Lachman test

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The Lachman test

The Lachman test , together with the so-called anterior drawer test , is an examination method that is used in trauma surgery and orthopedics to determine if the knee joint has torn cruciate ligament .

execution

In the Lachman test, both knees are always examined in order to be able to compare the values ​​obtained. For this purpose, the knee to be tested is usually held in a position of 20 to 30 ° with the patient lying down. Ideally, the heel of the leg rests on a bed. The examiner grips the lower leg with both hands so that his index fingers are in the hollow of the knee. The lower leg is then pulled forward. The degree to which the lower leg can be displaced in relation to the thigh (drawer) provides information about whether or not the cruciate ligament has been injured.

Result

To assess the Lachman test, the quality of the stroke (firm or soft) is used on the one hand and the drawer of the healthy knee is compared with the drawer of the injured knee on the other. With the help of the side difference, which is given in millimeters, a statement can be made about the stability of the knee. There are four different degrees of stability:

  1. Normal: 1–2 mm side difference
  2. Single positive (+): 3–5 mm side difference (slight instability)
  3. Double positive (++): 6-10 mm side difference (moderate instability)
  4. Triple positive (+++):> 10 mm side difference (severe instability)

Magnetic resonance tomography (“nuclear spin”) or arthroscopy , for example, can then be performed to confirm the diagnosis . In the case of the latter, there is also the possibility of therapy in the form of a partial cruciate ligament resection (in the event of a tear), a re-fixation of the torn ligament at its natural point of attachment or a cruciate ligament plasty .

Sources of error and reliability of the diagnosis

The main source of error lies in the masking of a posterior cruciate ligament tear. In this case, the lower leg can fall back against the thigh. Pulling it forward suggests a rupture of the anterior cruciate ligament, which is actually intact. Therefore, it should be ensured that the knee joint is in a "neutral position" before the test. In general, the Lachman test is the most reliable, non-invasive and painless clinical examination method for assessing the condition of the anterior cruciate ligament. The sensitivity of the anterior cruciate ligament is around 90%, which means that the test is significantly more meaningful than the drawer test.

Namesake and first description

The Lachman test is named after the American orthopedic surgeon John Lachman of Temple University ( Philadelphia ). The Lachman test was first described in 1976 by its successor at Temple University, Joseph S. Torg . Torg reports in this publication that Lachman had taught and practiced this simple and reliable test for many years at Temple University.

In 1992, Paessler and Michel discovered that the Greek doctor George Noulis had already described this method - now known as the Lachman test - in his dissertation in 1875 .

Individual evidence

  1. ↑ Rudolf Schabus, Elisabeth Bosina: The knee. The guide for the injured knee: Diagnostics - therapy - rehabilitation for injuries to the knee joint. 1st edition. Springer, Vienna 2007, ISBN 978-3-211-29686-8 , pp. 13-14.
  2. ↑ Rudolf Schabus, Elisabeth Bosina: The knee. The guide for the injured knee: Diagnostics - therapy - rehabilitation for injuries to the knee joint. 1st edition. Springer, Vienna 2007, ISBN 978-3-211-29686-8 , pp. 13-14.
  3. ^ Wolf Petersen, Thore Zantop: The anterior cruciate ligament: Basics and current practice of operative therapy. 1st edition. Deutscher Ärzte-Verlag, 2009, ISBN 978-3-7691-0562-9 , p. 54.
  4. ↑ H. Behrend et al.: Ligament knee injuries in practice. In: Switzerland Rundsch Med Prax. 95, 2006, pp. 1663-1671. PMID 17111852 .
  5. ^ A b K. D. Shelbourne, DA Foulk: Treatment of anterior cruciate ligament injuries. In: William E. Garrett (Ed.): Principles and practice of orthopedic Sport Medicine. Lippincott Williams & Wilkins, Philadelphia 2000, ISBN 0-7817-2578-X , pp. 743-761.
  6. ↑ a b M. Wolter: The follow-up treatment of anterior cruciate ligament surgery with and without an orthosis - a comparative study. (PDF file; 939 kB) Dissertation. LMU Munich, 2009, p. 22.
  7. ↑ RA Gurtler include: Lachman test revisited. In: Contemp Orthop. 20, 1990, pp. 145-154. PMID 10148032
  8. ↑ SJ Kim, HK Kim: Reliability of the anterior drawer test, the pivot shift test and the Lachman test. In: Clin Orthop Relat Res. 317, 1995, pp. 237-242.
  9. ^ DP König et al .: Diagnosis of anterior knee instability. Comparison between the Lachman test, the KT-1000 arthrometer and the ultrasound Lachman test. In: trauma surgeon. 101, 1998, pp. 209-213. PMID 9577218
  10. ^ W. Schwarz et al.: Manual ultrasound of the knee joint. A general practice method for diagnosis of fresh rupture of the anterior cruciate ligament. In: trauma surgeon. 100, 1997, pp. 280-285. PMID 9229778
  11. ↑ Who is John Lachman? ( Memento of the original from August 19, 2011 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. John Lachman Society, accessed February 4, 2010. @1@ 2Template: Webachiv / IABot / johnlachmansociety.org
  12. ↑ JS Torg et al .: Clinical diagnosis of anterior cruciate ligament instability in the athlete. In: Am J Sports Med. 4, 1976, pp. 84-93. PMID 961972 .
  13. ↑ kneeclinic.info: ACL Reconstruction. Retrieved February 4, 2010.
  14. ^ HH Paessler, D. Michel: How new is the Lachman test? In: Am J Sports Med. 20, 1992, pp. 95-98. doi: 10.1177 / 036354659202000122 PMID 1554082
  15. ↑ GA Malanga et al .: Physical Examination of the Knee: A Review of the Original Test Description and Scientific Validity of Common Orthopedic Tests.  ( Page no longer available , search in web archives )  Info: The link was automatically marked as defective. Please check the link according to the instructions and then remove this notice. In: Arch Phys Med Rehabil. 84, 2003, pp. 592-603. PMID 12690600 (Review)@1@ 2Template: Toter Link / www.fysio.rhvh.nl  

swell

  • A. Rüter, O. Trentz, M. Wagner (Ed.): Trauma surgery. Study edition 2., revised. u. exp. Edition. Elsevier, Urban & Fischer, 2008, ISBN 978-3-437-21851-4 , p. 1054.

further reading

  • DA and JC McGuire: Arthroscopic Lachman test: a new technique using anatomic references. In: Arthroscopy . 14, 1998, pp. 641-642. PMID 9754488
  • GG Adler et al .: Drop leg Lachman test. A new test of anterior knee laxity. In: Am J Sports Med. 23, 1995, pp. 320-323. PMID 7661260

Web links