TY - JOUR
T1 - Factors Associated with High-Grade Lachman, Pivot Shift, and Anterior Drawer at the Time of Anterior Cruciate Ligament Reconstruction
AU - MOON Group
AU - Magnussen, Robert A.
AU - Reinke, Emily K.
AU - Huston, Laura J.
AU - Andrish, Jack T.
AU - Jones, Morgan H.
AU - Parker, Richard D.
AU - McCarty, Eric C.
AU - Vidal, Armando F.
AU - Wolcott, Michelle L.
AU - Marx, Robert G.
AU - Amendola, Annunziato
AU - Wolf, Brian R.
AU - Flanigan, David C.
AU - Kaeding, Christopher C.
AU - Brophy, Robert H.
AU - Matava, Matthew J.
AU - Wright, Rick W.
AU - Dunn, Warren R.
AU - Hewett, Timothy E.
AU - Spindler, Kurt P.
N1 - Funding Information:
The authors report the following potential conflict of interest or source of funding: R.A.M. receives support from National Institutes of Health (NIH)–National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), Orthopaedic Research and Education Foundation (OREF), and Orthopaedic Journal of Sports Medicine. E.K.R. receives support from NIH/NIAMS (5R01 AR053684 and 5R01 AR055557), NFL Charities, OREF, DonJoy, Smith & Nephew, and Aircast. L.J.H. receives support from NIH/NIAMS (5R01 AR060846), NFL Charities, OREF, DonJoy, Smith & Nephew, and Aircast. K.P.S. receives support from NIH. A.F.V. receives support from Ceterix, Stryker, ArthroCare, and Smith & Nephew. R.G.M. receives support from The ACL Solution (Desmos Health, 2012), ACL Revision (Springer, 2014), Sports Medicine, and Journal of Bone and Joint Surgery. A.A. receives support from Arthrex, NIH, Department of Defense, Arthrosurface, and MTP Solutions. B.R.W. receives support from United Health Care, ConMed, OREF, and Arthrex. D.C.F. receives support from Smith & Nephew, Vericel, DePuy Mitek, NFL Charities, and Arthroscopy Association of North America. M.J.M. receives support from Ostesys, Arthrex, Breg, and Schwartz Biomedical. R.W.W. receives support from Board of Directors, American Board of Orthopaedic Surgery; Board of Directors, American Orthopaedic Association; Board of Directors, American Orthopaedic Society for Sports Medicine; NIH; NIAMS; and Wolters Kluwer Lippincott Williams & Wilkins.
Publisher Copyright:
© 2016 Arthroscopy Association of North America.
PY - 2016/6/1
Y1 - 2016/6/1
N2 - Purpose To determine which patient and injury factors are associated with the detection of high-grade laxity on examination under anesthesia before anterior cruciate ligament (ACL) reconstruction. Methods We identified 2,318 patients who underwent primary ACL reconstruction without associated ligament injuries. Demographic data and information regarding meniscal tears were collected. Patients with high-grade Lachman (difference from contralateral side >10 mm), pivot-shift (International Knee Documentation Committee grade 3+), or anterior drawer (difference from contralateral side >10 mm) tests were identified by physical examination under anesthesia before ACL reconstruction. Logistic regression modeling was used to evaluate whether chronicity of the ACL injury, patient age, sex, body mass index, generalized ligamentous laxity, and presence of meniscal tears were associated with increased odds of high-grade laxity, while we controlled for examining surgeon. Results Patients with chronic tears (>6 months from injury) had greater than twice the odds of having high-grade Lachman, pivot-shift, and anterior drawer tests (all P <.001) relative to patients with acute tears (<3 months from injury). Generalized ligamentous laxity (odds ratio [OR], 2.33; P <.001) and the presence of medial (OR, 1.63; P <.001) or lateral (OR, 1.41; P =.013) meniscus tears were associated with increased odds of a high-grade Lachman test. Age younger than 20 years (OR, 1.34; P =.023), female sex (OR, 1.49; P =.001), generalized ligamentous laxity (OR, 3.46; P <.001), and the presence of a medial (OR, 1.53; P <.001) or lateral (OR, 1.27; P =.041) meniscus tear were associated with increased odds of a high-grade pivot-shift test. Generalized ligamentous laxity (OR, 2.27; P <.001) and the presence of a medial (OR, 1.73; P =.001) or lateral (OR, 1.50; P =.010) meniscus tear were associated with increased odds of a high-grade anterior drawer test. Conclusions Chronic ACL tears, generalized ligamentous laxity, and meniscus tears are associated with increased odds of high-grade laxity with all 3 tests. Female patients and age younger than 20 years are associated with increased odds of a high-grade pivot-shift test. Level of Evidence Level II, lesser-quality prospective study.
AB - Purpose To determine which patient and injury factors are associated with the detection of high-grade laxity on examination under anesthesia before anterior cruciate ligament (ACL) reconstruction. Methods We identified 2,318 patients who underwent primary ACL reconstruction without associated ligament injuries. Demographic data and information regarding meniscal tears were collected. Patients with high-grade Lachman (difference from contralateral side >10 mm), pivot-shift (International Knee Documentation Committee grade 3+), or anterior drawer (difference from contralateral side >10 mm) tests were identified by physical examination under anesthesia before ACL reconstruction. Logistic regression modeling was used to evaluate whether chronicity of the ACL injury, patient age, sex, body mass index, generalized ligamentous laxity, and presence of meniscal tears were associated with increased odds of high-grade laxity, while we controlled for examining surgeon. Results Patients with chronic tears (>6 months from injury) had greater than twice the odds of having high-grade Lachman, pivot-shift, and anterior drawer tests (all P <.001) relative to patients with acute tears (<3 months from injury). Generalized ligamentous laxity (odds ratio [OR], 2.33; P <.001) and the presence of medial (OR, 1.63; P <.001) or lateral (OR, 1.41; P =.013) meniscus tears were associated with increased odds of a high-grade Lachman test. Age younger than 20 years (OR, 1.34; P =.023), female sex (OR, 1.49; P =.001), generalized ligamentous laxity (OR, 3.46; P <.001), and the presence of a medial (OR, 1.53; P <.001) or lateral (OR, 1.27; P =.041) meniscus tear were associated with increased odds of a high-grade pivot-shift test. Generalized ligamentous laxity (OR, 2.27; P <.001) and the presence of a medial (OR, 1.73; P =.001) or lateral (OR, 1.50; P =.010) meniscus tear were associated with increased odds of a high-grade anterior drawer test. Conclusions Chronic ACL tears, generalized ligamentous laxity, and meniscus tears are associated with increased odds of high-grade laxity with all 3 tests. Female patients and age younger than 20 years are associated with increased odds of a high-grade pivot-shift test. Level of Evidence Level II, lesser-quality prospective study.
UR - http://www.scopus.com/inward/record.url?scp=84955613724&partnerID=8YFLogxK
U2 - 10.1016/j.arthro.2015.11.018
DO - 10.1016/j.arthro.2015.11.018
M3 - Article
C2 - 26821957
AN - SCOPUS:84955613724
SN - 0749-8063
VL - 32
SP - 1080
EP - 1085
JO - Arthroscopy - Journal of Arthroscopic and Related Surgery
JF - Arthroscopy - Journal of Arthroscopic and Related Surgery
IS - 6
ER -