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Hip and knee
Published in Ian Mann, Alastair Noyce, The Finalist’s Guide to Passing the OSCE, 2021
Lachman test (anterior instability) – Flex the patient’s knee slightly, with support under the distal femur. Grasp the distal femur with your left hand and the proximal tibia with the right. Rest the fingers of your right hand over the joint and pull the tibia forwards. The test is positive if you feel the tibia shift forward with this action.
Examination of Knee Joint in a Child
Published in Nirmal Raj Gopinathan, Clinical Orthopedic Examination of a Child, 2021
In a concurrent PCL injury, the knee can be posteriorly subluxated at the beginning of the test. This may result in a false-positive pseudo-Lachman test for the ACL. The error can be appreciated if the contralateral knee is examined first and compared to the injured knee. The normally palpable prominences of the anteromedial and lateral tibial plateau in the flexed-knee position are not felt if the knee is PCL deficient and there is posterior subluxation. An abnormal contour or sag may be evident at the proximal anterior tibia when viewed from a lateral position.
Ligament Reconstruction with Reference to the Anterior Cruciate Ligament of the Knee
Published in Verna Wright, Eric L. Radin, Mechanics of Human Joints, 2020
The ACL is the major constraint on the anterior movement of the tibia with respect to the femur. When it is ruptured this constraint is lost, and the anterior laxity of the joint is increased above the normal. In the clinical situation, the surgeon determines whether the ACL is ruptured or intact using three manual examinations. These are the Lachman test, the anterior draw test, and the pivot shift test. The first two are carried out with the patient lying supine. The examiner applies a forward force on each of the tibiae of both knees and compares the anterior movement of the tibia in the injured knee with that of the contralateral joint. In the Lachman test this examination is carried out at 20–30° of knee flexion and in the anterior draw test at 90°. Grades are assigned to the difference in laxities of the two joints. Thus grade 0 is assigned to the injured knee should its laxity “feel” identical to that of the contralateral joint, in which case it is deemed normal. Grade 1 is assigned if there is a slight difference and grade 2 if the difference is moderate, and so on. Clearly this method is not objective, regardless of the grading system adopted. The examiner cannot apply manually, on every occasion, the same forceon both joints for every patient. This precludes any objective comparison of different examiners’ gradings of the same group of patients and hence monitoring the results of any type of treatment, since there would be no basis for pooling results from different centers.
Injury in elite women’s soccer: a systematic review
Published in The Physician and Sportsmedicine, 2020
Tahani A. Alahmad, Philip Kearney, Roisin Cahalan
The association between the risk of injury and joint hypermobility (laxity) was investigated in numerous reviewed studies [1,22,23]. Generalized Joint hypermobility of ≥ 4 on the Beighton [28] score was found to lead to a five-fold increase in injury among affected players [23]. Furthermore, knee joint laxity measured using the manual Lachman test was found to increase the risk of leg injuries [22]. The suggested mechanism of this relates to decreased joint proprioception, which renders the joint less sensitive to potentially damaging forces [29]. Similarly, a prospective study among elite men soccer players reported that joint hypermobility measured by the Beighton scale increased the incidence and severity of injuries among affected players [30]. However, Blokland et al, 2017 found no association between general joint hypermobility and increased soccer injury [1]. Notably interpreting this result was complicated by the implementation of preventative programs and methods (such as bracing/taping) during the observation period [1]. These findings suggest that joint hypermobility may increase injury risk, and that this risk may be addressed by appropriate proprioceptive rehabilitation programs and/or the use of protective equipment. However these findings require more investigation and must be interpreted with caution.
A novel clinical test for assessing patellar cartilage changes and its correlation with magnetic resonance imaging and arthroscopy
Published in Physiotherapy Theory and Practice, 2019
Paul Khoo, Abhijeet Ghoshal, Damien Byrne, Ramesh Subramaniam, Raymond Moran
Another test that is often confused with the CS is the “passive patellar compression test” (Doberstein, Romeyn, and Reineke, 2008). This test involves posteriorly directed pressure on the patella and passive manipulation of the patella in all directions, with provoked pain as a positive result. Although a similar manipulation of the patella is performed in the PST, the difference is the PST does not rely on the subjective sensation of pain as an endpoint. In fact, the examination was found to be pain free by almost all of our patients in the clinic. In this regard, the PST is similar to another commonly performed knee test, the Lachman test, which is also simple and quick to perform and has high levels of diagnostic accuracy without relying on pain as an endpoint (Makhmalbaf, Moradi, Ganji, and Omidi-Kashani, 2013; Nkanta and Vidya Sagar, 2012). The PST is also not harmful to patients as the mechanical forces transmitted through the patellofemoral joint when performing the PST, applied with fingers only, is less than those transmitted during other specific patellofemoral provocative tests such as squatting and stair climbing.
Outcomes after arthroscopic revision surgery for anterior cruciate ligament injuries
Published in Acta Orthopaedica, 2021
Alexei V Yumashev, Tatyana V Baltina, Dmitrii V Babaskin
To diagnose the ACL injury, 3 common tests were applied: the Lachman test, the anterior drawer test, and the pivot-shift test. Knee arthrometry was performed using a KT-1000 knee arthrometer (MEDmetric Corp, San Diego, CA, USA). Results from the Lachman and anterior drawer tests were then compared with the KT-1000 measurements. The study included patients who had positive Lachman tests, 2+ anterior drawer tests or greater, more than 3 mm of displacement between healthy and injured joints on KT 1000 testing, and grade 2 pivot shift tests or greater (noticeable displacement, rough slide with a click).