To investigate inter-rater and inter-device reliability of 4 clinical tests of knee laxity following anterior cruciate ligament injury and reconstruction
Abstract
Background:Clinical history-taking, combined with specific manual tests and the use of instrumented arthrometers, have been recommended to assess knee laxity after anterior cruciate ligament injury or reconstruction. However, the research examining the reliability of knee laxity tests vary significantly in methodology, data analysis, and subject heterogeneity, making comparisons across the research challenging. The KT1000, a commonly used instrumented arthrometer for evaluating knee laxity, is no longer in production, highlighting the need for a reliable, valid alternative suitable for clinical use.Aim: To investigate the inter-rater reliability of four clinical tests that measure knee laxity in the clinical setting, as well as the inter-device reliability (between the KT1000 and Lachmeter) on the anterior cruciate ligament injured and reconstructed knees.Study Design Method:A cross-sectional study of inter-rater and inter-device reliability of four different clinical tests for knee laxity: the Lachman Test, Pivot Shift test, KT1000 and Lachmeter. Two assessors, a Physiotherapist and Orthopaedic Consultant tested 50 subjects recruited from Haraldsplass Diakonale Sykehus who attended their routine follow-up post anterior cruciate ligament injury or reconstruction. Results:The intra-class correlation coefficients (ICC) indicate that the Lachmeter and KT1000 have moderate (ICC 0.71) to good (ICC 0.88) inter-device reliability values for side-to-side difference. The inter-rater reliability for the KT1000 and Lachmeter were good (ICC 0.82 and 0.80 respectively). The Kappa Cohen Coefficient indicated that inter-rater reliability for the Lachman test end-feel had a weak level of agreement (Kappa value: 0.56) and the Lachman Test amount of ATT and Pivot shift test had no level of agreement (Kappa value: 0.03 and 0.15 respectively).Conclusion:The Lachmeter is a reliable alternative to the KT1000 to assess knee laxity following ACLR. However, the Lachman test and Pivot Shift may not provide adequate inter-tester reliability when testing patients following anterior cruciate ligament reconstruction.
Description
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