Year: 2016
Type: article
Study design: Observational Study
Abstract: Objectives: Anterior cruciate ligament (ACL) is generally composed of anteromedial bundle (AMB) and posterolateral bundle (PLB).The function of AMB is not same as one of PLB.When they are injured, they should have different clinical features.At least, isolated one bundle ACL rupture should have different features compared to complete 2 bundles ACL rupture.The purpose of this study is to investigate the clinical features of a isolated one-bundle ACL rupture and a complete two-bundle ACL rupture.The hypothesis is that clinical evaluation, including physical examination and arthrometer measurements, can differentiate isolated from complete two-bundle ACL ruptures.Methods: This is a prospective research (18 November 2003 to 09 August 2011).525 ACL deficiencies were collected in this study.Two groups were confirmed by arthroscopy.27 patients with isolated one bundle ACL rupture (SB group), including 11 AMB rupture (AMB group) and 16 PLB rupture (PLB group), and 498 patients with complete two bundles ACL rupture (DB group) were employed for the biomechanical test before and after anesthetic according to arthroscopy.Statistics was done between DB group and SB group in order to investigate whether clinical evaluation can detect isolated one bundle or complete two bundles ACL rupture.Statistics was done between AMB group and PLB group in order to investigate whether clinical evaluation can detect AM bundle or PL bundle rupture.The clinical evaluation include KT1000 (unit: mm), Lachman test (grade 4) and Pivot shift test (grade 5) before anesthetic and Lachman test (grade 4) and Pivot shift test (grade 5) after anesthetic.The data were analyzed using a unpaired t test, nonparametric test and discriminant analysis.The data of KT1000 was analyzed with un-paired t test.The data about Lachman and Pivot shift test was analyzed with Mann-Whitney test.It was assumed that there was statistical significance when P <.05.According to the variables with statistical significant result, two formulae were developed with discriminant analysis.All statistical data were calculated with the SPSS statistical software package (SPSS version 17.0, SPSS Chicago, IL, USA).Results: In response to KT1000 side to side difference before anesthetic, between DB group (3.4216 ± 2.80607mm) and SB group (2.3077 ± 1.82799mm), there was significant differences between the two groups (t¼2.002,P¼ 0.046).In response to Lachman test before anesthetic, there was significant differences between DB group and SB group (Z ¼-2.051,P¼ 0.04).In response to Lachman test after anesthetic, there was significant differences between DB group and SB group (Z ¼-3.913,P¼ 0.000).In response to Pivotshift test after anesthetic, there was significant differences between DB group and SB group (Z ¼-6.305,P¼ 0.000).In response to Lachman test before and after anesthetic, there was not significant differences between AMB group and PLB group (Z ¼-1.210,P¼ 0.226, before; Z ¼-1.719,P¼ 0.086, after).In response to Pivot shift test before and after anesthetic, there was not significant differences between AMB group and PLB group (Z ¼-0.397,P¼ 0.691, before; Z ¼-0.307,P¼ 0.79, after).According to discriminant analysis, two formulae were developed to diagnose isolated one bundle or complete 2 bundles ACL tears.Before anesthetic, Z>0.7783 indicates a two-bundle tear and Z< 0.7783 indicates an isolated bundle tear (False accept rate 0.049).After anesthetic, Z> 2.665895 indicates an isolated bundle tear and Z< 2.665895 indicates a two-bundle tear (False accept rate 0.053).In general, false accept rate <0.1 means that the formula is useful.Conclusion: Clinical evaluation can differentiate an isolated one-bundle ACL rupture from a complete two-bundle ACL rupture.However, it cannot detect AM bundle rupture from PL bundle rupture.
Authors: Dongliang Shi, Freddie H. Fu
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $1,000
OpenAlex ID: W2527719997