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BACKGROUND: Anterior drawer test, Lachman test including evaluation of the endpoint, and pivot shift test have been commonly applied clinically in diagnosing anterior cruciate ligament (ACL) injury but how they function in the appraisal of partial ACL tears is less known. The aims of this study were to examine the diagnostic values of the commonly used knee function tests on patients in detecting ACL injury including partial injury patterns, to assess each of the test's predictive values on the specific ACL injury pattern, and to assess if using multiple tests collectively for the diagnosis of the injury could improve diagnostic accuracy. METHODS: We evaluated 36 consecutive patients who underwent ACL single bundle augmentation surgery. Those patients were matched by gender and age to 36 patients with a complete rupture of the ACL. Data was obtained from the patients' records. The rupture pattern was confirmed by arthroscopy. An examination under anesthesia was routinely performed by two surgeons who were blinded to the rupture pattern prior to surgery. RESULTS: Collectively using both Lachman test and pivot shift test increases ability to distinguish between partial tears and complete ruptures. When comparing partial PL tears and complete ruptures the pivot shift test is more important than the Lachman test. In diagnosing a complete rupture, the evaluation of the endpoint during the Lachman test is more sensitive than the evaluation of the anterior tibial translation during the Lachman test. CONCLUSION: Based on the findings of this study, a diagnostic algorithm has been implemented and is presented in this manuscript.

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PURPOSE: To investigate the long-term survivorship rates and functional outcomes of meniscal allograft transplantation (MAT) in patients with minimum 10-year postoperative follow-up. METHODS: Two reviewers independently searched EMBASE, MEDLINE, and PubMed from database inception for literature related to MAT according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. Data are reported in a narrative summary fashion with descriptive statistics. RESULTS: Eleven studies with a total of 658 patients and 688 MATs were included. Mean age of patients was 33.1 years (range 14-66), of whom 63% were male. Mean survivorship rates were 73.5% at 10-year and 60.3% at 15-year follow-up, with 2 studies reporting 19- and 24-year survivorship of 50% and 15.1%, respectively. Pre- and postoperative Lysholm scores ranged from 36 to 60.5 and 61 to 75, respectively. Pre- and postoperative Tegner scores ranged from 1 to 3 and 2.5 to 4.6, respectively. Postoperative Knee injury and Osteoarthritis Outcome Score subset scores were as follows: Pain: 61.6 to 76.3; Symptoms: 57.9 to 61.8; Function in Daily Living: 68.5 to 79.9; Sport and Recreation: 33.9 to 49.3; Quality of Life: 37.3 to 45.9. Postoperative International Knee Documentation Committee scores ranged from 46 to 77. Regarding surgical technique, 194 MAT bone-fixation technique (53.8%) and 165 MAT suture-only fixation techniques (46.2%) were reported. The most common type of allograft used was cryopreserved (54.5% of the allografts). The most frequent concomitant procedures performed with MAT were to address chondral (20.8% of the cases) and ligament injuries (12.4% of the cases), and realignment procedures (9.4% of the cases). The most common complications observed that were not directly related to concomitant procedures were meniscal allograft partial tears (11.1%), arthrofibrosis (3.6%), and infection (2.0%). Several criteria were used among studies to define failure of MAT, the most common parameters being removal of meniscal allograft (8/11 studies) and conversion to total knee arthroplasty (7/11 studies). CONCLUSIONS: MAT can yield good long-term survivorship rates, with 73.5% and 60.3% of allografts remaining functional after 10 and 15 years, respectively. Functional outcomes 10 years after MAT were fair and improved compared with preoperative scores. LEVEL OF EVIDENCE: Level IV, systematic review of Level III and IV studies.

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The heterogeneity of available cadaveric, histologic, and radiographic results related to the anterolateral ligament (ALL) does not support its existence as a discrete anatomic structure. Moreover, focusing narrowly on the ALL in isolation, what has previously been referred to as "ALL myopia," obscures a thorough appreciation for the stability contributions of both capsular and extracapsular structures. We consider injury to the soft tissues of the anterolateral knee-the anterolateral complex-just one component of what is frequently found to be a spectrum of pathology observed in the rotationally unstable, anterior cruciate ligament (ACL)-deficient knee. Increased lateral tibial slope, meniscal root tears, and "ramp" lesions of the medial meniscocapsular junction have all been implicated in persistent rotatory knee instability, and the restoration of rotational stability requires a stepwise approach to the assessment of each of these entities. Through an appreciation for the multifactorial nature of rotatory knee instability, surgeons will be better equipped to perform durable ACL reconstructions that maximize the likelihood of optimal clinical outcomes for patients. The purposes of this review are to provide an update on the relevant anatomy of the anterolateral knee soft tissues and to explain the multifactorial nature of rotatory knee instability in the setting of ACL deficiency.

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The anterolateral structures of the knee have recently garnered considerable interest regarding their role in rotatory knee instability related to anterior cruciate ligament tears. Isolated anterior cruciate ligament reconstruction may not always restore rotatory stability of the knee. In these patients, additional procedures, such as lateral reconstruction or tenodesis, may be indicated. The anatomy of the anterolateral structures of the knee has been well described. Histologic and anatomic studies have reported conflicting findings regarding the presence of a discrete ligament. The biomechanical role of the anterolateral capsule in restraining internal tibial rotation has been described as negligible. The existing body of research on the anterolateral knee structures provides insight into the composition of the anterolateral complex of the knee.

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PURPOSE: To conduct a systematic review to identify and summarize the various techniques that have been used to simulate the pivot-shift test in vitro. METHODS: Medline, Embase, and the Cochrane Library were screened for studies involving the simulated pivot-shift test in human cadaveric knees published between 1946 and May 2014. Study parameters including sample size, study location, simulated pivot-shift technique, loads applied, knee flexion angles at which simulated pivot shift was tested, and kinematic evaluation tools were extracted and analyzed. RESULTS: Forty-eight studies reporting simulated pivot-shift testing on 627 cadaveric knees fulfilled the criteria. Reviewer inter-rater agreement for study selection showed a κ score of 0.960 (full-text review). Twenty-seven studies described the use of internal rotation torque, with a mean of 5.3 Nm (range, 1 to 18 Nm). Forty-seven studies described the use of valgus torque, with a mean of 8.8 Nm (range, 1 to 25 Nm). Four studies described the use of iliotibial tract tension, ranging from 10 to 88 N. Regarding static simulated pivot-shift test techniques, 100% of the studies performed testing at 30° of knee flexion, and the most tested range of motion in the continuous tests was 0° to 90°. Anterior tibial translation was the most analyzed parameter during the simulated pivot-shift test, being used in 45 studies. In 22% of the studies, a robotic system was used to simulate the pivot-shift test. Robotic systems were shown to have better control of the loading system and higher tracking system accuracy. CONCLUSIONS: This study provides a reference for investigators who desire to apply simulated pivot shift in their in vitro studies. It is recommended to simulate the pivot-shift test using a 10-Nm valgus torque and 5-Nm internal rotation torque. Knee flexion of 30° is mandatory for testing. LEVEL OF EVIDENCE: Level IV, systematic review of basic science studies.

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