The Albright-Losee Low Profile Pivot Shift Test for ACL Deficiency

Area of Science:

• Orthopedic Surgery
• Sports Medicine
• Diagnostic Imaging

Background:

• Diagnosing anterior cruciate ligament (ACL) injuries in awake patients presents significant clinical challenges.
• Existing pivot-shift techniques often lack sufficient sensitivity for reliable ACL injury detection.
• This study introduces modifications to enhance a novel screening procedure for ACL disruption.

Purpose of the Study:

• To describe and critically review modifications of a novel screening procedure for ACL disruption.
• To improve the accuracy of diagnosing ACL injuries in awake, apprehensive patients.
• To provide guidance for clinicians to master this screening technique.

Main Methods:

• 18 cadavers were used to assess instability kinematics.
• Clinical studies involved 208 patients with ACL deficiency and 47 with intact ACLs, examined by multiple clinicians.
• Data were collected on patient condition, examiner experience, and diagnostic outcomes.

Main Results:

• Cadaveric analysis revealed specific patterns of anterior translation-internal rotation laxity.
• The novel clinical test demonstrated high sensitivity (94.7%) and specificity (97.3%) for ACL tears.
• Factors like pain, anxiety, and hamstring guarding presented challenges but did not negate test efficacy.

Conclusions:

• The modified Albright-Losee Test, when instability is perceived by both patient and examiner, significantly aids in determining ACL status.
• This test exhibits superior sensitivity compared to the Lachman Test in awake patients.
• With a positive predictive value of 98.8%, the test is highly valuable for sports medicine professionals, even amidst challenging clinical factors.