Digital hand-held arthrometry is a reliable and accurate adjunct for diagnosing acute anterior cruciate ligament tears

IF 2 Q2 ORTHOPEDICS

Journal of Experimental Orthopaedics Pub Date : 2025-04-28 DOI:10.1002/jeo2.70251

Richard Norris, Alan Price, Thomas W. Maddox, William Boswell, Cronan Kerin, Rachel A. Oldershaw

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Abstract

Purpose

To evaluate the intrarater reliability and predictive validity of Lachmeter® measurements for diagnosing acute anterior cruciate ligament (ACL) tears, and to propose diagnostic thresholds.

Methods

Lachmeter® measurements were recorded during the stabilised Lachman test for consecutive participants presenting to an acute knee injury clinic within 21-days of injury. Intrarater reliability for individual limb and side-to-side (STS) difference (injured limb minus uninjured limb) measurements was investigated using a cross-sectional, repeated-measures design and the intraclass correlation coefficient (ICC). The predictive validity of STS difference and injured limb measurements was investigated using a prospective cohort design; sensitivity, specificity, negative (LR−) and positive likelihood ratios (LR+) were calculated using magnetic resonance imaging as the reference standard.

Results

Intrarater reliability was excellent for individual limb and STS difference measurements in 102 participants. Of the 63 participants included in the validity analysis, 31 had a normal ACL and 32 had an ACL tear. LR- point estimates for STS differences <1.4 mm (0.07 [95% confidence interval [CI]: 0.02–0.29]) or injured limb measurements <7.5 mm (0.09 [95% CI: 0.02–0.34] produced ‘large’ shifts in the probability of ruling out an ACL tear. LR+ point estimates for STS differences ≥3.8 mm (10.67 [95% CI: 2.68–42.51]) or injured limb measurements ≥11.8 mm (10.67 [95% CI: 1.42–80.26]) produced ‘large’ shifts in the probability of ruling in a full-thickness ACL tear.

Conclusion

In participants presenting within 21-days of knee injury, intrarater reliability was excellent for Lachmeter® measurements recorded during the stabilised Lachman test. Based on predictive validity estimates, Lachmeter® measurements can be used to differentiate normal from torn ACLs in acute presentations, but not partial from full-thickness ACL tears. Diagnostic thresholds are proposed based on STS difference and injured limb measurements, and with consideration of the Lachman end point.

Level of Evidence: Level I.

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数字手持式关节测量是诊断急性前交叉韧带撕裂的可靠和准确的辅助手段

目的评估Lachmeter®测量诊断急性前交叉韧带（ACL）撕裂的内部信度和预测效度，并提出诊断阈值。方法对受伤后21天内连续出现在急性膝关节损伤诊所的受试者，在稳定拉赫曼试验期间记录Lachmeter®测量值。使用横断面、重复测量设计和类内相关系数（ICC）研究了个体肢体和侧对侧（STS）差异（受伤肢体减去未受伤肢体）测量的内部信度。采用前瞻性队列设计研究STS差异和损伤肢体测量的预测有效性；以磁共振成像为参比，计算灵敏度、特异度、阴性似然比（LR−）和阳性似然比（LR+）。结果102名受试者的个体肢体和STS差异测量结果具有良好的内部信度。在有效性分析的63名参与者中，31名ACL正常，32名ACL撕裂。STS差异的LR点估计值为1.4 mm（0.07[95%可信区间[CI]: 0.02-0.29]）或受伤肢体测量值为7.5 mm (0.09 [95% CI: 0.02-0.34])，在排除ACL撕裂的可能性方面产生了“大”变化。STS差异≥3.8 mm （10.67 [95% CI: 2.68-42.51]）或受伤肢体测量≥11.8 mm （10.67 [95% CI: 1.42-80.26]）的LR+点估计值在全层ACL撕裂的愈合概率上产生“大”变化。结论：在膝关节损伤21天内出现的参与者中，在稳定拉赫曼试验中记录的Lachmeter®测量值的体内可靠性非常好。基于预测有效性估计，Lachmeter®测量可用于区分急性表现的正常ACL撕裂，但不能部分区分全层ACL撕裂。基于STS差异和损伤肢体测量，并考虑Lachman终点，提出诊断阈值。证据等级：一级。

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