Anterior laxity of the knee assessed with gravity stress radiograph
- 166 Downloads
To clarify the advantage of prone position over supine position in radiographically-demonstrating anterior knee laxity measurement for anterior cruciate ligament (ACL) injury, and to optimize the radiographic technique for the ACL-deficient knees in a clinical setting.
Materials and methods
Thirty-nine patients with unilateral ACL injury had consented to participate in this study. They were divided into two groups and subjected to the different radiographic evaluations: study 1 (20 patients); supine versus prone position with knee full-extended, and study 2 (19 patients); comparison of (1) prone position with knee full-extended (FPV), (2) prone position with knee flexed at 15° (AGV), and (3) supine position with calf put on a board at 15° of knee flexion (SGV). Lateral radiographs for both knees were taken and were measured the side-to-side difference of tibial position related to femur.
In study 1, the side-to-side difference was 2.8 ± 1.0 mm in supine position and 4.3 ± 2.1 mm in prone position, showing a statistically significant difference. In study 2, the side-to-side difference was 3.7 ± 2.4 mm in FPV, 4.6 ± 2.0 mm in AGV, and 4.2 ± 2.8 mm in SGV, while the difference in the latter two positions was larger than that in FPV.
The anterior laxity in prone position is larger than that in supine position for ACL injury. Moreover, the gravity-assisted lateral radiograph in prone position with knee flexed at 15° could be one of the preferable radiographic techniques and could provide more information than the simple radiograph.
KeywordsAnterior cruciate ligament Radiography Gravity Prone Full-extension
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflicts of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
- 7.Kobayashi S, Terayama K. Quantitative stress radiography for diagnosis of anterior cruciate ligament deficiency. Comparison between manual and instrument techniques and between methods with knee flexed at 20 degrees and at 90 degrees. Arch Orthop Trauma Surg. 1993;112(3):109–12.Google Scholar
- 8.Balasch H, Schiller M, Friebel H, Hoffmann F. Evaluation of anterior knee joint instability with the Rolimeter. A test in comparison with manual assessment and measuring with the KT-1000 arthrometer. Knee Surg Sports Traumatol Arthrosc. 1999;7(4):204–8. https://doi.org/10.1007/s001670050149.CrossRefPubMedGoogle Scholar
- 10.Panisset J-C, Ntagiopoulosb P-G, Sagginc PR, Dejour D. A comparison of telos stress radiography versus Rolimeter in the diagnosis of different patterns of anterior cruciate ligament tears. Orthop Traumatol Surg Res. 2012;98(7):751–8. https://doi.org/10.1016/j.otsr.2012.07.003.CrossRefPubMedGoogle Scholar
- 11.Dejour H, Walch G, Chambat P, Ranger P. Active subluxation in extension: a new concept of study of the ACL deficient knee. Am J Knee Surg. 1998;1:204–11.Google Scholar
- 14.Nagai K, Hoshino Y, Nishizawa Y, Araki D, Matsushita T, Matsumoto T, et al. Quantitative comparison of the pivot shift test results before and after anterior cruciate ligamentre construction by using the three-dimensional electromagnetic measurement system. Knee Surg Sports Traumatol Arthrosc. 2015;23(10):2876–81.CrossRefPubMedGoogle Scholar