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Diagnostic Value of Stress Radiography and Arthrometer Measurement for Anterior Instability in Anterior Cruciate Ligament Injured Knees at Different Knee Flexion Position.
Arthroscopy 2019; 35(6):1721-1732A

Abstract

PURPOSE

To evaluate diagnostic value of stress radiography and arthrometer measurements for anterior instability at different knee flexion angle positions.

METHODS

Forty-three patients with complete anterior cruciate ligament (ACL) rupture (group 1) and 37 normal subjects (group 2) were enrolled prospectively. Arthrometer (KT-1000) measurements and stress radiography by Telos were used to evaluate side-to-side differences. Results were recorded according to the knee position (30°, 45°, 60°, and 90°). Areas under the receiver operating characteristic curves (AUCs) were used to evaluate the diagnostic accuracy of each evaluation method. The calculated cutoff values at 30° position were used to evaluate the sensitivity and specificity of combined evaluation with stress radiography and arthrometer measurements.

RESULTS

The side-to-side differences on stress radiography and arthrometer measurements were significantly different between groups (P < .05), except for the values at the 90° position in arthrometer measurements (P = .844). The amount of anterior translation decreased in both arthrometer measurements and stress radiography between 30° and 45° positions (P < .000); however, no further decrease was observed beyond 45°. The AUC of stress radiography at the 30° position was significantly higher than other values (AUC = 0.955; P = .000). Moreover, the clinical cutoff value of 3 mm showed 86.0% sensitivity and 89.2% specificity in stress radiography at 30°, which were higher than those in arthrometer measurements. Combined use of stress radiography and arthrometer measurements at the 30° position showed 100% sensitivity and 59.5% specificity as a screening test.

CONCLUSIONS

Evaluation at the 30° knee position was significantly superior to that at other positions for both stress radiography and arthrometer measurements, whereas the 90° knee flexion position was not meaningful for any measurements. Evaluation needs to be performed with a 3-mm cutoff value for stress radiography at the 30° knee position; however, combined use of stress radiography and arthrometer measurements at the 30° knee flexion can have a higher diagnostic value.

LEVEL OF EVIDENCE

Level I, diagnostic study of established criteria.

Authors+Show Affiliations

Department of Orthopedic Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, South Korea.Department of Orthopedic Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, South Korea.Department of Orthopedic Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, South Korea; Orthopedic Department, Centre Hospitalier de Versailles, Le Chesnay, France. Electronic address: ksh170177@nate.com.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31072721

Citation

Lee, Han-Jun, et al. "Diagnostic Value of Stress Radiography and Arthrometer Measurement for Anterior Instability in Anterior Cruciate Ligament Injured Knees at Different Knee Flexion Position." Arthroscopy : the Journal of Arthroscopic & Related Surgery : Official Publication of the Arthroscopy Association of North America and the International Arthroscopy Association, vol. 35, no. 6, 2019, pp. 1721-1732.
Lee HJ, Park YB, Kim SH. Diagnostic Value of Stress Radiography and Arthrometer Measurement for Anterior Instability in Anterior Cruciate Ligament Injured Knees at Different Knee Flexion Position. Arthroscopy. 2019;35(6):1721-1732.
Lee, H. J., Park, Y. B., & Kim, S. H. (2019). Diagnostic Value of Stress Radiography and Arthrometer Measurement for Anterior Instability in Anterior Cruciate Ligament Injured Knees at Different Knee Flexion Position. Arthroscopy : the Journal of Arthroscopic & Related Surgery : Official Publication of the Arthroscopy Association of North America and the International Arthroscopy Association, 35(6), pp. 1721-1732. doi:10.1016/j.arthro.2019.01.046.
Lee HJ, Park YB, Kim SH. Diagnostic Value of Stress Radiography and Arthrometer Measurement for Anterior Instability in Anterior Cruciate Ligament Injured Knees at Different Knee Flexion Position. Arthroscopy. 2019;35(6):1721-1732. PubMed PMID: 31072721.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Diagnostic Value of Stress Radiography and Arthrometer Measurement for Anterior Instability in Anterior Cruciate Ligament Injured Knees at Different Knee Flexion Position. AU - Lee,Han-Jun, AU - Park,Yong-Beom, AU - Kim,Seong Hwan, Y1 - 2019/05/06/ PY - 2018/09/03/received PY - 2019/01/21/revised PY - 2019/01/28/accepted PY - 2019/5/11/pubmed PY - 2019/5/11/medline PY - 2019/5/11/entrez SP - 1721 EP - 1732 JF - Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association JO - Arthroscopy VL - 35 IS - 6 N2 - PURPOSE: To evaluate diagnostic value of stress radiography and arthrometer measurements for anterior instability at different knee flexion angle positions. METHODS: Forty-three patients with complete anterior cruciate ligament (ACL) rupture (group 1) and 37 normal subjects (group 2) were enrolled prospectively. Arthrometer (KT-1000) measurements and stress radiography by Telos were used to evaluate side-to-side differences. Results were recorded according to the knee position (30°, 45°, 60°, and 90°). Areas under the receiver operating characteristic curves (AUCs) were used to evaluate the diagnostic accuracy of each evaluation method. The calculated cutoff values at 30° position were used to evaluate the sensitivity and specificity of combined evaluation with stress radiography and arthrometer measurements. RESULTS: The side-to-side differences on stress radiography and arthrometer measurements were significantly different between groups (P < .05), except for the values at the 90° position in arthrometer measurements (P = .844). The amount of anterior translation decreased in both arthrometer measurements and stress radiography between 30° and 45° positions (P < .000); however, no further decrease was observed beyond 45°. The AUC of stress radiography at the 30° position was significantly higher than other values (AUC = 0.955; P = .000). Moreover, the clinical cutoff value of 3 mm showed 86.0% sensitivity and 89.2% specificity in stress radiography at 30°, which were higher than those in arthrometer measurements. Combined use of stress radiography and arthrometer measurements at the 30° position showed 100% sensitivity and 59.5% specificity as a screening test. CONCLUSIONS: Evaluation at the 30° knee position was significantly superior to that at other positions for both stress radiography and arthrometer measurements, whereas the 90° knee flexion position was not meaningful for any measurements. Evaluation needs to be performed with a 3-mm cutoff value for stress radiography at the 30° knee position; however, combined use of stress radiography and arthrometer measurements at the 30° knee flexion can have a higher diagnostic value. LEVEL OF EVIDENCE: Level I, diagnostic study of established criteria. SN - 1526-3231 UR - https://www.unboundmedicine.com/medline/citation/31072721/Diagnostic_Value_of_Stress_Radiography_and_Arthrometer_Measurement_for_Anterior_Instability_in_Anterior_Cruciate_Ligament_Injured_Knees_at_Different_Knee_Flexion_Position L2 - https://linkinghub.elsevier.com/retrieve/pii/S0749-8063(19)30130-6 DB - PRIME DP - Unbound Medicine ER -