Objective Anterior Cruciate Ligament Testing

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Abstract
We examined subjects with the Stryker knee laxity tester as part of the clinical examination to determine its usefulness in evaluating the anterior cruciate ligament. We measured 123 athletes with no history of knee injury, as well as 30 patients with ACL injury proven by arthroscopy, and 11 injured patients with intact ACL at arthroscopy. We recorded anterior and posterior tibial displacement at 20 degrees of knee flexion and 20 lbs force in each direction. Anterior laxity and side to side difference correlated with ACL injury; posterior and total AP laxity did not. In normal subjects, mean anterior laxity was 2.5 mm. Only 8% of normal knees had anterior laxity of 5 mm or more. Ten percent of normal subjects had a side to side difference of 2 mm or more. In ACL tears, mean laxity was 8.1 mm, with 94% measuring 5 mm or more. Of the subjects, 89% with unilateral ACL injury had an increase of 2 mm or more on the injured side. Ten of ten acute ACL tears were detected by these criteria, with no false positives. In injured knees with intact ACL, measurements did not differ significantly from normal. We found the objective knee laxity measurement to be a useful complement to clinical knee examination.