title: Similarities and differences of diagnostic manual tests for anterior cruciate ligament insufficiency: a global survey and kinematics assessment.
abstract: BACKGROUND
  The Lachman and pivot-shift tests are 2 standard manual tests to diagnose anterior cruciate ligament (ACL) insufficiency. However, the global variation of these testing procedures is not known.
  
  
  OBJECTIVE
  To survey currently used testing techniques and to measure the knee movement during manual tests among various expert surgeons from across the globe.
  
  
  METHODS
  Controlled laboratory study.
  
  
  METHODS
  Part 1: descriptive survey. A questionnaire asking about testing procedures of Lachman and pivot-shift tests was conducted among 33 ACL surgeons. Part 2: knee kinematics comparison. Lachman and pivot-shift tests were performed on a unilateral ACL-injured patient by 5 surgeons, while knee kinematics was recorded by an electromagnetic system. Tibial translation was measured during the Lachman test, while tibial translation, rotation, and pivot-shift acceleration were calculated during the pivot-shift test.
  
  
  RESULTS
  Part 1: Tibial anterior drawer by a medially placed hand was widely advocated for the Lachman test. Flexion type of the pivot-shift test maneuver was supported by two thirds, while extension type was supported by one third. However, the "feeling" of subluxation or reduction during the pivot shift was the primary evaluation method used by the vast majority of surgeons. Part 2: Increased tibial translation during the Lachman test was observed in the ACL-injured knee with significant variation between examiners (P < .01). Tibial translation and pivot-shift acceleration during the pivot-shift test increased in the ACL-injured side (P < .01), but tibial rotation was too diverse to find any trend (P = .31). Tibial translation and acceleration of the pivot shift in the ACL-injured knee showed no significant difference between examiners (P > .05).
  
  
  CONCLUSIONS
  The Lachman test can display a wide variation of actual movement despite maneuver similarity, while the pivot-shift test could possibly be measurable by tibial translation and/or acceleration beyond their procedural variation.
  
  
  CONCLUSIONS
  We should recognize the limitations of these manual tests and the possibilities of their objective measurement.
authors: Department of Orthopaedic Surgery, Kobe University, Kobe, Hyogo, Japan. kurodar@med.kobe-u.ac.jp
authors: Ryosuke
authors: R
authors: Kuroda
authors: Yuichi
authors: Y
authors: Hoshino
authors: Seiji
authors: S
authors: Kubo
authors: Daisuke
authors: D
authors: Araki
authors: Shinya
authors: S
authors: Oka
authors: Kouki
authors: K
authors: Nagamune
authors: Masahiro
authors: M
authors: Kurosaka
mesh_terms: D016118:Anterior Cruciate Ligament / Q000503:physiopathology; D000070598:Anterior Cruciate Ligament Injuries; D001696:Biomechanical Phenomena; D055590:Electromagnetic Phenomena; D006801:Humans; D007593:Joint Instability / Q000175:diagnosis* / Q000503:physiopathology; D007718:Knee Injuries / Q000175:diagnosis* / Q000503:physiopathology; D010808:Physical Examination; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D016059:Range of Motion, Articular; D012399:Rotation; D018709:Statistics, Nonparametric; D013314:Stress, Mechanical; D011795:Surveys and Questionnaires