Noninvasive and Reliable Quantification of Anteromedial Rotatory Knee Laxity: A Pilot Study on Healthy Individuals.

Autor:	Willinger L; Department of Sports Orthopaedics, Technical University of Munich, Munich, Germany., Runer A; Department of Sports Orthopaedics, Technical University of Munich, Munich, Germany., Vieider R; Department of Sports Orthopaedics, Technical University of Munich, Munich, Germany., Muench LN; Department of Sports Orthopaedics, Technical University of Munich, Munich, Germany.; Department of Trauma and Reconstructive Surgery, Artemed Klinikum München Süd, Munich, Germany., Siebenlist S; Department of Sports Orthopaedics, Technical University of Munich, Munich, Germany., Winkler PW; Department of Sports Orthopaedics, Technical University of Munich, Munich, Germany.; Department of Orthopaedics and Traumatology, Kepler University Hospital Linz, Linz, Austria.
Jazyk:	angličtina
Zdroj:	The American journal of sports medicine [Am J Sports Med] 2024 Apr; Vol. 52 (5), pp. 1229-1237. Date of Electronic Publication: 2024 Mar 20.
DOI:	10.1177/03635465241234263
Abstrakt:	Background: Anteromedial rotatory instability (AMRI) of the knee is a complex and severe condition caused by injury to the anterior cruciate ligament and/or the medial collateral ligament. Clinical studies dealing with AMRI are rare, and objective measurements are nonexistent. Purpose/hypothesis: The objectives of this study were, first, to quantify anteromedial rotatory knee laxity in healthy individuals using a noninvasive image analysis software and, second, to assess intra- and interrater reliability and equivalence in measuring anteromedial knee translation (AMT). It was hypothesized that AMT could be reliably quantified using a noninvasive image analysis software. Study Design: Cohort study; Level of evidence, 3. Methods: This prospective proof-of-concept study included healthy individuals aged 16 to 40 years with no history of knee injury or surgery. Three adhesive surface markers were placed on predefined landmarks on the medial side of the knee. Three independent investigators examined anteromedial rotatory knee laxity with an anterior drawer test in different tibial rotations (neutral tibial rotation, 15° of external tibial rotation, and 15° of internal tibial rotation). The entire examination of each knee was recorded, and AMT including the side-to-side difference (SSD) was assessed using a freely available and validated image analysis software (PIVOT iPad application). Group comparisons were performed using a 1-way analysis of variance with Bonferroni-adjusted post hoc analysis. Intraclass correlation coefficients (ICCs) were calculated to assess inter- and intrarater reliability of AMT measurements. Equivalence of measurements was evaluated using the 2 one-sided t -test procedure. Results: Anteromedial rotatory knee laxity was assessed in 30 knees of 15 participants (53% male) with a mean age of 26.2 ± 3.5 years. In all 3 raters, the highest AMT was observed in neutral tibial rotation (range of means, 2.2-3.0 mm), followed by external tibial rotation (range of means, 2.0-2.4 mm) and internal tibial rotation (range of means, 1.8-2.2 mm; P < .05). Intrarater reliability of AMT (ICC, 0.88-0.96) and SSD (ICC, 0.61-0.96) measurements was good to excellent and moderate to excellent, respectively. However, interrater reliability was poor to moderate for AMT (ICC, 0.44-0.73) and SSD (ICC, 0.12-0.69) measurements. Statistically significant equivalence of AMT and SSD measurements was observed between and within raters for almost all testing conditions. Conclusion: Anteromedial rotatory knee laxity could be quantified using a noninvasive image analysis software, with the highest AMT observed during neutral tibial rotation in uninjured individuals. Reliability and equivalence of measurements were good to excellent within raters and moderate between raters. Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: S.S. has received consulting fees from Arthrex GmbH, KLS Martin Group, Medartios AG, and medi GmnH. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.
Databáze:	MEDLINE
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