What Really Happens during the Lachman Test?

Logan, Martin; Williams, Andrew M.; Lavelle, Jonathon; Gedroyc, W.; Freeman, Michael

doi:10.1177/0095399703258698

Cited by 62 publications

(19 citation statements)

References 33 publications

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“…Historically, the Lachman test has been the most accurate and reliable for diagnosing an ACL rupture, 22 and the pivot-shift test is notably thought of as the least sensitive of the three. 8 , 9 , 14 , 17 , 23 Previous studies 7 , 19 have demonstrated the lever sign test to be more sensitive in correctly diagnosing both acute and chronic ACL tears, as well as complete and partial ACL tears, as compared with the anterior drawer, Lachman, and pivot-shift tests.…”

Section: Discussionmentioning

confidence: 99%

Accuracy of the Lever Sign Test in the Diagnosis of Anterior Cruciate Ligament Injuries

Jarbo

Hartigan

Scott

et al. 2017

Orthopaedic Journal of Sports Medicine

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Background:The lever sign test is a new physical examination tool to diagnose anterior cruciate ligament (ACL) tears. Preliminary results suggest almost 100% sensitivity and specificity to diagnose acute and chronic complete ACL tears and clinically significant partial tears as compared with magnetic resonance imaging (MRI).Purpose:To assess the sensitivity and specificity of the lever sign test for the diagnosis of acute ACL injuries, as compared to MRI. We also aimed to determine the accuracy of the lever sign test compared with 3 other tests (anterior drawer, Lachman, and pivot shift) when performed by providers of various training levels, and with the patient awake or under anesthesia.Study Design:Cohort study (diagnosis); Level of evidence, 2.Methods:We evaluated patients with a chief concern of acute (≤4 weeks) knee pain seen between October 2014 and January 2015, with a thorough history, physical examination, and standard radiographs. MRI was the reference standard; patients without an MRI evaluation were excluded. The 4 physical examination maneuvers were performed on each symptomatic knee during the initial clinic visit (for nonsurgical patients) or under anesthesia in the operating room (for surgical patients) by a randomly assigned undergraduate student, medical student, orthopaedic resident, or orthopaedic fellow. The senior author trained all staff to perform the lever sign test. Statistical analyses were performed.Results:Of 102 patients, 54 were surgical (28 female, 26 male), and 48 were nonsurgical (16 female, 32 male); the mean patient age was 23 years (range, 15-66 years). The overall accuracy of the lever sign test was 77% (63% sensitivity, 90% specificity); the accuracy was similar between patients under anesthesia and awake (77% vs 76%, respectively). There were no significant differences when comparing the sensitivity and specificity of the lever sign test with patients under anesthesia and awake (sensitivity: under anesthesia, 86%, and awake, 68% [P = .40]; specificity: under anesthesia, 85%, and awake, 96% [P = .17]). Furthermore, the accuracy of the lever sign test was similar when performed on female versus male patients (75% vs 79%, respectively) or when performed by undergraduate students and medical students compared with orthopaedic residents and fellows (84% vs 88%, respectively).Conclusion:Our study results challenge the exceptional sensitivity and specificity values (both 100%) of the lever sign test, as reported by the original author of the test.

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Section: Discussionmentioning

confidence: 99%

Accuracy of the Lever Sign Test in the Diagnosis of Anterior Cruciate Ligament Injuries

Jarbo

Hartigan

Scott

et al. 2017

Orthopaedic Journal of Sports Medicine

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“…The MRI-compatible devices of previous studies applied neither an axial compression load, reproducing gravity without additional stress, 10 , 48 , 50 nor a sagittal force on the knee. 14 , 34 Logan et al 33 and Al-Dadah et al 2 assessed the tibiofemoral relationship using weightbearing MRI. They found that the most pronounced effect of the ACL deficiency was the anterior displacement of the lateral tibial plateau relative to the lateral femoral condyle compared with that of the medial side.…”

Section: Discussionmentioning

confidence: 99%

A Preliminary In Vivo Assessment of Anterior Cruciate Ligament–Deficient Knee Kinematics With the KneeM Device

Tardy

Marchand

Kouyoumdjïan

et al. 2014

Orthopaedic Journal of Sports Medicine

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Background:Methods of objectively measuring rotational knee laxity are either experimental or difficult to use in daily practice. A new method has been developed to quantitatively assess rotatory laxity using an open MRI system and new tool, the KneeM device.Purpose/Hypothesis:To perform a preliminary evaluation of a novel knee rotation measurement device to assess knee kinematics during flexion in an MRI field, in both anterior cruciate ligament (ACL)–deficient and healthy contralateral knees. The hypothesis was that the KneeM device would allow in vivo reproduction and analysis of knee kinematics during flexion in healthy and ACL-deficient knees.Study Design:Controlled laboratory study.Methods:Ten subjects (7 men and 3 women; mean age ± standard deviation, 32.3 ± 9.4 years) with ACL-deficient knees and contralateral uninjured knees participated in the study. An open MRI was performed with the KneeM device at a mean 4.9 months (range, 3.0-7 months) after ACL injury. The device exerted on the knee an anterior drawer force of 100 N, with an internal rotation of 20°, through the range of flexion (0°, 20°, 40°, and 60°). Both ACL-deficient and healthy contralateral knees were analyzed using the Iwaki method.Results:There was no statistical difference of anterior translation in the medial compartment between intact and ACL-deficient knees at all degrees of flexion. However, significant differences in the anterior translation of the lateral compartment were observed between ACL-deficient and intact contralateral knees at 0° and 20° of flexion (P = .005 and P = .002, respectively). Between 20° and 40°, the lateral plateau of ACL-deficient knees translated 7.7 mm posteriorly, whereas the medial compartment remained stable, reflecting a sudden external rotation of the lateral plateau under the femoral condyle.Conclusion:This preliminary study suggests that measurement of tibiofemoral movements in both compartments during flexion using the KneeM device was useful for quantifying rotatory laxity in ACL-deficient knees. Moreover, this device seemed to allow a “mechanized pivot shift” and allowed reproduction of the “pivot” phase in the MRI field between 20° and 40° of flexion.Clinical Relevance:This device could be used for diagnostic purposes or to investigate the outcomes of ACL reconstructions.

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“…In order to evaluate the motion during Lachman test in a real clinical setting, in vivo studies without anesthesia are necessary. Logan et al 14) evaluated the Lachman test results of awake participants. The study evaluated the three static points; reverse Lachman, neutral and Lachman, using open MRI.…”

Section: Discussionmentioning

confidence: 99%

“…However, because soft tissue markers have a mismatch between the skin and the bone and bony markers can only be used under anesthesia, these studies only assessed the knee joint under sedation or the cadaveric knees. Two studies performed 3D analysis during Lachman test without anesthesia 14 15) , but they evaluated only static points: neutral, reverse Lachman and Lachman test using open magnetic resonance imaging (MRI) 14) ; neutral and Lachman test using computed tomography (CT) scan 15) .…”

Section: Introductionmentioning

confidence: 99%

Dynamic Three-Dimensional Analysis of Lachman Test for Anterior Cruciate Ligament Insufficiency: Analysis of Anteroposterior Motion of the Medial and Lateral Femoral Epicondyles

Koo

Kyung

Jeong

et al. 2015

Knee Surg Relat Res

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PurposeTo evaluate dynamic three-dimensional (3D) kinematic properties of the anterior cruciate ligament (ACL)-insufficient knees and healthy contralateral knees in awake patients during the Lachman test using biplane fluoroscopy.Materials and MethodsTen patients with unilateral ACL-insufficient knees and healthy contralateral knees were enrolled in this study. Each patient underwent the Lachman test three times in the awake state. The knee joint motions were captured using biplane fluoroscopy. After manual registration of 3D surface data from 3D-computed tomography to biplane images, dynamic 3D kinematic data were analyzed.ResultsThe average anteroposterior (AP) translation of the medial femoral epicondyle of the ACL-insufficient knees (11.5±4.2 mm) was significantly greater than that of the contralateral knees (7.7±3.5 mm) (p<0.05). However, there was no statistically significant side-to-side difference in the average AP translation of the lateral femoral epicondyle. During the Lachman test, the distal femur was more externally rotated than the proximal tibia, which showed significant difference between both sides.ConclusionsDuring the Lachman test, the medial femoral epicondyle of the ACL-insufficient knee exhibited greater AP motion than that of the contralateral knee, whereas there was no significant side-to-side difference with regard to the AP motion of the lateral femoral epicondyle.

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What Really Happens during the Lachman Test?

Abstract: Rupture of the ACL leads to increased anterior tibial translation coupled with tibial internal rotation.

Cited by 62 publications

References 33 publications

Accuracy of the Lever Sign Test in the Diagnosis of Anterior Cruciate Ligament Injuries

Accuracy of the Lever Sign Test in the Diagnosis of Anterior Cruciate Ligament Injuries

A Preliminary In Vivo Assessment of Anterior Cruciate Ligament–Deficient Knee Kinematics With the KneeM Device

Dynamic Three-Dimensional Analysis of Lachman Test for Anterior Cruciate Ligament Insufficiency: Analysis of Anteroposterior Motion of the Medial and Lateral Femoral Epicondyles

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