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The Journal of Bone and Joint Surgery, Vol 60, Issue 5 664-674, Copyright © 1978 by Journal of Bone and Joint Surgery, Inc
In vivo knee stability. A quantitative assessment using an instrumented clinical testing apparatus
KL Markolf, A Graff-Radford and HC Amstutz
Twenty-eight male and twenty-one female subjects with no history of
previous injury to their knees were examined using a newly developed
clinical testing apparatus designed to record anterior-posterior tibial
force versus displacement and varus-valgus moment versus angulation during
manual manipulation of the knee. Joint stiffness and laxity were measured
from test tracings made with the knee muscles relaxed and tensed. Agreement
between these measurements and those made previously on thirty-five fresh
cadaver knee specimens was very good. Anterior-posterior laxity averaged
3.7 millimeters in full extension, 5.5 in 20 degrees of flexion, and 4.8
millimeters in 90 degrees of flexion, while the mean varus-valgus laxity
was 6.7 degrees in full extension. The common clinical assumption that
normal right-left differences are negligible was found to be invalid.
Individual right-left differences averaged 26 to 35 per cent for laxity and
19 to 24 per cent for stiffness. There was no discernible tendency for one
knee to be more stable than the other; random interchanges of relative
stability between the right and left knees were observed for each
individual at different knee positions. When requested to tense the knee
muscles, these subjects were able to increase their knee stiffness an
average of two to four times while knee laxity was reduced to 25 to 50 per
cent of the normal value.
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