Anterior Instability

Fremerey et al. assessed proprioception in the knee using the angle reproduction test in 20 healthy volunteers, 10 patients with acute anterior instability, and 20 patients with chronic anterior instability after ACL reconstruction with BTB [49]. Three months after operation, there remained a slight decrease in proprioception compared with the preoperative recordings, but 6 months after reconstmction, restoration of proprioception was seen at the positions of near full extension and full flexion. However, in the mid-range position, proprioception was not restored. At follow-up, an average of 3.7 years after reconstruction, there was further improvement of proprioception in the mid-range position, but not fully restored. 

Fig. 6.67a,b. Anterior shoulder instability, a Chronic anterior instability in an elderly patient. Note the anterior dislocation of the humeral head (HH) relative to the acromion (Acr) and the coracoid (asterisk).b Anterior glenohumeral dislocation, subcoracoid type. Anteroposterior radiograph demonstrates anterior displacement of the humeral head, which appears located inferior to the coracoid process. A Hill-Sachs deformity is present (arrow)... 

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Norwood LA, Cross Ml (1979) Anterior cmciate ligament functional anatomy of its bundles in rotatory instabilities. Am J Sports Med 7 23-26... 

Lipke JM, Janecki CJ, Nelson CL, McLeod P, Thompson C, Thompson J, Haynes DW (1981) The role of incompetence of the anterior cruciate and lateral ligaments in anterolateral and anteromedial instability. A biomechanical study of cadaver knees. J Bone Joint Surg Am 63 954-960... 

Matsumoto H, Suda Y, Otani T, NiM Y, Seedhom BB, Fujikawa K (2001) Roles of the anterior cruciate ligament and the medial collateral ligament in preventing valgus instability. J Orthop Sci 6(l) 28-32... 

Abstract Anterior cruciate ligament (ACL) injury is one of the most common knee traumas, particularly during sport activities. Giving way is a subjective symptom of the knee with ACL insufficiency. A number of clinical tests for ACL laxity have been proposed since it was first described by Stark in 1850. To quantitatively evaluate knee laxity, several knee ligament measurement devices have been also developed. The results of the manual tests and quantitative measurement are described in a grading system for further clinical evaluations, most commonly using the IKDC (International Knee Documentation Committee) evaluation form. Recently the importance of pivot-shift test as a detector of a dynamic rotational instability has been reported. In recent years, with new technologies, dynamic three-dimensional knee instability measurement devices also have been developed. 

The pivot-shift phenomenon [9, 31], which consists of a tibial anterior dislocation and a subsequent reduction of lateral compartment of the knee joint, is a dynamic instability [3, 9]. Losee reported the pivot-shift test in which the hip was abducted and the knee was passively flexed from full extension with internal tibial torque, axial load, and valgus stress applied manually to induce the pivot-shift phenomenon (Eig. 11.3) [3]. The pivot-shift test is usually positive in ACL-deficient knees but sometimes positive in ACL-reconstructed knees in which anterior stability has been successfully restored. The pivot-shift test has been reported to be associated with subjective symptoms and knee functions [32] therefore, this test has been considered as an important test to assess knee stability. The grade of the pivot-shift phenomenon can be graded by the examiner subjectively as none (—), glide (+), clunk (++), or gross (+++) according to the International Knee Documentatimi Committee (IKDC) form (Table 11.2) [33]. 

Torg JS, Conrad W, Kalen V (1976) Clinical diagnosis of anterior cmciate ligament instability in the athlete. Am J Sports Med 4 84-93... 

Balasch H, Schiller M, Friebel H, Hofftnann F (1999) Evaluation of anterior knee Joint instability with the rolimeter. A test in comparison with manual assessment and measuring with the kt-1000 arthrometer. Knee Surg Sports Traumatol Arthrosc 7 204—208... 

Maeyama A, Hoshino Y, Debandi A, Kato Y, Saeki K, Asai S, Goto B, Smolinski P, Fu FH (2011) Evaluation of rotational instability in the anterior cruciate ligament deficient knee using triaxial accelerometer a biomechanical model in porcine knees. Knee Surg Sports Traumatol Arthrosc 19 1233-1238... 

Clancy WG Jr (1983) Anterior cruciate ligament functional instability a static intra-articular and dynamic extra-articular procedure. Clin Orthop Relat Res 172 102-106... 

Hamer CD, Giffin JR, Dunteman RC, Annunziata CC, Friedman MJ (2000) Evaluation and treatment of recurrent instability after anterior cmciate ligament reconstmction. J Bone Joint Surg Am 82 1652-1664... 

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