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.
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Article info
Publication history
Published online: January 25, 2016
Accepted:
November 5,
2015
Received:
May 13,
2015
Footnotes
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.
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© 2016 by the Arthroscopy Association of North America
