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Ligamentous laxity or ligament laxity can appear in a variety of ways and levels of severity. In most people, ligaments (which are the tissues that connect bones to each other) are naturally tight in such a way that the joints are restricted to 'normal' ranges of motion.
The pivot-shift test [1] is one of the three major tests for assessing anterior cruciate injury or laxity, the other two being the anterior drawer and Lachman test. However, unlike the other two, it tests for instability, an important determinant as to how the knee will function. [ 1 ]
When a doctor suspects ACL injury in a person who reports a popping sound in the knee followed by swelling, pain, and instability of the knee joint, they can perform several tests to evaluate the damage to the knee. These tests include the pivot-shift test, anterior drawer test, and Lachman test.
In a first degree tear, the ligament has less than 5 mm laxity with a definite resistance when the knee is pulled. In a second degree sprain, there is laxity when the knee is tested at 25 degrees of flexion, but no laxity at extension with a definite resistance when the knee is pulled.
The knee is flexed at 15 degrees with the patient supine. [2] The examiner should place one hand behind the tibia and the other grasping the patient's thigh. It is important that the examiner's thumb be on the tibial tuberosity. [3] The tibia is pulled forward to assess the amount of anterior motion of the tibia in comparison to the femur. An ...
The foot is externally rotated 10-15° and the examiner supplies an anterior and external rotational force. The joint can then be evaluated for tibial anteromedial rotation, taking care to recognize the possibility of posterolateral corner instability giving similar rotational test results. As always, compare the test in the opposite knee. [4 ...
Figure 4 Test - The patient lies supine and flexes their affected knee to approximately 90° then crosses it over the normal side with the foot across the knee and the hip externally rotated. The practitioner applies a varus stress on the joint by pushing the affected knee towards the exam table.
Initially, patients have their knees immobilized for the ligament to heal. Physical therapy is often prescribed as a nonsurgical treatment of a tear, in which functional rehabilitation and range of motion exercises that focus primarily on the hips, gluteal muscles, and quadriceps are used to strengthen the muscles surrounding the knee. During ...
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