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Knee Pain
Published in Benjamin Apichai, Chinese Medicine for Lower Body Pain, 2021
The patient lies in a supine position with the hips flexed at 45 degrees and the knees flexed at 90 degrees. A posterior force is applied to the proximal tibia with one hand while stabilizing the distal femur with another hand. The test is positive if there is pain or an increase of tibia posterior translation of more than 5 mm, and the laxity will be apparent as compared to the contralateral knee. However, due to the pain and muscle spasm caused by knee flexion, the posterior drawer test is often difficult to perform, and some are misdiagnosed as a negative result.
Orthopaedics and Trauma, including Neurosurgery
Published in Kaji Sritharan, Samia Ijaz, Neil Russell, Tim Allen-Mersh, 300 Essentials SBAs in Surgery, 2017
Kaji Sritharan, Samia Ijaz, Neil Russell, Tim Allen-Mersh
The anterior drawer test tests the anterior cruciate ligament. The valgus stress test tests the medial collateral and the varus stress test tests the lateral collateral. The posterior drawer test tests the posterior cruciate. A meniscal tear is unlikely to cause a haemarthrosis, and you would not bear weight with a tibial plateau fracture.
Ankle injuries
Published in Sebastian Dawson-Bowling, Pramod Achan, Timothy Briggs, Manoj Ramachandran, Stephen Key, Daud Chou, Orthopaedic Trauma, 2014
Derek Park, Anthony Sakellariou, Dishan Singh
Two provocative tests may be used clinically to assess lateral ligament injuries. The anterior drawer test is performed with the knee flexed to relax the gastrocnemius-soleus complex (Fig. 21.10). Comparison of the degree of laxity is made with the contralateral side. A sulcus sign may be present just anterior to the fibula, as the skin and lax ATFL are ‘sucked’ inward by negative pressure within the ankle. The test is more sensitive if slight internal rotation of the talus is applied during anterior translation.
Rongjin Niantong Fang ameliorates cartilage degeneration by regulating the SDF-1/CXCR4-p38MAPK signalling pathway
Published in Pharmaceutical Biology, 2022
Jun Chen, Nan Chen, Ting Zhang, Jie Lin, Yunmei Huang, Guangwen Wu
Thirty rats were randomly divided into the blank, model, and treatment groups (n = 10). After a week of routine feeding, rats were anaesthetised by intraperitoneal injection of 3% pentobarbital sodium (30 mg/kg). (Liu et al. 2005; Chen et al. 2016; Wu et al. 2019; Xu et al. 2021). Briefly, the rat model of OA was established using modified Hulth’s method in all groups except the blank group. A 1 cm longitudinal incision was made on the skin of the medial right-posterior knee, the medial collateral and anterior cruciate ligaments were transected via the medial approach, and the medial meniscus was removed. Then the joint capsule was sutured layer by layer. The blank group only received a 1 cm longitudinal incision on the skin of the medial right-posterior knee, and the skin was sutured. A prophylactic antibiotic with sodium penicillin (200,000 units) was given 3 days after surgery. The drawer test was used to determine whether the cruciate ligaments were transected.
Evaluation of anterotalofibular and calcaneofibular ligament stress tests utilizing musculoskeletal ultrasound imaging
Published in Physiotherapy Theory and Practice, 2022
Rob Sillevis, Eric Shamus, Arie van Duijn
The International Ankle Consortium developed the International Ankle Consortium Rehabilitation-Oriented AssessmenT (ROAST) tool based on a Delphi study (Delahunt et al., 2018). The ROAST recommends that clinicians go through a systematic approach evaluating patients with ankle sprains. This should include an assessment of the osseous and ligamentous structures (Delahunt et al., 2018). To assess the osseous structures, the ROAST recommends using the Ottawa Ankle Rules. These have a high sensitivity, and if they are used following an ankle inversion trauma and none of the rules are positive, the posttest probability of ankle joint fracture is less than 1% (Delahunt et al., 2018). To assess ligament integrity, the anterior drawer test is recommended over the talar tilt test (Delahunt et al., 2018). The ROAST identifies the anterior drawer test as the most sensitive clinical stability test to assess for the complete rupture of the anterior talofibular ligament (Delahunt et al., 2018). Docherty and Rybak-Webb (2009) reported minimal differences between the reliability of both tests with the talar tilt test having an intra-rater reliability of 0.74 and an inter-rater reliability of 0.76. The anterior drawer test has an intra-rater reliability of 0.65 and an inter-rater reliability of 0.81 (Docherty and Rybak-Webb, 2009). Based on the current literature there is no clear diagnostic utility or clear preference of either the anterior drawer or the talar tilt test when evaluating the integrity of the ATFL (Cleland, Koppenhaver, Su, and Netter, 2016).
Relationship between outcome scores and knee laxity following total knee arthroplasty: a systematic review
Published in Acta Orthopaedica, 2019
Andreas Kappel, Mogens Laursen, Poul T Nielsen, Anders Odgaard
Sagittal laxity measurements were done using an arthrometer in 8 studies (KT-1000 in 3 studies, KT-2000 in 2 studies [Genourob, Laval, France], Rolimeter in 2 studies [Aircast, Summit, NJ, USA], and KS measure arthrometer in 1 study [Sigmax Medical, Tokyo, Japan]) and stress radiography with the Telos device in 2 studies [Telos Arzt- und Krankenhausbedarf GmbH, Hungen, Germany]. The method resembles the drawer test and the result was measured as a distance in mm. Sagittal laxity measurements performed in the range from 60° to 90° of flexion were found to associate with outcome in 4 of 7 studies. Statistically significant correlation was found in the study by Matsumoto et al. (2017) who found correlation between laxity at 60° and 1 KOOS sub-score, i.e., KOOS pain; no correlation to laxity at 90° was found. 4 studies analyzed the results following stratification. Seon et al. (2010) measured laxity using stress radiographs at 90° and found that stable knees with laxity below 10 mm obtained better WOMAC scores. Seah et al. (2012) and Jones et al. (2006) performed the laxity measurements under equal conditions, with KT-1000 at 75–80°, and used the same stratification of the results, and both studies reported statistically significantly better outcomes for the group with laxity in the range from 5 to 10 mm. Both studies included only CR implants. Schuster et al. (2011) performed the measurements with the Rolimeter at 90° of flexion and used different limits for stratification, but did not find any significant association.