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The Journal of Bone and Joint Surgery, Vol 66, Issue 2 242-252, Copyright © 1984 by Journal of Bone and Joint Surgery, Inc
Measurement of knee stiffness and laxity in patients with documented absence of the anterior cruciate ligament
KL Markolf, A Kochan and HC Amstutz
Thirty-five patients with documented absence of the anterior cruciate
ligament were tested on the University of California, Los Angeles,
instrumented clinical knee-testing apparatus and we measured the response
curves for the following testing modes: anterior-posterior force versus
displacement at full extension and at 20 and 90 degrees of flexion;
varus-valgus moment versus angulation at full extension and 20 degrees of
flexion; and tibial torque versus rotation at 20 degrees of flexion.
Absolute values of stiffness and laxity and right-left differences for
these injured knees were compared with identical quantities measured
previously for a control population of forty-nine normal subjects with no
history of treatment for injury to the knee. For both the uninjured knees
and the knees without an anterior cruciate ligament, at 20 and 90 degrees
of flexion the anterior-posterior laxity was greatest at approximately 15
degrees of external rotation of the foot. The injured knees demonstrated
significantly increased total anterior-posterior laxity and decreased
anterior stiffness when compared with the uninjured knees in all tested
positions of the foot and knee. The mean increase in paired
anterior-posterior laxity for the injured knees in this group of patients
at +/- 200 newtons of applied anterior-posterior force was 3.1 millimeters
(+39 per cent) at full extension, 5.5 millimeters (+57 per cent) at 20
degrees of flexion, and 2.5 millimeters (+34 per cent) at 90 degrees of
flexion. The mean reduction in anterior stiffness for injured knees was
also greatest (-54 per cent) at 20 degrees of knee flexion. Only slight
reduction in posterior stiffness (-16 per cent) was measured at 20 degrees
of flexion, and this probably reflected the presence of associated capsular
and meniscal injuries. In the group of anterior cruciate-deficient knees,
the patients with an absent medial meniscus showed greater total
anterior-posterior laxity in all three positions of knee flexion than did
the patients with an intact or torn meniscus. Varus-valgus laxity at full
extension increased an average of 1.7 degrees (+36 per cent) for the
injured knees, while varus and valgus stiffness decreased 21 per cent and
24 per cent. Absence of the medial meniscus (in a knee with absence of the
anterior cruciate ligament) increased varus-valgus laxity at zero and 20
degrees of flexion.(ABSTRACT TRUNCATED AT 400 WORDS)
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