Healthy knee KT1000 measurements of anterior tibial translation have significant variation

Abstract

Purpose

The most commonly used arthrometer for measuring and reporting anterior tibial translation after anterior cruciate ligament reconstruction is the KT1000. Reports on its consistency and reproducibility vary in the literature, but it remains the “gold standard”. The purpose of this study was to assess agreement of KT1000 measurements in a daily clinical setting.

Methods

A retrospective analysis of anterior knee translation in the healthy knee of 770 patients over a 17-year time period was performed. In this cohort, a total of 24 investigators performed 1890 measurement sets at 89 Newtons (N), 134N and at maximum manual force (MMax) level. To assess the inter- and intra-observer agreement, the intraclass-correlation coefficient (ICC) was calculated. The “investigator effect” was a difference between two examiners in the same patient and the “device effect’’ a difference within one examiner in the same patient. Minimally important difference (MID) was calculated as 0.5 of the standard deviation.

Results

Thirteen investigators were female, performing 1099 measurements and 11 were male, performing 791 measurements. ICC ranged between 0.558 and 0.644. At the MMax level, male investigators had a higher mm reading than female investigators (p < 0.001). Increased experience did not correlate with a higher ICC. MID ranged between 0.85 and 1.65 mm.

Conclusion

This study investigated the KT1000 arthrometer in a clinical setting with a large number of investigators. This device delivers moderate agreement of results. Both the device and investigator effect are present. The MMax level has shown the lowest agreement and a dependency on the investigator gender.

Level of evidence

Level III diagnostic study

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Acknowledgements

We would like to thank Darli Myat, PhD, for maintaining the database.

Funding

No funding was received for this study.

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Authors

Contributions

AK and SP conceptualized the study, AK, SP, VK and TO gathered the data. AK analyzed the data. AK and DP interpreted the data. AK and SP drafted the manuscript, VK, TO, BF and DP revised it. The major revision was performed by AK and BF. All authors have given approval for the final version of the manuscript. All authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Antonio Klasan.

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The authors report no conflicts of interest with respect to this study.

Ethical approval

The database used for this study has a prospective, ongoing ethical approval (HREC/17/HAWKE/140).

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All patients provided written consent for the data collection.

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The research has been performed at the Sydney Orthopaedic Research Institute.

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Klasan, A., Putnis, S.E., Kandhari, V. et al. Healthy knee KT1000 measurements of anterior tibial translation have significant variation. Knee Surg Sports Traumatol Arthrosc 28, 2177–2183 (2020). https://doi.org/10.1007/s00167-019-05768-w

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Keywords

  • Knee
  • Arthrometer
  • Anterior cruciate ligament
  • Anterior tibial translation