Abstract
PurposeThe purpose of this study was to identify biomechanical factors, in both reconstructed and healthy knees, that correlate with patient satisfaction after ACL reconstruction.MethodsSeventeen patients who had undergone unilateral ACL reconstruction were reviewed 9 years post-op. Patients completed subjective questionnaires and underwent manual knee laxity testing (Lachman-Trillat, KT-1000, and pivot shift) and automated laxity testing. During automated testing, both legs were rotated into external rotation and then internal rotation until peak rotational torque reached 5.65 Nm. Load-deformation curves were generated from torque and rotation data. Features of the curves were extracted for analysis. Total leg rotation and anterior laxity during KT-1000 testing were combined into a single factor (Joint Play Envelope or JPE). Patients were divided into groups based on patient satisfaction scores (Group 1: Higher Satisfaction, Group 2: Lower Satisfaction, Group 3: Unsatisfied). Load-deformation curve features and manual laxity testing results were compared between groups 1 and 2 to determine which biomechanical factors could distinguish between the groups. Diagnostic screening values were calculated for KT-1000 testing, the pivot shift test, total leg rotation and JPE.ResultsDuring manual testing, no significant differences in biomechanical factors were found when comparing reconstructed knees in group 1 and group 2. When comparing the reconstructed and healthy knees within group 2, the reconstructed knees had a significantly higher displacement during the KT-1000 manual maximum test (p < 0.002). When considering the reconstructed knees alone, neither the result of the pivot shift test nor KT-1000 testing could distinguish between group 1 and group 2. During automated testing, there were no significant differences between the groups when comparing the reconstructed lower limbs. The healthy lower limbs in group 2 had more maximum external rotation (p < 0.02) and decreased stiffness at maximum external rotation (p < 0.02) when compared to the healthy lower limbs in group 1. Total leg rotation was unable to distinguish between group 1 and group 2. JPE could distinguish between group 1 and group 2 when considering the reconstructed limb alone (p < 0.02). All four diagnostic screening values for JPE were equal or higher than in the other criteria. JPE also showed the most significant correlation with patient satisfaction.ConclusionsJoint Play Envelope is an objective measure that demonstrated improved predictive value as compared to other tests when used as a measure of satisfaction in patients with ACL reconstructed knees.
Highlights
Materials and methodsOutcome analysis, with an emphasis on patient satisfaction, has been of increased interest in sports medicine since Kocher et al published a study in 2004 that described the relationship between ligament stability and subjective assessment of knee function [11]
Joint Play Envelope is an objective measure that demonstrated improved predictive value as compared to other tests when used as a measure of satisfaction in patients with anterior cruciate ligament (ACL) reconstructed knees
Patient satisfaction after anterior cruciate ligament (ACL) reconstruction was shown to be significantly correlated with the grade of the pivot shift test during the manual clinical knee examination and not the amount of anterior tibial translation during the Lachman-Trillat test
Summary
With an emphasis on patient satisfaction, has been of increased interest in sports medicine since Kocher et al published a study in 2004 that described the relationship between ligament stability and subjective assessment of knee function [11]. Patient satisfaction after anterior cruciate ligament (ACL) reconstruction was shown to be significantly correlated with the grade of the pivot shift test during the manual clinical knee examination and not the amount of anterior tibial translation during the Lachman-Trillat test. In the decades prior to the Kocher study, surgeons had focused primarily on correcting increased anterior tibial translation by reducing the positive Lachman-Trillat findings present in an ACL deficient knee. Joint Play Area (JPA) is a single biomechanical factor that combines both absolute translational and rotational instability within the knee and may be able to provide similar information as the pivot shift test. It may be more descriptive to rename the term “joint play area” and call it “joint play envelope” (JPE) since it is a three-dimensional measure rather than a two-dimensional measure
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