title: The combination of tibial anterior translation and axial rotation into a single biomechanical factor improves the prediction of patient satisfaction over each factor alone in patients with ACL reconstructed knees.
abstract: OBJECTIVE
  The purpose of this study was to identify biomechanical factors, in both reconstructed and healthy knees, that correlate with patient satisfaction after ACL reconstruction.
  
  
  METHODS
  Seventeen patients who had undergone unilateral ACL reconstruction were reviewed 9 years post-op. Patients completed subjective questionnaires and underwent manual knee laxity testing (Lachman-Trillat, KT-1000, and pivot shift) and automated laxity testing. During automated testing, both legs were rotated into external rotation and then internal rotation until peak rotational torque reached 5.65 Nm. Load-deformation curves were generated from torque and rotation data. Features of the curves were extracted for analysis. Total leg rotation and anterior laxity during KT-1000 testing were combined into a single factor (Joint Play Envelope or JPE). Patients were divided into groups based on patient satisfaction scores (Group 1: Higher Satisfaction, Group 2: Lower Satisfaction, Group 3: Unsatisfied). Load-deformation curve features and manual laxity testing results were compared between groups 1 and 2 to determine which biomechanical factors could distinguish between the groups. Diagnostic screening values were calculated for KT-1000 testing, the pivot shift test, total leg rotation and JPE.
  
  
  RESULTS
  During manual testing, no significant differences in biomechanical factors were found when comparing reconstructed knees in group 1 and group 2. When comparing the reconstructed and healthy knees within group 2, the reconstructed knees had a significantly higher displacement during the KT-1000 manual maximum test (p < 0.002). When considering the reconstructed knees alone, neither the result of the pivot shift test nor KT-1000 testing could distinguish between group 1 and group 2. During automated testing, there were no significant differences between the groups when comparing the reconstructed lower limbs. The healthy lower limbs in group 2 had more maximum external rotation (p < 0.02) and decreased stiffness at maximum external rotation (p < 0.02) when compared to the healthy lower limbs in group 1. Total leg rotation was unable to distinguish between group 1 and group 2. JPE could distinguish between group 1 and group 2 when considering the reconstructed limb alone (p < 0.02). All four diagnostic screening values for JPE were equal or higher than in the other criteria. JPE also showed the most significant correlation with patient satisfaction.
  
  
  CONCLUSIONS
  Joint Play Envelope is an objective measure that demonstrated improved predictive value as compared to other tests when used as a measure of satisfaction in patients with ACL reconstructed knees.
authors.affiliation: University Orthopedics, Decatur, GA, USA.
authors.forename: Thomas P
authors.initials: TP
authors.lastname: Branch
authors.affiliation: ArthroMetrix LLC, 441 Armour Place NE, Atlanta, GA, 30324, USA. stinton@gmail.com.
authors.forename: Shaun K
authors.initials: SK
authors.lastname: Stinton
authors.affiliation: Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA, USA.
authors.forename: William C
authors.initials: WC
authors.lastname: Hutton
authors.affiliation: Department Orthopedic Surgery, Centre Albert-Trillat, Hôpital de la Croix-Rousse, Lyon, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Neyret
mesh_terms: D059549:Anterior Cruciate Ligament Reconstruction; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007593:Joint Instability / Q000503:physiopathology / Q000523:psychology; D007719:Knee Joint / Q000503:physiopathology; D008297:Male; D017060:Patient Satisfaction; D012189:Retrospective Studies; D012399:Rotation
keywords: ACL; ACL reconstruction; Anterior knee laxity; Joint play envelope; Knee laxity; Patient satisfaction; Rotational knee laxity