive pivot-shift test at 3 months after injury in an awake patient is the strongest predictor for the future need for reconstruction. Furthermore, a normal pivot-shift test at 3 months indicates a low risk for reconstruction and is characteristic for copers.},
  author       = {Kostogiannis, Ioannis and Ageberg, Eva and Neuman, Paul and Dahlberg, Leif and Fridén, Thomas and Roos, Harald},
  issn         = {1552-3365},
  keyword      = {predictorsACL,laxity,pivot-shift test,copers,long-term follow-up},
  language     = {eng},
  number       = {8},
  pages        = {1528--1533},
  publisher    = {American Orthopaedic Society for Sports Medicine},
  series       = {American Journal of Sports Medicine},
  title        = {Clinically Assessed Knee Joint Laxity as a Predictor for Reconstruction After an Anterior Cruciate Ligament Injury: A Prospective Study of 100 Patients Treated With Activity Modification and Rehabilitation.},
  url          = {http://dx.doi.org/10.1177/0363546508317717},
  volume       = {36},
  year         = {2008},
}