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First published on March 11, 2004, doi:10.1177/0363546503261722
This version was published on April 1, 2004
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The American Journal of Sports Medicine 32:629-634 (2004)
© 2004 American Orthopaedic Society for Sports Medicine

Relationships Between Objective Assessment of Ligament Stability and Subjective Assessment of Symptoms and Function After Anterior Cruciate Ligament Reconstruction

Mininder S. Kocher, MD, MPH*,{dagger},{ddagger}, J. Richard Steadman, MD{dagger}, Karen K. Briggs, MBA{dagger}, William I. Sterett, MD{dagger} and Richard J. Hawkins, MD{dagger}

From the {dagger} Steadman Hawkins Sports Medicine Foundation, Vail, Colorado, and {ddagger} Harvard Medical School and Harvard School of Public Health, Boston, Massachusetts

* Address correspondence to Mininder S Kocher, MD, MPH, Children’s Hospital Department of Orthopaedic Surgery, Children’s Hospital, 300 Longwood Avenue, Boston, MA 02115 (e-mail: mininder.kocher{at}childrens.harvard.edu).

Background: Relationships between objective assessment of ligament stability and subjective assessment of symptoms and function after anterior cruciate ligament reconstruction have not been established.

Hypothesis: Relationships exist between objective and subjective assessments after anterior cruciate ligament reconstruction.

Study Design: Case series.

Methods: Patients (N = 202) undergoing anterior cruciate ligament reconstruction with 2-year minimum follow-up were studied. Objective variables of ligament stability at follow-up included instrumented laxity, Lachman examination, and pivot-shift examination. Subjective variables of symptoms at follow-up included pain, swelling, giving way, locking, crepitus, stiffness, and limping. Subjective function at follow-up included walking, squatting, stair climbing, running, cutting, jumping, twisting, activity limitation, sports level, activities of daily living level, work level, knee function, sports participation, Lysholm score, and satisfaction with outcome.

Results: Instrumented knee laxity and Lachman examination had no significant (P > .05) relationships with any subjective variables of symptoms and function. Pivot-shift examination had significant associations with satisfaction (P = .03), partial giving way (P = .01), full giving way (P = .01), difficulty cutting (P = .01), difficulty twisting (P = .01), activity limitation (P = .01), overall knee function (P = .03), sports participation (P = .02), and Lysholm score (P = .01).

Conclusions: The pivot-shift examination may be a better measure of "functional instability" than instrumented knee laxity or Lachman examination after anterior cruciate ligament reconstruction.

Key Words: anterior cruciate ligament (ACL) • outcomes assessment • ligament stability • disability • impairment




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