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Wang X, Wu Y, Li J, Li Y, Xu S. Deep Learning-Assisted Automatic Diagnosis of Anterior Cruciate Ligament Tear in Knee Magnetic Resonance Images. Tomography 2024; 10:1263-1276. [PMID: 39195729 DOI: 10.3390/tomography10080094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Revised: 07/08/2024] [Accepted: 07/11/2024] [Indexed: 08/29/2024] Open
Abstract
Anterior cruciate ligament (ACL) tears are prevalent knee injures, particularly among active individuals. Accurate and timely diagnosis is essential for determining the optimal treatment strategy and assessing patient prognosis. Various previous studies have demonstrated the successful application of deep learning techniques in the field of medical image analysis. This study aimed to develop a deep learning model for detecting ACL tears in knee magnetic resonance Imaging (MRI) to enhance diagnostic accuracy and efficiency. The proposed model consists of three main modules: a Dual-Scale Data Augmentation module (DDA) to enrich the training data on both the spatial and layer scales; a selective group attention module (SG) to capture relationships across the layer, channel, and space scales; and a fusion module to explore the inter-relationships among various perspectives to achieve the final classification. To ensure a fair comparison, the study utilized a public dataset from MRNet, comprising knee MRI scans from 1250 exams, with a focus on three distinct views: axial, coronal, and sagittal. The experimental results demonstrate the superior performance of the proposed model, termed SGNET, in ACL tear detection compared with other comparison models, achieving an accuracy of 0.9250, a sensitivity of 0.9259, a specificity of 0.9242, and an AUC of 0.9747.
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Affiliation(s)
- Xuanwei Wang
- Department of Orthopedics, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310000, China
| | | | - Jiafeng Li
- Department of Orthopedics, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310000, China
| | - Yifan Li
- Department of Orthopedics, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310000, China
| | - Sanzhong Xu
- Department of Orthopedics, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310000, China
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Oxfeldt M, Pedersen AB, Hansen M. Intra-Tester and Inter-Tester Reliability of the Lachmeter When Measuring Knee Joint Laxity. TRANSLATIONAL SPORTS MEDICINE 2023; 2023:5583949. [PMID: 38654920 PMCID: PMC11022768 DOI: 10.1155/2023/5583949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 07/05/2023] [Accepted: 07/17/2023] [Indexed: 04/26/2024]
Abstract
Knee injuries are common among all age groups, and clinical knee examination is essential for the prognosis, follow-up, and rehabilitation process. The Lachmeter is a newly developed digitized modification of the Rolimeter, making it easier and faster for the test personnel to read the test result. In the present study, we aimed to evaluate the intra-tester and inter-tester reliability of the Lachmeter when testing healthy and traumatic knees. 24 healthy participants and a smaller sample of six ACL patients were examined with the Lachmeter by two intermediate testers and re-examined on a second visit within 21 days. All measurements were performed using two different grip techniques: a Lachman grip and an anterior drawer grip. Intra- and inter-tester reliability was evaluated using intra-class correlation coefficient (ICC), standard error of measurement (SEM), smallest detectable change (SDC), Student's paired t-test, and Bland-Altman plots. The results showed in healthy subjects poor to good intra-tester reliability (ICC range: -0.28-0.87, SEM range: 0.33-1.14 mm, and SDC range: 0.91-3.17 mm) and inter-tester reliability (ICC range: 0.41-0.87, SEM range: 0.27-0.67 mm, and SDC range: 0.75-1.87 mm). In ACL patients, intra-tester reliability was moderate to excellent (ICC range: 0.53-0.94, SEM range: 0.14-0.88 mm, and SDC range: 0.38-2.44 mm), with the exception of one measurement (ICC: 0.26 95% CI [-3.43; 0.89]), whereas inter-tester reliability was overall good (ICC range: 0.61-0.89, SEM range: 0.29-0.71 mm, and SDC range: 0.79-1.97 mm). Reliability measures between grip techniques indicated that the Lachman grip was more reliable than the anterior drawer grip. In conclusion, the Lachmeter showed variation between reliability measures, ranging from poor to good in healthy subjects and moderate to excellent in ACL patients. Future studies are needed to validate the Lachmeter against a gold-standard knee laxity assessment.
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Affiliation(s)
- Mikkel Oxfeldt
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | | | - Mette Hansen
- Department of Public Health, Aarhus University, Aarhus, Denmark
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Petersen W, Häner M, Guenther D, Lutz P, Imhoff A, Herbort M, Stein T, Schoepp C, Akoto R, Höher J, Scheffler S, Stöhr A, Stoffels T, Mehl J, Jung T, Eberle C, Vernacchia C, Ellermann A, Krause M, Mengis N, Müller PE, Best R, Achtnich A. Management after acute injury of the anterior cruciate ligament (ACL), part 2: management of the ACL-injured patient. Knee Surg Sports Traumatol Arthrosc 2022; 31:1675-1689. [PMID: 36471029 DOI: 10.1007/s00167-022-07260-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 11/25/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE The aim of this consensus project was to create a treatment algorithm for the management of the ACL-injured patient which can serve as an aid in a shared decision-making process. METHODS For this consensus process, a steering and a rating group were formed. In an initial face-to-face meeting, the steering group, together with the expert group, formed various key topic complexes for which various questions were formulated. For each key topic, a structured literature search was performed by the steering group. The results of the literature review were sent to the rating group with the option to give anonymous comments until a final consensus voting was performed. Sufficient consensus was defined as 80% agreement. RESULTS During this consensus process, 15 key questions were identified. The literature search for each key question resulted in 24 final statements. Of these 24 final statements, all achieved consensus. CONCLUSIONS This consensus process has shown that ACL rupture is a complex injury, and the outcome depends to a large extent on the frequently concomitant injuries (meniscus and/or cartilage damage). These additional injuries as well as various patient-specific factors should play a role in the treatment decision. The present treatment algorithm represents a decision aid within the framework of a shared decision-making process for the ACL-injured patient. LEVEL OF EVIDENCE Level V.
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Affiliation(s)
- Wolf Petersen
- Department of Orthopedics, Sportsclinic Berlin, Martin Luther Hospital, Caspar-Theyß-Straße 27-31, 14193, Berlin-GrunewaldBerlin, Germany
| | - Martin Häner
- Department of Orthopedics, Sportsclinic Berlin, Martin Luther Hospital, Caspar-Theyß-Straße 27-31, 14193, Berlin-GrunewaldBerlin, Germany.
| | - Daniel Guenther
- Department of Orthopaedic Surgery, Trauma Surgery, and Sports Medicine Cologne Merheim Medical Center (Witten/Herdecke University), Ostmerheimer Str. 200, 51109, Cologne, Germany
| | - Patricia Lutz
- Department of Orthopaedics and Trauma Surgery, State Hospital Feldkirch, Carinagasse 41, 6800, Feldkirch, Austria
| | - Andreas Imhoff
- Department for Orthopedic Sports Medicine, Technical University Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Mirco Herbort
- OCM Clinic Munich, Steinerstrasse 6, 81369, Munich, Germany
| | - Thomas Stein
- SPORTHOLOGICUM® Frankfurt Am Main, Siesmayerstraße 44, 60323, Frankfurt Am Main, Germany
- Department of Sports Medicine, Goethe University Frankfurt, Ginnheimer Landstraße 39, 60487, Frankfurt Am Main, Germany
| | - Christian Schoepp
- Department of Arthroscopic Surgery, Sports Traumatology and Sports Medicine, BG Klinikum, Duisburg gGmbH, Großenbaumer Allee 250, 47249, Duisburg, Germany
| | - Ralph Akoto
- Department of Trauma and Orthopaedic Surgery, Sports Traumatology, BG Hospital Hamburg, Hamburg, Germany
- Department of Orthopaedics, Trauma Surgery and Sports Medicine, Cologne-Merheim Medical Center, University of Witten/Herdecke, Cologne, Germany
| | - Jürgen Höher
- SPORTSCLINIC COLOGNE, Ostmerheiemer Str. 200, 51109, Cologne, Germany
| | - Sven Scheffler
- Sporthopaedicum Berlin, Bismarckstrasse 45-47, 10627, Berlin, Germany
| | - Amelie Stöhr
- OCM Clinic Munich, Steinerstrasse 6, 81369, Munich, Germany
| | | | - Julian Mehl
- Department for Orthopedic Sports Medicine, Technical University Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Tobias Jung
- Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, Berlin, Germany
- Berlin Institute of Health, Berlin, Germany
| | - Christian Eberle
- ARCUS Sports Clinic, Rastatter Str. 17-19, 75179, Pforzheim, Germany
| | - Cara Vernacchia
- Department of Physical Medicine and Rehabilitation, Shirley Ryan Ability Lab, Chicago, IL, USA
- McGaw/Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Andree Ellermann
- ARCUS Sports Clinic, Rastatter Str. 17-19, 75179, Pforzheim, Germany
| | - Matthias Krause
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Natalie Mengis
- ARCUS Sports Clinic, Rastatter Str. 17-19, 75179, Pforzheim, Germany
- KSA Aarau/Spital Zofingen, Mühlethalstrasse 27, 4800, Zofingen, Schweiz
| | - Peter E Müller
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - Raymond Best
- Department of Orthopaedic and Sports Trauma Surgery, Sportklinik Stuttgart, Taubenheimstraße 8, 70372, Stuttgart, Germany
- Department of Sports Medicine and Orthopaedics, University of Tuebingen, Hoppe Seyler Strasse 5, 72074, Tuebingen, Germany
| | - Andrea Achtnich
- Department for Orthopedic Sports Medicine, Technical University Munich, Ismaninger Strasse 22, 81675, Munich, Germany
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ElSayed M, Rashwan AS, Kamal H. Use of oblique sagittal and coronal weighted images for diagnosis and grading of ACL graft injury. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2022. [PMCID: PMC9127290 DOI: 10.1186/s43055-022-00790-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background This study was done to evaluate the value of adding the oblique sagittal and oblique coronal MRI to the standard MRI knee protocol for evaluation of suspected ACL graft injuries. Results This was a cross-sectional analytic study where we reviewed 36 MRI knee examinations of 36 patients (30 males, 6 females, age range: 17–60 years, mean age: 26 years) who were subjected to ACL reconstruction and follow-up arthroscopy. Two experienced radiologists, blinded to the results of each other, evaluated the status and the severity of the ACL graft injury using the routine knee MRI (protocol A) and using the routine MRI after adding the oblique sagittal and coronal imaging (protocol B). Weighted kappa statistics were used to evaluate the diagnostic accuracies of the knee MRI before and after the addition of the oblique sagittal and coronal weighted images (protocol A and protocol B, respectively) and to assess the interobserver agreement. The weighted kappa values according to the routine knee MRI were 0.357 (reader 1) and 0.399 (reader 2). The inclusion of additional oblique coronal imaging increased the weighted kappa values to 0.505 (reader 1) and 0.528 (reader 2). The interobserver agreement weighted kappa value also increased from 0.606 to 0.759 by adding the oblique sagittal and coronal imaging to the routine knee MRI examination.
Conclusion The additional use of oblique sagittal and coronal MRI of the knee improves the diagnostic accuracy for diagnosing and grading ACL graft injury with the arthroscopy used as a gold standard.
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Return to sport soccer after anterior cruciate ligament reconstruction: ISAKOS consensus. J ISAKOS 2022; 7:150-161. [PMID: 35998884 DOI: 10.1016/j.jisako.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 08/07/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Many factors can affect the return to pivoting sports, after an Anterior Cruciate Ligament Reconstruction. Prehabilitation, rehabilitation, surgical and psychological aspects play an essential role in the decision to return to sports. The purpose of this study is to reach an international consensus about the best conditions for returning to sports in soccer-one of the most demanding level I pivoting sports after anterior cruciate ligament (ACL) reconstruction. METHODS 34 International experts in the management of ACL injuries, representing all the Continents were convened and participated in a process based on the Delphi method to achieve a consensus. 37 statements related to ACL reconstruction were reviewed by the experts in three rounds of surveys in complete anonymity. The statements were prepared by the working group based on previous literature or systematic reviews. Rating agreement through a Likert Scale: strongly agree, agree, neither agree or disagree, disagree and strongly disagree was used. To define consensus, it was established that the assertions should achieve a 75% of agreement or disagreement. RESULTS Of the 37 statements, 10 achieved unanimous consensus, 18 non-unanimous consensus and 9 did not achieve consensus. In the preoperative, the correction of the range of motion deficit, the previous high level of participation in sports and a better knowledge of the injury by the patient and compliance to participate in Rehabilitation were the statements that reached unanimous consensus. During the surgery, the treatment of associated injuries, as well as the use of autografts, and the addition of a lateral extra-articular tenodesis in some particular cases (active young athletes, <25 years old, hyperlaxity, high rotatory laxity and revision cases) obtained also 100% consensus. In the postoperative period, psychological readiness and its validation with scales, adequate physical preparation, as well as not basing the RTSS purely on the time of evolution after surgery, were the factors that reached unanimous Consensus. CONCLUSIONS The consensus statements derived from this international ISAKOS leaders, may assist clinicians in deciding when to return to sports soccer in patients after an ACL reconstruction. Those statements that reached 100% consensus have to be strongly considered in the final decision to RTS soccer.
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Sokal PA, Norris R, Maddox TW, Oldershaw RA. The diagnostic accuracy of clinical tests for anterior cruciate ligament tears are comparable but the Lachman test has been previously overestimated: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 2022; 30:3287-3303. [PMID: 35150292 PMCID: PMC9464183 DOI: 10.1007/s00167-022-06898-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 01/20/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE The diagnostic accuracy of clinical tests for anterior cruciate ligament injury has been reported in previous systematic reviews. Numerous studies in these reviews include subjects with additional knee ligament injury, which could affect the sensitivity of the tests. Meta-analyses have also been performed using methods that do not account for the non-independence of sensitivity and specificity, potentially overestimating diagnostic accuracy. The aim of this study was to report the diagnostic accuracy of clinical tests for anterior cruciate ligament tears (partial and complete) without concomitant knee ligament injury. METHODS A systematic review with meta-analysis was performed according to the PRISMA guidelines. Meta-analyses included studies reporting the specificity and/or sensitivity of tests with or without concomitant meniscal injury. Where possible, pooled diagnostic estimates were calculated with bivariate random-effects modelling to determine the most accurate effect sizes. Diagnostic accuracy values are presented for the anterior drawer, Lachman, Lever sign and pivot shift tests overall and in acute or post-acute presentations. RESULTS Pooled estimates using a bivariate model for overall sensitivity and specificity respectively were as follows: anterior drawer test 83% [95% CI, 77-88] and 85% [95% CI, 64-95]; Lachman test 81% [95% CI, 73-87] and 85% [95% CI, 73-92]; pivot shift test 55% [95% CI, 47-62] and 94% [95% CI, 88-97]; Lever sign test 83% [95% CI, 68-92] and 91% [95% CI, 83-95]. For specific presentations, the sensitivity and specificity of the Lachman test, respectively, were: complete tears 68% [95% CI, 54-79] and 79% [95% CI, 51-93]; post-acute injuries 70% [95% CI, 57-80] and 77% [95% CI, 53-91]. CONCLUSIONS The pivot shift and Lever sign were the best tests overall for ruling in or ruling out an anterior cruciate ligament tear, respectively. The diagnostic accuracy of the Lachman test, particularly in post-acute presentations and for complete tears, is lower than previously reported. Further research is required to establish more accurate estimates for the Lachman test in acute presentations and partial ligament tears using bivariate analysis. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Pawel A Sokal
- Department of Musculoskeletal and Ageing Science, Institute of Life Course and Medical Sciences, Faculty of Health and Life Sciences, University of Liverpool, William Henry Duncan Building, 6 West Derby Street, Liverpool, L7 8TX, UK
- Department of Medicine, School of Medicine, University of Liverpool, Liverpool, L69 3GE, UK
| | - Richard Norris
- Department of Musculoskeletal and Ageing Science, Institute of Life Course and Medical Sciences, Faculty of Health and Life Sciences, University of Liverpool, William Henry Duncan Building, 6 West Derby Street, Liverpool, L7 8TX, UK
- Department of Trauma and Orthopaedics, Aintree University Hospital, Liverpool University Hospitals NHS Foundation Trust, Lower Lane, Fazakerley, Liverpool, L9 7AL, UK
| | - Thomas W Maddox
- Department of Musculoskeletal and Ageing Science, Institute of Life Course and Medical Sciences, Faculty of Health and Life Sciences, University of Liverpool, William Henry Duncan Building, 6 West Derby Street, Liverpool, L7 8TX, UK
- Small Animal Teaching Hospital, Institute of Infection, Veterinary and Ecological Sciences, Faculty of Health and Life Sciences, University of Liverpool, Leahurst Campus, Chester High Road, Neston, CH64 7TE, Wirral, UK
| | - Rachel A Oldershaw
- Department of Musculoskeletal and Ageing Science, Institute of Life Course and Medical Sciences, Faculty of Health and Life Sciences, University of Liverpool, William Henry Duncan Building, 6 West Derby Street, Liverpool, L7 8TX, UK.
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Key S, Baygin M, Demir S, Dogan S, Tuncer T. Meniscal Tear and ACL Injury Detection Model Based on AlexNet and Iterative ReliefF. J Digit Imaging 2022; 35:200-212. [PMID: 35048231 PMCID: PMC8921447 DOI: 10.1007/s10278-022-00581-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 10/14/2021] [Accepted: 12/30/2021] [Indexed: 12/12/2022] Open
Abstract
Magnetic resonance (MR) is one of the special imaging techniques used to diagnose orthopedics and traumatology. In this study, a new method has been proposed to detect highly accurate automatic meniscal tear and anterior cruciate ligament (ACL) injuries. In this study, images in three different slices were collected. These are the sagittal, coronal, and axial slices, respectively. Images taken from each slice were categorized in 3 different ways: sagittal database (sDB), coronal database (cDB), and axial database (aDB). The proposed model in the study uses deep feature extraction. In this context, deep features have been obtained by using fully-connected layers of AlexNet architecture. In the second stage of the study, the most significant features were selected using the iterative RelifF (IRF) algorithm. In the last step of the application, the features are classified by using the k-nearest neighbor (kNN) method. Three datasets were used in the study. These datasets, sDB, and cDB, have four classes and consist of 442 and 457 images, respectively. The aDB used in the study has two class labels and consists of 190 images. The model proposed within the scope of the study was applied in 3 datasets. In this context, 98.42%, 100%, and 100% accuracy values were obtained for sDB, cDB, and aDB datasets, respectively. The study results showed that the proposed method detected meniscal tear and anterior cruciate ligament (ACL) injuries with high accuracy.
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Corban J, Lorange JP, Laverdiere C, Khoury J, Rachevsky G, Burman M, Martineau PA. Artificial Intelligence in the Management of Anterior Cruciate Ligament Injuries. Orthop J Sports Med 2021; 9:23259671211014206. [PMID: 34277880 PMCID: PMC8255602 DOI: 10.1177/23259671211014206] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 01/05/2021] [Indexed: 11/22/2022] Open
Abstract
Background: Technological innovation is a key component of orthopaedic surgery. With the integration of powerful technologies in surgery and clinical practice, artificial intelligence (AI) may become an important tool for orthopaedic surgeons in the future. Through adaptive learning and problem solving that serve to constantly increase accuracy, machine learning algorithms show great promise in orthopaedics. Purpose: To investigate the current and potential uses of AI in the management of anterior cruciate ligament (ACL) injury. Study Design: Systematic review; Level of evidence, 3. Methods: A systematic review of the PubMed, MEDLINE, Embase, Web of Science, and SPORTDiscus databases between their start and August 12, 2020, was performed by 2 independent reviewers. Inclusion criteria included application of AI anywhere along the spectrum of predicting, diagnosing, and managing ACL injuries. Exclusion criteria included non-English publications, conference abstracts, review articles, and meta-analyses. Statistical analysis could not be performed because of data heterogeneity; therefore, a descriptive analysis was undertaken. Results: A total of 19 publications were included after screening. Applications were divided based on the different stages of the clinical course in ACL injury: prediction (n = 2), diagnosis (n = 12), intraoperative application (n = 1), and postoperative care and rehabilitation (n = 4). AI-based technologies were used in a wide variety of applications, including image interpretation, automated chart review, assistance in the physical examination via optical tracking using infrared cameras or electromagnetic sensors, generation of predictive models, and optimization of postoperative care and rehabilitation. Conclusion: There is an increasing interest in AI among orthopaedic surgeons, as reflected by the applications for ACL injury presented in this review. Although some studies showed similar or better outcomes using AI compared with traditional techniques, many challenges need to be addressed before this technology is ready for widespread use.
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Affiliation(s)
- Jason Corban
- Division of Orthopaedic Surgery, Department of Surgery, McGill University, Montreal, Quebec, Canada
| | | | - Carl Laverdiere
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Jason Khoury
- Division of Orthopaedic Surgery, Department of Surgery, McGill University, Montreal, Quebec, Canada
| | - Gil Rachevsky
- Division of Orthopaedic Surgery, Department of Surgery, McGill University, Montreal, Quebec, Canada
| | - Mark Burman
- Division of Orthopaedic Surgery, Department of Surgery, McGill University, Montreal, Quebec, Canada
| | - Paul Andre Martineau
- Division of Orthopaedic Surgery, Department of Surgery, McGill University, Montreal, Quebec, Canada
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Clinical tests used to diagnose anterior cruciate ligament tears are less sensitive in obese patients: a retrospective cohort study. CURRENT ORTHOPAEDIC PRACTICE 2021. [DOI: 10.1097/bco.0000000000000943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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McQuivey KS, Christopher ZK, Chung AS, Makovicka J, Guettler J, Levasseur K. Implementing the Lever Sign in the Emergency Department: Does it Assist in Acute Anterior Cruciate Ligament Rupture Diagnosis? A Pilot Study. J Emerg Med 2019; 57:805-811. [PMID: 31708315 DOI: 10.1016/j.jemermed.2019.09.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 08/28/2019] [Accepted: 09/09/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Within the emergency department (ED) setting, anterior cruciate ligament (ACL) rupture is commonly misdiagnosed, leading to improper treatment and potential meniscal injury and total joint replacement. Utilizing traditional clinical tests to diagnosis ACL rupture leads to the correct diagnosis in about 30% of cases. The lever sign is a new and effective clinical test used to diagnose ACL rupture with 100% sensitivity. OBJECTIVE We aim to study if the lever sign used in the ED setting is more sensitive to diagnose ACL rupture than traditional tests. METHODS Patients between 12 and 55 years of age were examined utilizing either traditional methods or the lever sign. Diagnostic findings in the ED were compared with those of a sports medicine specialist using magnetic resonance imaging as the diagnostic standard. A survey was given to ED providers to collect data on diagnosis and physician confidence in diagnosis. RESULTS The sensitivity of the lever sign was 100% (94.7% accuracy, 93.75% specificity), whereas the sensitivity of the anterior drawer/Lachman test was 40% (87.5% accuracy, 100% specificity). Physician confidence in diagnosis was higher utilizing the lever sign vs. the anterior drawer/Lachman test at 8.45 (±1.82) compared with 7.72 (±1.82) out of 10, respectively. There was no statistically significant association between diagnostic accuracy with either test and level of training of the ED provider. CONCLUSION Implementation of the lever sign in the ED setting resulted in a higher sensitivity, higher physician confidence in screening test diagnosis, and a decrease in the number of undiagnosed ACL ruptures.
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Affiliation(s)
- Kade S McQuivey
- Department of Orthopedics, Mayo Clinic Arizona, Phoenix, Arizona
| | | | - Andrew S Chung
- Department of Orthopedics, Mayo Clinic Arizona, Phoenix, Arizona
| | - Justin Makovicka
- Department of Orthopedics, Mayo Clinic Arizona, Phoenix, Arizona
| | - Joseph Guettler
- Department of Orthopedics, Beaumont Health System, Royal Oak, Michigan
| | - Kelly Levasseur
- Department of Emergency Medicine, Beaumont Health System, Royal Oak, Michigan
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Ghasem Hanafi M, Momen Gharibvand M, Jaffari Gharibvand R, Sadoni H. Diagnostic Value of Oblique Coronal and Oblique Sagittal Magnetic Resonance Imaging (MRI) in Diagnosis of Anterior Cruciate Ligament (ACL) Tears. J Med Life 2019; 11:281-285. [PMID: 30894883 PMCID: PMC6418321 DOI: 10.25122/jml-2018-0015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction: Tears of the anterior cruciate ligament (ACL) are common among young athletes and diagnosis may be difficult especially in the young population. Therefore, finding a new method to increase the correct diagnosis is necessary. Materials and Methods: This double-blind prospective observational study was conducted on 51 patients with suspected ACL rupture. In this study, in addition to the standard protocols, the oblique-sagittal and oblique-coronal MRI were assessed and used in three different methods, including A method (orthogonal MRI protocol), B method (orthogonal MRI protocol and oblique-sagittal MRI), and C method (orthogonal MRI protocol and oblique-coronal MRI). Results: In detecting both complete and partial rupture of ACL, B method had highest diagnostic accuracy (kappa = 0.338, P=0.001), and after that, C method had acceptable accuracy (kappa = 0.292, P=0.011). In addition, in detecting a partial rupture of ACL, B method (kappa = 0.5, P<0.001), and C method had acceptable accuracy (kappa = 0.361, P=0.006). Meanwhile, in detecting a complete rupture of ACL, B method had the highest diagnostic accuracy (kappa = 0.898, P<0.001), and subsequently A method had significant accuracy (kappa = 0.812, P<0.001). Conclusions: Our results showed that the evaluation of ACL rupture by oblique-sagittal MRI in addition to orthogonal MRI protocol is accurate and with high sensitivity and specificity values. It allows to find abnormal images immediately with higher accuracy in the emergency department and more critically ill patients may benefit from the advantages of this imaging protocol.
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Affiliation(s)
- Mohammad Ghasem Hanafi
- Department of Radiology, Golestan Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mohammad Momen Gharibvand
- Department of Radiology, Golestan Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Razieh Jaffari Gharibvand
- Department of Orthopedic Surgery, Ahvaz Jundishapur University of Medical Sciences (AJUMS), Ahvaz, IR Iran
| | - Hanon Sadoni
- Department of Radiology, Golestan Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Lichtenberg MC, Koster CH, Teunissen LPJ, Oosterveld FGJ, Harmsen AMK, Haverkamp D, Hoornenborg D, Berg RP, Bloemers FW, Faber IR. Does the Lever Sign Test Have Added Value for Diagnosing Anterior Cruciate Ligament Ruptures? Orthop J Sports Med 2018; 6:2325967118759631. [PMID: 29568784 PMCID: PMC5858649 DOI: 10.1177/2325967118759631] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background: Diagnosing an anterior cruciate ligament (ACL) rupture based on a physical examination remains a challenge for both surgeons and physical therapists. The lever sign test was developed to overcome the practical limitations of other tests and to optimize diagnosis. An evaluation of the measurement properties of the lever sign test is needed to make adequate interpretations in practice. Purpose: To evaluate the reliability and diagnostic value of the lever sign test. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: A total of 94 patients were recruited between November 2014 and July 2016. Patients were included if they were at least 16 years old, suffered from knee trauma, and had indications for knee arthroscopic surgery. Lever sign, anterior drawer, Lachman, and pivot-shift test outcomes were examined by an orthopaedic/trauma surgeon and a physical therapist. A test-retest design was used to investigate interrater reliability. Moreover, the lever sign test outcomes, alone and in combination with the other diagnostic tests, were compared with arthroscopic results, which served as the gold standard for the test’s diagnostic value. Results: The lever sign test and pivot-shift test had kappa values exceeding 0.80 for interrater reliability. The kappa values for the anterior drawer test and Lachman test were 0.80 and 0.77, respectively. The lever sign test showed the highest specificity (100%) and the lowest sensitivity (39%) when compared with the other 3 tests. Moreover, its positive and negative predictive values were 100% and 65%, respectively, while an accuracy of 71% was calculated. Clustering the lever sign test parallel with the other 3 tests resulted in the highest accuracy of 91%. Conclusion: The lever sign test appears to have high interrater reliability and is the most specific test, showing a maximal positive predictive value. A positive lever sign test result indicates an ACL rupture. These results support the added value of the lever sign test for diagnosing ACL ruptures.
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Affiliation(s)
| | - Christiaan H Koster
- Department of Trauma Surgery, VU University Medical Center Amsterdam, Amsterdam, the Netherlands
| | - Lennart P J Teunissen
- Faculty of Physical Activity and Health, Saxion University of Applied Sciences, Enschede, the Netherlands
| | - Frits G J Oosterveld
- Faculty of Physical Activity and Health, Saxion University of Applied Sciences, Enschede, the Netherlands
| | - Annelieke M K Harmsen
- Department of Trauma Surgery, VU University Medical Center Amsterdam, Amsterdam, the Netherlands
| | - Daniel Haverkamp
- Department of Orthopaedic Surgery, Medical Centre Slotervaart, Amsterdam, the Netherlands
| | - Daniel Hoornenborg
- Department of Orthopaedic Surgery, Medical Centre Slotervaart, Amsterdam, the Netherlands
| | - Robert P Berg
- Department of Orthopaedic and Trauma Surgery, Regional Hospital Koningin Beatrix, Winterswijk, the Netherlands
| | - Frank W Bloemers
- Department of Trauma Surgery, VU University Medical Center Amsterdam, Amsterdam, the Netherlands
| | - Irene R Faber
- Faculty of Physical Activity and Health, Saxion University of Applied Sciences, Enschede, the Netherlands
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Abstract
The Orthopaedic Section of the American Physical Therapy Association (APTA) has an ongoing effort to create evidence-based practice guidelines for orthopaedic physical therapy management of patients with musculoskeletal impairments described in the World Health Organization's International Classification of Functioning, Disability, and Health (ICF). The purpose of these revised clinical practice guidelines is to review recent peer-reviewed literature and make recommendations related to knee ligament sprain. J Orthop Sports Phys Ther. 2017;47(11):A1-A47. doi:10.2519/jospt.2017.0303.
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Analysis of the influence of anaesthesia on the clinical and quantitative assessment of the pivot shift: a multicenter international study. Knee Surg Sports Traumatol Arthrosc 2017; 25:3004-3011. [PMID: 27095250 DOI: 10.1007/s00167-016-4130-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 04/05/2016] [Indexed: 01/18/2023]
Abstract
PURPOSE The main goal of this work was to evaluate the pivot shift test in awake and anesthetized patients by using two different quantitative methodologies and comparing the results with the standard clinical grading, taking advantage of a multicenter international study. METHODS Patients between 16 and 50 years of age undergoing primary unilateral single-bundle anterior cruciate ligament (ACL) reconstruction were considered eligible. The pivot shift test was performed pre-operatively, with the patient awake and again with the patient under general anaesthesia. The pivot shift test was clinically graded as defined by the International Knee Documentation Committee. The instrumented assessment was performed by using two non-invasive acquisition systems; specifically, a system exploiting an inertial sensor and a video-based application developed on a commercial tablet using skin markers. Lateral compartment translation and the tibial acceleration reached during joint reduction were used as quantitative parameters. RESULTS A total of 103 patients were enrolled in the study. Statistically significant difference was found between the distributions of clinical grade evaluated in awake patients and those under general anaesthesia (P < 0.01). Comparing awake patients to those under general anaesthesia, lower values were found both for tibial acceleration (3.7 ± 1.5 vs 6.0 ± 4.6 m/s2, P < 0.01) and lateral compartment translation of the involved limb (2.2 ± 1.7 vs 3.0 ± 2.2 mm, P < 0.01). CONCLUSIONS This study indicated that significant differences in the grading of the pivot shift test exist between awake and anesthetized patients, regardless of the use of quantitative instruments during the evaluation. Actual clinical assessment reported indeed its weakness, presenting subjective variability and dependence on tester's experience. However, several factors might influence the validity of awake examination such as experience level of examiner and cultural factors, as seen in this international multicenter study. LEVEL OF EVIDENCE Prospective comparative study, Level II.
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Li K, Du J, Huang LX, Ni L, Liu T, Yang HL. The diagnostic accuracy of magnetic resonance imaging for anterior cruciate ligament injury in comparison to arthroscopy: a meta-analysis. Sci Rep 2017; 7:7583. [PMID: 28790406 PMCID: PMC5548790 DOI: 10.1038/s41598-017-08133-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 06/30/2017] [Indexed: 12/11/2022] Open
Abstract
We performed this meta-analysis to examine the diagnostic accuracy of MRI for the diagnosis of anterior cruciate ligament (ACL) injury in comparison to arthroscopy. We also compared the diagnostic accuracy of MRI with magnetic field intensities (MFI) greater than or equal to 1.5T with those below 1.5T, in addition to different MRI sequences. Studies relevant to the diagnosis of ACL injury by MRI and arthroscopy were analyzed. Computer and manual retrieval were carried out on studies published between January 1, 2006 and May 31, 2016. Twenty-one papers were included. Neither threshold nor non-threshold effects were present (p = 0.40, p = 0.06). The pooled sensitivity (SE), specificity (SP), positive likelihood ratio (LR+), negative likelihood ratio (LR−) and diagnostic odds ratio (DOR) with 95% confidence interval (CI) were 87% (84–90%), 90% (88–92%), 6.78 (4.87–9.44), 0.16 (0.13–0.20) and 44.70 (32.34–61.79), respectively. The area under the curve (AUC) was 0.93. The risk of publication bias was negligible (p = 0.75). In conclusion, examination by MRI is able to provide appreciable diagnostic performance. However, the principle, which states that the higher the MFI, the better the diagnostic accuracy, could not be verified. Additionally, conventional sequences (CSs) associated with proton density-weighted imaging (PDWI) are only slightly better than CSs alone, but not statistically different.
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Affiliation(s)
- Kun Li
- Department of Orthopedic Surgery, First Affiliated Hospital of Soochow University, Suzhou, 215000, China
| | - Jun Du
- Department of Orthopedic Surgery, First Affiliated Hospital of Soochow University, Suzhou, 215000, China.,Department of Orthopedic Magnetic Resonance Chamber, First Affiliated Hospital of Soochow University, Suzhou, 215000, China
| | - Li-Xin Huang
- Department of Orthopedic Surgery, First Affiliated Hospital of Soochow University, Suzhou, 215000, China
| | - Li Ni
- Department of Orthopedic Surgery, First Affiliated Hospital of Soochow University, Suzhou, 215000, China
| | - Tao Liu
- Department of Orthopedic Surgery, First Affiliated Hospital of Soochow University, Suzhou, 215000, China
| | - Hui-Lin Yang
- Department of Orthopedic Surgery, First Affiliated Hospital of Soochow University, Suzhou, 215000, China.
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Michaleff ZA, Campbell P, Protheroe J, Rajani A, Dunn KM. Consultation patterns of children and adolescents with knee pain in UK general practice: analysis of medical records. BMC Musculoskelet Disord 2017; 18:239. [PMID: 28576118 PMCID: PMC5457541 DOI: 10.1186/s12891-017-1586-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 05/17/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Knee problems are common in children and adolescents. Despite this, little is known about the epidemiology of knee problems in children and adolescents who consult in general practice. The aim of this study was to describe consultations by children and adolescents about knee problems in general practice, and examine patterns of patient presentations and consultations by age group, sex and area of socio-economic deprivation. METHODS Consultations records specific to the knee region were extracted from a general practice consultation database (CiPCA) over a one year period. Knee consultation codes were organised into 'symptom' or 'diagnosis' (sub-categorised: 'trauma', 'non-trauma') categories. Descriptive statistics were used to describe patient presentations and number of consultations overall, and stratified analysis carried out on age group, sex, and area of socio-economic deprivation. RESULTS Out of all musculoskeletal consultations, knee problems were the fourth most common patient presentation, responsible for the second highest number of consultations. Patient presentations and consultations increased up to age 12-15 years and then stabilised. Symptoms codes e.g. 'knee pain' were used more commonly than diagnosis codes e.g. 'knee sprain' overall. However, symptom code use declined as age increased, more symptom codes were used in girls compared to boys, and more diagnosis codes were used in patients from areas of high socio-economic deprivation. CONCLUSIONS This study provides insight into the epidemiology of knee problems in children and adolescents in general practice. Future research is needed to improve our understanding of the knee problems encountered by GPs, and the influence socio-economic deprivation has on consultations.
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Affiliation(s)
- Zoe A Michaleff
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK.
| | - Paul Campbell
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - Joanne Protheroe
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - Amit Rajani
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - Kate M Dunn
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK
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Medda S, Kundu R, Sengupta S, Pal AK. Anatomical variation of posterior slope of tibial plateau in adult Eastern Indian population. Indian J Orthop 2017; 51:69-74. [PMID: 28216753 PMCID: PMC5296851 DOI: 10.4103/0019-5413.197545] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Upper surface of the proximal tibial end, tibial plateau, has a slope directed posteroinferiorly relative to the long axis of the middle of the shaft. It has important consideration in surgeries such as knee arthroplasty, high tibial osteotomy, and medical imaging of the knee joint. The aim of the present study was to estimate the tibial plateau angle (TPA) by plain radiograph in the adult Eastern Indian population as during literature review, we were unable to find any study, except one (without specific reference axis), on this variable among the Indian population. MATERIALS AND METHODS A sample was taken from adult patients attending the outpatient department of orthopedics of the institute with minor knee problems. Measurement of the TPA was done in the true lateral radiographs of the knee joints of the selected subjects by a standardized method. RESULTS TPA varied widely from 6° to 24°, with the mean ± standard deviation value 13.6° ±3.5°. Student's unpaired t-test revealed no significant difference of TPA between left and right knees, both in male (P = 0.748) and female (P = 0.917) separately and in the entire study population irrespective of gender (P = 0.768). Comparison of TPA between male (13.3° ± 3.3°) and female (13.9° ± 3.4°) by Student's unpaired t-test showed no sexual dimorphism (P = 0.248). There were poor correlations of TPA with age and body mass index. CONCLUSION The present study described the variations of the TPA in the adult Eastern Indian population (range 6°-24°, mean ± SD 13.6° ± 3.5°, no laterality, no sexual dimorphism, poor correlation with age and BMI). Knowledge of this study could be used in different orthopedic surgeries and imaging technique in or around the knee joint.
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Affiliation(s)
- Shyamalendu Medda
- Department of Anatomy, Burdwan Medical College, Burdwan, West Bengal, India
| | - Rajib Kundu
- Department of Anatomy, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
| | - Sohini Sengupta
- Department of Radiodiagnosis, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
| | - Ananda Kisor Pal
- Department of Orthopedics, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
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Efficacy of knee joint aspiration in patients with acute ACL injury in the emergency department. Injury 2016; 47:1744-9. [PMID: 27262773 DOI: 10.1016/j.injury.2016.05.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 05/09/2016] [Accepted: 05/16/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the influence of joint aspiration on the sensitivity of physical examination for diagnosing acute anterior cruciate ligament (ACL) lesion in the second outpatient-department (OPD) follow-up referred from emergency department (ED). METHODS This retrospective study included sixty patients underwent ACL reconstruction with initial visit at ED. They were divided into two groups based on the presence or absence of joint aspiration at ED. All participants were referred to second OPD follow-up within 7-14days after the injury. Clinical manifestation (including visual analogue scale (VAS) for pain, range of motion (ROM), and severity of knee effusion) and physical examination (Lachman test and pivot shift test) were checked in ED and the second OPD follow-up. RESULTS The group of patients with joint aspiration (G1) showed substantial decreases in mean values of VAS for pain (p=0.005), ROM (p=0.001), and effusion level (p<0.001), even higher VAS and effusion level and lower ROM at the initial visit of ED than the other group (G2). The sensitivity of positive Lachman and pivot shift test was significantly (p<0.05) increased following knee joint aspiration. Positive Lachman test was recorded at 76.5% in the second follow-up in G1, which was significantly (p=0.047) higher than that (47.6%) in G2. The percentage of positive pivot shift test was recorded at 76.5% in the second follow-up in G1, which as significantly (p<0.001) higher than that (31.0%) in G2. CONCLUSIONS Knee joint aspiration in acute ACL injury with suspected hemarthrosis could be considered as a diagnostic procedure. Joint aspiration in early medical attendance might be able to lower pain scores or raise the sensitivity of physical examination for diagnosing acute ACL injury at follow up visit in orthopedic outpatient department. LEVEL OF EVIDENCE Retrospective cohort study III.
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Kopkow C, Lange T, Hoyer A, Lützner J, Schmitt J. Physical tests for diagnosing anterior cruciate ligament rupture. Hippokratia 2015. [DOI: 10.1002/14651858.cd011925] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Christian Kopkow
- Faculty of Medicine Carl Gustav Carus, TU Dresden; Center for Evidence-Based Healthcare; Fetscherstr. 74 Dresden Saxony Germany 01307
| | - Toni Lange
- Faculty of Medicine Carl Gustav Carus, TU Dresden; Center for Evidence-Based Healthcare; Fetscherstr. 74 Dresden Saxony Germany 01307
| | - Annika Hoyer
- German Diabetes Center, Leibniz Institute for Diabetes Research at Heinrich Heine University Düsseldorf; Institute for Biometry and Epidemiology; Auf´m Hennekamp 65 Düsseldorf Germany 40225
| | - Jörg Lützner
- University Hospital Carl Gustav Carus; Centre for Orthopaedic and Trauma Surgery; Fetscherstr. 74 Dresden Saxony Germany 01307
| | - Jochen Schmitt
- Faculty of Medicine Carl Gustav Carus, TU Dresden; Center for Evidence-Based Healthcare; Fetscherstr. 74 Dresden Saxony Germany 01307
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Diagnostic accuracy of physical examination for anterior knee instability: a systematic review. Knee Surg Sports Traumatol Arthrosc 2015; 23:2805-13. [PMID: 25763847 DOI: 10.1007/s00167-015-3563-2] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 03/02/2015] [Indexed: 01/15/2023]
Abstract
PURPOSE Determining diagnostic accuracy of Lachman, pivot shift and anterior drawer tests versus gold standard diagnosis (magnetic resonance imaging or arthroscopy) for anterior cruciate ligament (ACL) insufficiency cases. Secondarily, evaluating effects of: chronicity, partial rupture, awake versus anaesthetized evaluation. METHODS Searching MEDLINE, EMBASE and PubMed identified studies on diagnostic accuracy for ACL insufficiency. Studies identification and data extraction were performed in duplicate. Quality assessment used QUADAS tool, and statistical analyses were completed for pooled sensitivity and specificity. RESULTS Eight studies were included. Given insufficient data, pooled analysis was only possible for sensitivity on Lachman and pivot shift test. During awake evaluation, sensitivity for the Lachman test was 89 % (95 % CI 0.76, 0.98) for all rupture types, 96 % (95 % CI 0.90, 1.00) for complete ruptures and 68 % (95 % CI 0.25, 0.98) for partial ruptures. For pivot shift in awake evaluation, results were 79 % (95 % CI 0.63, 0.91) for all rupture types, 86 % (95 % CI 0.68, 0.99) for complete ruptures and 67 % (95 % CI 0.47, 0.83) for partial ruptures. CONCLUSION Decreased sensitivity of Lachman and pivot shift tests for partial rupture cases and for awake patients raised suspicions regarding the accuracy of these tests for diagnosis of ACL insufficiency. This may lead to further research aiming to improve the understanding of the true accuracy of these physical diagnostic tests and increase the reliability of clinical investigation for this pathology. LEVEL OF EVIDENCE IV.
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Robotic axial lower leg testing: repeatability and reproducibility. Knee Surg Sports Traumatol Arthrosc 2015; 23:2892-9. [PMID: 26359177 PMCID: PMC4577538 DOI: 10.1007/s00167-015-3768-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 08/20/2015] [Indexed: 12/20/2022]
Abstract
PURPOSE The purpose of this study was to determine the test-retest reliability and the repeatability over multiple days of a robotic testing device when used to measure laxity of the lower leg during a simulated dial test. METHODS Ten healthy subjects were evaluated using an instrumented robotic lower leg testing system over 4 days. Three testing cycles were performed each day. Each leg was rotated into external and then internal rotation by servomotors until a torque threshold of 5.65 N m was reached. Load-deformation curves were generated from torque and rotation data. Both average-measure and single-measure intraclass correlation coefficients (ICC) were compared across the curves. ICC scores were also compared for features of the curves including: maximum external rotation at -5.65 N m of torque, maximum internal rotation at 5.65 N m of torque, rotation at torque 0, compliance (slope of load-deformation curve) at torque 0, endpoint compliance in external rotation, endpoint compliance in internal rotation, and play at torque 0. Play at torque 0 was defined as the width of the hysteresis curve at torque 0. RESULTS Average-measure ICC scores and test-retest scores were >0.95 along the entire load-deformation curve except around zero torque. ICC scores at maximum internal and external rotation ranged from 0.87 to 0.99 across the left and right knees. ICC scores for the other features of the curves ranged from 0.61 to 0.98. The standard error of the mean ranged from 0.0497 to 1.1712. CONCLUSIONS The robotic testing device in this study proved to be reliable for testing a subject multiple times both within the same day and over multiple days. These findings suggest that the device can provide a level of reliability in rotational testing that allows for clinical use of test results. Objective laxity data can improve consistency and accuracy in diagnosing knee injuries and may enable more effective treatment.
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