Operative management of isolated posterior cruciate ligament injuries improves stability and reduces the incidence of secondary osteoarthritis: a systematic review.

PURPOSE: To evaluate the evidence for operative and non-operative management of isolated posterior cruciate ligament (PCL) injuries. METHODS: Using Pubmed, EMBASE and Cochrane databases, a systematic review was conducted of studies investigating the treatment of isolated PCL injuries published until July 2020. Quality assessment was performed with the Cochrane risk of bias tool (level I), the Newcastle-Ottowa Scale (level II-III) and the National Institute of Health quality assessment tool (level IV). Clinical outcome measures included residual laxity, return to sports, patient-reported outcome measures, subsequent articular degeneration and complications. RESULTS: Twenty-seven studies [23 case series, 2 case-control, 1 cohort study and 1 randomized controlled trial (RCT)] including 5197 patients (5199 knees) with a mean age of 29.5 ± 3.6 years (range 15-68) fulfilled the study requirements. Significantly less residual laxity was found after posterior cruciate ligament reconstruction (PCLR) compared to non-operative management (3.43 vs. 5.47 mm, CI: 1.84-2.23, p < 0.001). Both treatment modalities yielded satisfying functional outcomes and a high return to sports (64-77%, mean: 70.3, CI: 67.8-72.2). Osteoarthritis (OA) occurred less frequently following PCLR (21.5 vs. 44.1%, p < 0.001). CONCLUSION: In the absence of level I RCTs, this systematic review suggests that surgical management for selected isolated PCL injuries is a reasonable option to consider, especially when the surgeon aims at minimizing residual laxity and presumably secondary osteoarthritis. LEVEL OF EVIDENCE: IV.

Successful reconstruction of the posterior cruciate ligament: assessment of posterior cruciate ligament footprints using an objective coordinate system.

INTRODUCTION: Anatomic cruciate ligament reconstruction is known to be correlated with better clinical results. The aim of the study was to provide a simple method to enable anatomic results in the setting of PCL reconstruction. We, therefore, assessed the tibial and femoral insertion site of the posterior cruciate ligament (PCL) by the use of an objective coordinate system in an anatomical study. We also sought to show reproducibility of these measurements using intra- and inter-observer coefficients. MATERIALS AND METHODS: We studied 64 knees, previously preserved according to Thiel's technique. After proper preparation of the articular surfaces of both the tibiae and femora, photographs were taken according to a standardized protocol. PCL footprints were measured by the use of a coordinate system twice by two examiners. We evaluated these measurements by use of the Cohen's kappa inter- and intra-observer coefficient for two observers. RESULTS: Tibial and femoral measurements of PCL footprints were generated with highly comparable inter- (k = 0.970) and intra-observer (k = 0.992) coefficients and may, therefore, be considered as highly reproducible. CONCLUSION: Our findings confirmed the reproducibility of defining PCL footprints using a coordinate system and may contribute to planning intraoperative graft-placement to ensure optimal conditions in the upcoming techniques for PCL reconstruction.

Allografts in reconstruction of the posterior cruciate ligament: a health economics perspective.

PURPOSE: To review the relative cost-effectiveness of allografts and autografts in reconstruction of the posterior cruciate ligament. METHODS: Systematic review and cost-effectiveness analysis. RESULTS: The available evidence does not show any significant difference in clinical effectiveness between autografts and allografts. Given that, only a cost analysis is provided, which shows that allografts are more costly. CONCLUSION: Given the lack of any benefit of allografts over autografts, autografts should be preferred on cost grounds, if available. However, there may be situations where an allograft is indicated, for example, in multiple ligament reconstructions. LEVEL OF EVIDENCE: IV.

Surgical reconstruction is a cost-efficient treatment option for isolated PCL injuries.

PURPOSE AND HYPOTHESIS: The main purpose of the study is to put focus on the costs related to treating posterior cruciate ligament (PCL) injuries and the possible implications of chosen treatment strategy to the respective institutions and society. METHODS: Costs of treating PCL injuries nonoperatively and for both single-bundle (SB) and double-bundle (DB) reconstruction were estimated. These costs were translated into equivalent quality-adjusted life years (QALY) given a threshold value of Euro (€) 70,000 per QALY. Expected gain in knee osteoarthritis outcome score (KOOS) quality of life (QoL) following surgery based on KOOS data from 112 patients was used as a basis for calculating the cost efficiency ratio. RESULTS: The average calculated cost of nonoperative treatment was €3382. Incremental cost for SB PCLR was €8585 (154%) and another increment of €5220 (61%) for DB PCLR using numbers from a European hospital. This is equivalent to increments of 0.074 (SB) and another 0.075 (DB) QALYs given the €70,000 threshold. For DB to be as cost efficient as SB reconstruction, the incremental gain in KOOS QoL has to be at the same level as for SB reconstruction compared to nonoperative treatment. CONCLUSION: Though surgical reconstruction adds a substantial cost to nonoperative treatment alone, it can be considered cost-effective. Double-bundle reconstruction is less cost efficient than SB reconstruction, but should probably still be considered the treatment of choice for certain patient categories. Randomized controlled trials looking at outcome following nonoperative, SB and DB PCL reconstruction are needed. The clinical relevance of this is that surgical reconstruction of PCL injuries is a cost-efficient treatment alternative in patients with an isolated PCL injury. This finding should be taken into consideration when deciding on how to treat these injuries. LEVEL OF EVIDENCE: III.

Rupture of the Posterior Cruciate Ligament: Preoperative and Postoperative Assessment.

Posterior cruciate ligament (PCL) ruptures are not common, but reconstruction is increasing because PCL-deficient knees are prone to develop osteoarthritis. Preoperative MRI may confirm a total or partial disruption of PCL fibers. An overstretched PCL is often mistaken for an intact PCL while the knee is functionally PCL deficient, resulting in false-negative MRI reports. Posterior translation of the medial condyle is a useful indirect sign on imaging. Preoperative stress radiographs are used to quantify the degree of PCL deficiency, and posterior translation determines whether to treat conservatively or with surgery. Early postoperative imaging is performed to evaluate tunnel placement and fixation devices. Late postoperative imaging is performed to assess graft rupture, arthrofibrosis, or tunnel widening. Pre- and postoperative imaging plays an important part in planning and treating functionally PCL-deficient knees and PCL ruptures.

Second-look arthroscopic assessment of arthroscopic single-bundle posterior cruciate ligament reconstruction: comparison of mixed graft versus achilles tendon allograft.

BACKGROUND: Although controversy continues over the choice of graft tissue, including autografts, allografts, and synthetic ligaments, for posterior cruciate ligament (PCL) reconstruction, the use of a mixed graft consisting of a hamstring (semitendinosus and gracilis) autograft plus tibialis anterior allograft tendon has not been studied in detail. HYPOTHESIS: Outcomes of PCL reconstructions performed with a mixed graft would be superior to those using solely an Achilles tendon allograft in terms of functional knee scores, posterior stability, and the graft appearance. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: Fifty-eight patients who underwent isolated single-bundle PCL reconstruction using an arthroscopic trans-septal portal with remnant preservation technique were evaluated. They were divided into group A (mixed tendon; n = 30) and group B (Achilles tendon; n = 28). Knee function was evaluated using the Lysholm knee score, Tegner activity score, and the International Knee Documentation Committee (IKDC) grading scale. Anteroposterior stability was measured using the Telos stress view. Twenty patients (66.7%) from group A and 21 patients (75.0%) from group B underwent hardware removal and a second-look arthroscopic examination. RESULTS: The Lysholm knee scores in groups A and B increased from a respective average of 43 and 50 preoperatively to 90 and 88 at follow-up. The IKDC grade and Tegner activity scores were also significantly improved in both groups. Stability was improved in both groups, with an average posterior laxity of 3.0 mm (group A) and 3.3 mm (group B) at follow-up (P > .05). However, there were 4 intraoperative complications in group B: 2 bone fractures and 2 graft pullouts during precyclic tensioning. Second-look arthroscopy revealed a partial tear in 8 cases (40%) from group A and 15 cases (71.4%) from group B (P = .03). All of the partial tears were located in the femoral aperture area. Complete synovial coverage was demonstrated in 10 patients (50%) from group A and 5 patients (23.8%) from group B (P = .04). However, clinical outcomes and stability were not affected by the arthroscopic graft appearance. CONCLUSION: Satisfactory results were obtained for groups A and B in patients who underwent reconstruction for isolated PCL injury. However, 4 intraoperative complications (14.3%) were encountered with use of the Achilles tendon allograft (group B), with a relative higher rate of partial tear and less synovialization in the femoral aperture area.

Serial assessment of knee joint moments in posterior cruciate ligament and posterolateral corner reconstructed patients during a turn running task.

INTRODUCTION: During post-operative rehabilitation for posterior cruciate ligament (PCL) reconstruction, flexion is limited to 90° for the first 6 weeks, and hamstring strengthening is initiated at 3 months because of static stability. The posterolateral corner sling (PLCS) procedure is frequently performed with PCL reconstruction to help alleviate posterolateral rotator instability, and it is possible, during this procedure, to damage the dynamic motion and to over-constrain the knee. MATERIALS AND METHODS: For the patients group, PCL and PLCS reconstructions were performed simultaneously, and all reconstructed patients had stable knees and showed no complications. A motion analysis system was used to measure and calculate kinematic and kinetic data for seven patients after PCL and PLCS reconstruction (patients group) and seven normal subjects (control group) during a turn running task. The study was conducted on two groups at both 3 months (return to daily activity) and 6 months (return to light sports) post-operation. At 6 months after surgery, the dial test was also performed to observe the static rotational stability. RESULTS: Compared to the control group, the patients group showed a decreased extension moment (-1.15 ± 0.46 vs. -3.51 ± 0.69 Nm/kg, p = 0.000), a decreased valgus moment (-1.36 ± 0.72 vs. -2.15 ± 0.54 Nm/kg, p = 0.041) and a decreased external rotational moment (-0.15 ± 0.11 vs. -0.37 ± 0.10 Nm/kg, p = 0.002) 3 months post-operatively. However, these results approximated to the normal control, and the patients group showed an improved extension moment (-2.95 ± 0.67 Nm/kg, p = 0.188), valgus moment (-1.73 ± 0.58 Nm/kg, p = 0.359) and external rotational moment (-0.30 ± 0.09 Nm/kg, p = 0.325) at 6 months post-operatively. A static rotational stability revealed a similar or over-constrained state compared with the contralateral knee, and no patient showed rotational instability. CONCLUSIONS: PCL-PLCS reconstructed patients were reluctant to engage in, or lacked strength for, daily rotational activities. Therefore, we must consider more active and systematic co-contraction exercise of the hamstring and quadriceps and rehabilitation program about rotation that is not adverse to the static stability in PCL-PLCS reconstructed patients for early return to daily activities.

Dislocation and bicruciate lesions of the knee: epidemiology and acute stage assessment in a prospective series.

INTRODUCTION: Knee dislocation and bicruciate lesions are rare. Assessments of results from retrospective series carry an insufficient level of evidence. A prospective multicenter study was therefore set up, under the auspices of the French Society of Orthopedic Surgery. MATERIAL AND METHODS: The inclusion period covered the whole of 2007. Clinical, imaging (dynamic X-ray and MRI) and vascular (angioscan and arteriography) assessment was performed systematically. In patients over the age of 60 years, ligament lesions were always managed non-surgically; in those under the age of 60 years, surgery was considered in the absence of associated vascular lesion or open dislocation and if there was frontal laxity exceeding 15 degrees or a posterior drawer test greater than 10mm. The posterior cruciate ligament (PCL) and peripheral ligament tears were repaired or reinforced under arthroscopy or by arthrotomy. The anterior cruciate ligament was never operated on. In all other cases, management was conservative. RESULTS: Sixty-seven knees were included (55 male, 11 female; mean age: 37 years). Fifteen patients (25.4%) had bicruciate lesion, and 44 (74.6%) knee dislocation. Mean trauma-to-reduction interval was 3 hrs 50 min. Only one of the nine cases of popliteal artery lesion exhibited discernible distal pulse wave. Only three of these patients underwent vascular surgical repair. Twelve knees (five bicruciate lesions, seven dislocations) had isolated common peroneal nerve damage. DISCUSSION: This prospective study detailed the epidemiology and treatment of the lesions encountered, with the option of PCL and peripheral ligament reconstruction. The results, however, still require long-term analysis.

Assessment and management of posttraumatic haemarthrosis of the knee.

Traumatic haemarthrosis of the knee poses significant diagnostic difficulty in the acute phase. Orthopaedic follow up is essential. An update of current recommended practice is provided, and the pros and cons of arthroscopy and magnetic resonance imaging are discussed.

A clinically relevant assessment of posterior cruciate ligament and posterolateral corner injuries. Evaluation of isolated and combined deficiency.

BACKGROUND: The treatment of symptomatic posterior cruciate ligament injuries of the knee is controversial. Identification of concomitant injuries of the posterolateral corner is important to optimize surgical and clinical outcomes, although this diagnosis is sometimes difficult. The purpose of this study was to determine the physical examination and stress radiography parameters of isolated injuries of the posterior cruciate ligament and combined injuries of the posterior cruciate ligament and posterolateral corner. Our hypothesis was that Grade-3 posterior drawer laxity is an indicator of a concomitant injury of the posterolateral corner. METHODS: Ten pairs of cadaver knees (a total of twenty knees) were evaluated with posterior drawer testing, dial testing, and stress radiography. Stress radiography was performed by applying a 200-N posterior drawer at 90 degrees of knee flexion. The knees were tested while intact and then retested following the sequential resection of the posterior cruciate ligament followed by the posterolateral corner structures. RESULTS: All intact specimens were rated as Grade 0 on posterior drawer testing. Sectioning of the posterior cruciate ligament resulted in Grade-2 posterior drawer in all specimens. The additional resection of the posterolateral corner resulted in Grade-3 posterior drawer in all specimens. Dial testing of the intact knees resulted in a mean (and standard error) of 10.5 degrees +/- 1.0 degrees and 10.5 degrees +/- 0.80 degrees of external rotation at 30 degrees and 90 degrees, respectively. This increased significantly to 15.1 degrees +/- 1.1 degrees and 16.2 degrees +/- 0.89 degrees, respectively, following sectioning of the posterior cruciate ligament (p < 0.05). After resection of the posterolateral corner, rotation was further increased to a mean of 21.6 degrees +/- 1.5 degrees at 30 degrees and 27.5 degrees +/- 1.6 degrees at 90 degrees (p < 0.05). On stress radiography, the average posterior displacements measured 2.9 +/- 0.5 mm in the intact specimens, 12.7 +/- 1.0 mm after resection of the posterior cruciate ligament, and 22.3 +/- 1.6 mm after the additional resection of the posterolateral corner (p < 0.05). The corrected posterior displacement, calculated by subtracting the displacement in the intact knees, was 9.8 mm after resection of the posterior cruciate ligament and 19.4 mm after the additional resection of the posterolateral corner. CONCLUSIONS: A grade of 3 on posterior drawer testing and >10 mm of posterior tibial translation on stress radiography correlate with the presence of a posterolateral corner injury in addition to a complete disruption of the posterior cruciate ligament.

Acute traumatic hemarthrosis of the adult's knee--a diagnostic options in arthroscopic era. Literature review.

The review presenting the most common causes of acute knee hemarthrosis in adults, discuss diagnostic accuracy, advantages and disadvantages as well as cost-effectiveness assessment of physical examination, magnetic resonance imaging and artrhroscopy as diagnostic tools in appraisal of acute injured knee.

Cruciate ligament assessment in MRI scans: a pilot study of a static drawer technique.

Ten subjects with cruciate ligament rupture (five ACL and five PCL), and four normal subjects underwent magnetic resonance imaging (MRI) with a novel splint that stresses the knee. The splint acted as a fulcrum to translate the tibia in an anterior and posterior direction, depending on application. The MRI images showed that translation of the tibial plateaux occurred but not in a simple manner. The resultant images did not show marked anterior tibial translation in the ACL ruptured knee with an anterior drawer, nor posterior tibial translation for the PCL injured knee in posterior drawer. The medial plateau tended to move posteriorly in anterior drawer in the normal knees. The secondary MRI findings of ACL injury and associated meniscal injuries were enhanced. A further study with 50 subjects in each group, and arthroscopic confirmation of the findings, would be required to confirm these results.

Magnetic resonance imaging of posterior cruciate ligament injuries: assessment of healing.

This study evaluated posterior cruciate ligament (PCL) healing using magnetic resonance imaging (MRI). Forty knees with acute PCL injuries underwent acute and follow-up (>6 months) MRI examinations. Twenty-three knees had isolated injuries, and 17 knees had associated ligament damage. The initial MRI scans showed 22 high-grade injuries with complete disruption, 14 with midgrade injuries with extensive edema on T2 images with some bridging fibers present, and 4 patients had low-grade injuries. At a mean time of 3.2+/-1.3 years after the initial MRI, the follow-up MRIs revealed the PCL healed with continuity in all of the low-grade and mid-grade injuries, and in 19 of 22 high-grade injuries. Of the 19 high-grade PCL tears that healed, 4 healed with normal contour and 15 were continuous with altered morphology at follow-up. Of 11 high-grade PCL-injured knees with associated ligament damage, only 1 PCL failed to regain continuity. The 3 PCLs that did not regain continuity were in 2 patients with isolated injuries and 1 patient with associated anterior cruciate and medial collateral ligament injuries. These results demonstrate that most nonoperatively treated PCL injuries, even in association with other knee ligament damage, can heal with continuity.

Knee dislocation: initial assessment and implications for treatment.

OBJECTIVE: To evaluate bicruciate knee injuries and determine whether they should be treated as knee dislocations, especially with regard to vascular injuries. DESIGN: Retrospective. SETTING: University hospital, level 1 trauma center. PATIENTS: Fifty patients admitted between 1987 and 1994 who had sustained knee dislocations or bicruciate ligament injuries. MAIN OUTCOME MEASURES: Mechanism of injury, direction of dislocation, knee ligament injury pattern, presence or absence of periarticular fracture, presence of vascular and nerve injuries, and location of associated trauma were measured. RESULTS: Twenty-two knees had classic knee dislocations. Twenty-eight knees presented as "reduced" bicruciate ligament injuries. Vascular injury occurred just as frequently in bicruciate ligament injuries as in knee dislocations. The direction of the knee dislocation did not predict ligament injury pattern or the presence of arterial injury. CONCLUSION: Bicruciate ligament injuries are equivalent to knee dislocations with regard to mechanism of injury, severity of ligamentous injury, and frequency of major arterial injuries.

Intratester and intertester reliability of the KT-1000 arthrometer in the assessment of posterior laxity of the knee.

We measured tibial translation in the knees of 22 subjects with posterior cruciate ligament tears or reconstructions by using the KT-1000 arthrometer. To assess the reliability of the device, two testers made measurements. One tester was a novice and the second tester had substantial clinical experience with the KT-1000 arthrometer. The quadriceps neutral angle was found for the uninvolved knee. Anterior and posterior translation and total anterior-posterior excursion were then measured. The quadriceps neutral angle was then reproduced in the involved knee and the same measurements were taken. Each subject was tested twice by each tester. The intraclass correlation coefficient values for the novice, experienced, and intertester reliability were 0.67, 0.79, and 0.62, respectively, for corrected posterior translation; 0.59, 0.68, and 0.64, respectively, for corrected anterior translation; 0.70, 0.74, and 0.29, respectively, for quadriceps neutral angle; and 0.84, 0.83, and 0.62, respectively, for total anterior-posterior excursion. Ninety-five percent confidence intervals for the novice, experienced, and intertester reliability were +/-2.95, +/-2.53, and +/-3.27 mm, respectively, for corrected posterior translation; +/-3.99, +/-3.89, and +/-3.74 mm, respectively, for corrected anterior translation; and +/-10.70 degrees, +/-11.73 degrees, and +/-16.25 degrees, respectively, for quadriceps neutral angle. The KT-1000 arthrometer was found to be a moderately reliable tool for the measurement of tibial translation in patients with posterior cruciate ligament tears and reconstructions.

[Value of MRI in assessment of cruciate ligament replacement]. / Wertigkeit der MRT in der Beurteilung des Kreuzbandersatzes.

To evaluate the predictive value of MRI in the early postoperative course after cruciate ligament replacement, a prospective study was performed. Twenty patients with reconstructed anterior and/or posterior cruciate ligament were examined clinically and with contrast-enhanced MRI 2, 12, 24 weeks, 1 and 2 years postoperatively. The clinical examinations were evaluated according to the scores by Lysholm, OAK and IKDC. The MRI scans (SP 63, 1.5 Tesla) were evaluated regarding the quality and signal intensity of the reconstructed ligament. During the first postoperative year a significant increase in signal intensity and inhomogeneity of the neoligament in MRI was observed in 16 patients with an average value for signal/noise of 1.1 2 weeks postoperatively up to 6.9 1 year postoperatively. In 12 patients the reconstructed ligament could not be evaluated in the 1-year postoperative MRI, whereas none of these patients was suspected clinically of having instability. In the 2-year postoperative MRI, the signal intensity of the neoligament was found to be decreasing again with improvement in judgement.

[Assessment with magnetic resonance of reconstruction of the posterior cruciate ligament. Preliminary experience]. / Valutazione con Risonanza Magnetica della plastica ricostruttiva del legamento crociato posteriore. Esperienza preliminare.

Posterior cruciate ligament (PCL) tears are definitely less common than anterior cruciate ligament (ACL) tears: their incidence in literature ranges 3-20% of all capsuloligamentous injuries versus 45-90% for ACL tears. Recent papers reported that if these injuries are not operated on, they evolve first into medial femorotibial and femoropatellar arthrosis and then into tricompartmental arthrosis. There are several MR studies dealing with ACL reconstruction, while MR studies on PCL reconstruction are lacking, both because the frequency of the latter injuries is lower and because they are difficult to demonstrate. We report our preliminary experience with PCL reconstruction studied with MRI in 12 patients submitted to arthroscopy. We used the ipsilateral patellar tendon (11 cases) or the contralateral one (1 case). The patients were submitted to MRI 4-16 months after surgery. Axial, coronal and sagittal images were acquired, together with oblique sagittal and coronal slices to show the graft completely. We also used SE, GE and fat suppression STIR MR sequences, trying to identify which of them are the most useful in patients with healing or exudative reaction in the intercondylar notch. MR exams were performed with a dedicated permanent magnet (0.2 T) and a permanent total body unit (0.3 T). The graft was clearly depicted on all images in 11 patients, while graft retear was shown in 1 patient. MRI did depict the whole graft in all patients, which finding is useful to study the signal intensity changes which indicate graft trophism. MRI also depicted correctly the femoral and tibial tunnel position and alignment, the presence of possible impingement with bone, the presence and extent of the healing reaction or of serum-hematic material in the intercondylar notch. The latter factor prevents the graft depiction, in which case the MR techniques providing the highest possible contrast in the different structures under examination are mandatory. Finally, MRI permitted to study possible associated capsuloligamentous or meniscal injuries and the state of femorotibial and femoropatellar chondral covering, the presence of articular synovia changes and the amount of possible joint effusion. We believe that MRI exhibited a high standard of sensitivity, versatility and diagnostic accuracy in the examination of surgical patients submitted to arthroscopic PCL reconstruction. Further studies and long-term follow-up will help define the use of MRI in these patients.

Assessment of posterior cruciate ligament graft performance using robotic technology.

We used the information on in situ forces provided by robotics to compare two methods of posterior cruciate ligament graft fixation. Twenty porcine knees were studied using robotic technology to determine and repeat intact, deficient, and reconstructed knee motion under 110 N of posterior tibial loading at 30 degrees, 60 degrees, and 90 degrees of knee flexion. Reconstruction was performed using a bone-patellar tendon-bone graft with the distal end of the graft placed in the posterolateral aspect of the posterior cruciate ligament tibial insertion. Specimens were separated into two groups based on the femoral fixation site: the proximal or anterior aspect of the femoral insertion. Repetition of knee motion allowed measurement of the force in the intact posterior cruciate ligament and graft using the principle of superposition. The forces in the graft and the intact ligament provided additional information to evaluate graft performance. Force in the intact posterior cruciate ligament was significantly greater at 90 degrees than at 30 degrees and 60 degrees of knee flexion. The forces in both graft types were significantly lower than those of the posterior cruciate ligament, but the force in the anteriorly placed graft was significantly greater at 90 degrees than at 30 degrees and 60 degrees of knee flexion, similar to the intact posterior cruciate ligament. Thus, the anteriorly placed graft had a more physiologic increase in tension with knee flexion, when the joint provided less restraint.

[The radiological Lachman test: an extremely exact and predictive method for the assessment of recent and old injuries to the cruciate ligaments]. / Der radiologische Lachman-Test: Eine äusserst exakte und aussagekräftige Methode zur Beurteilung frischer und alter Kreuzbandverletzungen.

The object of this paper is to examine the efficiency of the Lachmantest in the evaluation of injuries to the cruciate ligaments. As our examinations show-100% correct results-this test gives high qualitative and quantitative evidence and furthermore complies with all the necessary demands required for a standardization of a method of measuring. The standardized X-ray-Lachman-test therefore not only shows any injuries to the cruciate ligaments in new and old injuries of the knee joint without anesthesia but is also suitable for a progress control after the restauration of the cruciate ligaments or plastic ligament surgery respectively.