Introduction: The anterior drawer test for anterior cruciate ligament (ACL) deficiency, requires a subjective assessment of joint movement, as the tibia is pulled forward. The aim of this study was to objectively quantify this movement using a magnetic tracking device.

Materials and Methods: Ten patients aged 24 to 44 years were assessed as having unilateral ACL deficiency with conventional clinical tests. These patients were then re-assessed using a magnetic tracking device (Polhemus Fastrak). Patients had magnetic sensors attached around their femurs and tibias using elasticated Velcro straps. The Anterior Drawer test was then performed with the patient lying within range of the system’s magnetic source. The test was performed three times on the normal and injured knees of each patient, using a spring balance to apply a standard 20 lb (=89 N) force. During the tests, sensor position and orientation data was collected with an accuracy better than 1 mm and 1 degree, respectively. The data was sampled at 10Hz and stored on a computer for post-test analysis. This analysis deduced the tibial displacement resulting from each anterior drawer.

Results: During the anterior drawer test the supine patient’s knee is in 90 degrees flexion, with the foot planted on the examination couch. As the tibia is pulled anteriorly, it rotates upwards from the foot and the femur experiences a corresponding rotation from the hip. These complex coupled movements are best quantified in terms of absolute displacement of the tibia from the femur. In the normal knees, the mean displacement of the tibia from the femur was 4.2 mm (SD=1.6). In comparison the ACL deficient knees had a mean displacement of 6.3 mm (SD=2.9). This is 50 % more. A paired t test of this data showed a highly significant difference, with P = 0.005.

Conclusion: This study has quantified the movement produced during the Anterior Draw test for ACL deficiency. The tracker’s lightweight sensors caused minimal disturbance to the established clinical test. The system therefore provides objective measurement data to augment the clinicians subjective assessment.

Introduction: We performed a prospective double blind randomised clinical trial to measure the effect of pre-operative infiltration of local anaesthetic around arthroscopy wounds compared to post-operative infiltration on post operative pain relief. The underlying clinical principle is for therapeutic intervention to be made in advance of the pain rather than as a reaction to it.

Methods: 36 patients undergoing daycase unilateral knee arthroscopy between October 2000 and March 2001 were studied. The pre-operative group had 10ml 0.25% bupivicaine infiltrated around the arthroscopy portal site following induction of general anaesthesia (G.A.), the postoperative group received 10ml 0.25% bupivicaine after the procedure but before reversal of the G.A. Pain was assessed using a 10cm Visual Analogue Score (VAS) at pre-operative, 1, 2 and 24 hours post operative. At each assessment the patients were blinded to the previous scores that they had submitted. Oral analgesic use in the post-operative 24 hours was also recorded.

Results: There were 18 patients in each group. The mean Visual Analogue Pain Scores (VAS) were lower in the post-op group (1.3) compared to the pre-op group (1.58) at pre-operative assessment. However this difference was not statistically significant (p=0.5607).

At 1 hour post-op the mean VAS in the post-op group was 1.58 and in the pre-op group 2.59. This difference was not statistically significant (p=0.18).

The mean VAS at 2 hours post-op in the pre-op, group was 1.76 compared to 1.82 in the post-op group. This difference was not statistically significant (p=0.9932).

At 24 hours the pre-op group had a lower mean VAS (2.25) than the post-op group (2.4). This difference was however not statistically significant (p=0.7418).

Analysis of the post-operative analgesia requirement in both groups failed no reveal a statistically significant difference (p=0.3965).

Conclusion: In daycase knee arthroscopy under general anaesthesia there is no beneficial role in the use of pre-emptive local anaesthetic infiltration around the arthroscopy portal sites as compared to post-operative infiltration.

Purpose: Femoral roll causes the sagittal plane axis of the knee to move posteriorly and anteriorly with flexion and extension. The aim of this study was to measure this movement with a surface marker imaging system and assess the effect of Anterior Cruciate Ligament (ACL) deficiency on the Sagittal Axis Pathway (SAP) of the knee.

Method: Twelve normal and fourteen unilateral ACL deficient subjects were video recorded as they flexed and extended their knees in the sagittal plane. Video stills were captured at 150 intervals from 90o flexion to full extension. An imaging system was then used to extract the co-ordinates of leg markers from each still. These co-ordinates were then processed to derive the SAP for each knee throughout its range of movement.

Results: Pooling all the normal results together (24 bilateral + 14 unilateral = 38 knees), it was found that a 90° knee extension caused the sagittal axis to displace anteriorly with a mean value of 20.0mm (SD=7.8). In comparison the 14 ACL deficient knees were found to have a mean anterior displacement of 9.2 mm (SD=8.0). A bilateral comparison of the 12 pairs of normal knees showed no significant difference between left and right sides (paired-t, p=0.99). However, a bilateral comparison of the 14 unilateral ACL deficient patients showed a significant difference between normal and injured sides (paired-t, p=0.00025). In this group, the normal knees axis at full extension had a mean location 28.9mm (SD=8.8) posterior to the front of the tibial plateau. In comparison the injured knees axis has a mean location 37.8 mm (SD=8.5) posterior to the front of the tibial plateau. Again, this was highly significant (paired-t, p=0.0001).

Conclusion: These results indicate that normal knees have a mean forward roll of 20 mm for a 90° knee extension. In comparison ACL deficient knees have a reduced roll of 9.2 mm which occurs at the rear of the joint. This reduction in roll is consistent with the abnormal ligament biomechanics.