Human knee laxity in ACL-deficient and physiological contralateral joints: intra-operative measurements using a navigation system

Background: The comprehension of human knee laxity and of the failures of relevant surgical reconstructions of the anterior cruciate ligament (ACL) can be enhanced by the knowledge of the laximetric status of the contralateral healthy knee (CHK). Rarely this is available in patients, directly from the skeletal structures, and for a number of the standard clinical tests. The general aim of this study was to measure the extent to which laxity occurs immediately before surgery in the ACL deficient knee (ADK) with respect to CHK, in a number of standard clinical evaluation tests. Method: Thirty-two patients with ACL deficiency were analyzed at ADK and at CHK by a navigation system immediately before reconstructions. Knee laxity was assessed based on digitized anatomical references during the antero-posterior drawer, Lachman, internal-external rotation, varus-valgus, and pivot-shift tests. Antero-posterior laxity was normalized based on patient-specific length of the tibial plateau. Results: In the drawer test, statistical significance (p < 0.05) was found for the larger antero-posterior laxity in ADK than in CHK, on average, of 54% in the medial and 47% in the lateral compartments, when measured in normalized translations. In the Lachman test, these were about 106% and 68%. The pivot-shift test revealed a significant 70% larger antero-posterior central laxity and a 32% larger rotational laxity. No statistically relevant differences were observed in the other tests. Conclusion: The first conclusion is that it is important to measure also the antero-posterior and rotational laxity of the uninjured contralateral knee in assessing the laxity of the injured knee. A second is that the Lachman test shows knee laxity better than the AP drawer, and that the pivot-shift test was the only one able to reveal rotational instability. The present original measurements and analyses contribute to the knowledge of knee joint mechanics, with possible relevant applications in biomedical and clinical research.