Torg, Am J Sports Med 1976 - Clinical Diagnosis of Anterior Cruciate Ligament Instability in the Athlete

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Clinical Diagnosis of Anterior Cruciate Ligament Instability in the Athlete

Torg, Kalen, et al.·Am J Sports Med·1976·671 citations·Retrospective cohort

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Torg tested whether anterior translation near full extension (0 to 15 degrees of flexion) detects ACL disruption more reliably than the 90-degree anterior drawer test in athletes. Clinical series of 250 athlete knees with preoperative examination correlated with operative findings, including tests repeated after meniscectomy.

Key Findings

The ACL was torn in 69% (172/250) of knees, second in frequency only to the medial meniscus (80%).
Of 171 knees undergoing medial meniscectomy, 79% had an associated ACL disruption at surgery.
In combined medial meniscus and ACL tears without valgus laxity, the anterior drawer was negative or equivocal in 56 of 93 knees. The Lachman test was positive in all except 5 bucket-handle tears.
All 78 isolated meniscus tears had negative Lachman, drawer and rotatory tests before and after meniscectomy. In ACL plus medial meniscus tears with valgus laxity, an intact meniscus masked rotatory instability in 75%.
Significance: The paper described the Lachman test, showing that anterior translation near extension detects ACL tears that the classic flexed-knee anterior drawer misses and that a positive result is not produced by meniscal tears alone.

Board PearlThe Lachman test is performed at 0 to 15 degrees of knee flexion, and a soft or mushy end point indicates ACL disruption, whereas an intact ACL gives a hard end point.

Clinical Diagnosis of Anterior Cruciate Ligament Instability in the Athlete

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Clinical Diagnosis of Anterior Cruciate Ligament Instability in the Athlete

Torg, Kalen, et al.·Am J Sports Med·1976·671 citations·Retrospective cohort

|

Torg tested whether anterior translation near full extension (0 to 15 degrees of flexion) detects ACL disruption more reliably than the 90-degree anterior drawer test in athletes. Clinical series of 250 athlete knees with preoperative examination correlated with operative findings, including tests repeated after meniscectomy.

Key Findings

The ACL was torn in 69% (172/250) of knees, second in frequency only to the medial meniscus (80%).
Of 171 knees undergoing medial meniscectomy, 79% had an associated ACL disruption at surgery.
In combined medial meniscus and ACL tears without valgus laxity, the anterior drawer was negative or equivocal in 56 of 93 knees. The Lachman test was positive in all except 5 bucket-handle tears.
All 78 isolated meniscus tears had negative Lachman, drawer and rotatory tests before and after meniscectomy. In ACL plus medial meniscus tears with valgus laxity, an intact meniscus masked rotatory instability in 75%.
Significance: The paper described the Lachman test, showing that anterior translation near extension detects ACL tears that the classic flexed-knee anterior drawer misses and that a positive result is not produced by meniscal tears alone.

Board PearlThe Lachman test is performed at 0 to 15 degrees of knee flexion, and a soft or mushy end point indicates ACL disruption, whereas an intact ACL gives a hard end point.

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