Abstract
BackgroundThe stump impingement reflex is a subtle bounce to the knee thought to be caused by hamstring contraction when the knee is brought into extension and the torn ACL stump impinges between the distal femur and the tibial plateau. We have studied the diagnostic value of this sign.FindingsFrom Feb 2008-Feb 2009, we audited 30 patients who underwent urgent arthroscopy for acutely locked knees. The presence of the stump impingement reflex prior to surgery was compared with the intra-operative findings. The diagnostic values of the stump impingement sign were found to be: Sensitivity 58%, Specificity 81%, Positive predictive value 70%, Negative predictive value 72% and Accuracy 71%.ConclusionsWe believe that the stump impingement reflex is a specific sign for ACL stump impingement as a cause of knee locking. We recommend close inspection for this sign when examining locked knees.
Highlights
A knee is considered locked when it acutely loses full extension, during both active and passive movements and is held or “locked” in flexion
We believe that the stump impingement reflex is a specific sign for anterior cruciate ligament (ACL) stump impingement as a cause of knee locking
The causes of knee locking may be related to intra-articular pathology [1] i.e. a mechanical block (86%) [2] or due to an acute haemarthrosis and hamstring muscle spasm [3,4]
Summary
A knee is considered locked when it acutely loses full extension, during both active and passive movements and is held or “locked” in flexion. The causes of knee locking may be related to intra-articular pathology [1] i.e. a mechanical block (86%) [2] or due to an acute haemarthrosis and hamstring muscle spasm [3,4]. Both Noyes and Dehaven comment that a ruptured anterior cruciate ligament (ACL) is the commonest cause of locking (72%) and with bucket handle meniscal tears (62%, 15%) and loose bodies/chondral injuries (20%, 6%) may frequently occur in their respective series [5,6].
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