Inter-rater reliability of the GNRB® knee arthrometer (original) (raw)
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Objective evaluation of anterior knee laxity; comparison of the KT-1000 and GNRB(®) arthrometers
Knee Surgery Sports Traumatology Arthroscopy, 2012
Purpose Accurate measurement of laxity after anterior cruciate ligament (ACL) rupture is usually performed with the KT-1000 arthrometer, and reproducibility and reliability are discussed. A new arthrometer, the GNRB Ò , has been recently developed in an attempt to improve intraand inter-examiner reproducibility. The aim of this diagnostic study was to evaluate the intra-and inter-examiner reproducibility of the GNRB Ò and the KT-1000. Methods Three protocols were designed to evaluate and compare the two arthrometers. Fifteen physiotherapists conducted tests on 15 subjects with healthy knees. The intra-and inter-reproducibility of the two tests were compared by analysis of variance and the F-test. Results Measure reproducibility was significantly worst with the KT-1000 than with the GNRB Ò (machine effect, P \ 0.001) regardless of operator experience. There was no significant difference between experienced and inexperienced examiners with the GNRB Ò (no 'examiners effect'). Regardless of the machine, there was a 'side effect' with healthy knees. Conclusion This clinical study demonstrates the superior intra-and inter-examiner reproducibility of the GNRB Ò over the KT-1000. There appears to be some technological advantages to using the GNRB Ò including pressure control of the patella, accuracy of the displacement transducer, control of the load on the calf, and control of hamstring activity. Level of evidence Diagnostic study, Level I.
Reproducibility of instrumented knee joint laxity measurement in healthy subjects
Rheumatology, 2006
Objective. To determine the reproducibility of frontal plane knee joint laxity measurement through the assessment of intra-and inter-rater reliability coefficients and intra-and inter-rater agreement coefficients. Methods. Two raters independently assessed the laxity of the knee joint in the frontal plane by three repeated measurements. Fourteen days later the assessment was repeated. Complete data were obtained from 20 healthy subjects. Laxity was assessed using a device which consisted of a chair with a free-moving arm that supported the subject's lower leg. Medial and lateral loads were applied, resulting in a varus and valgus movement in the knee joint. The intra-and inter-rater reliability coefficients [intraclass correlation coefficients (ICC)] were estimated, as were the intra-and inter-rater agreement parameters [standard error of measurement (SEM) and minimal detectable difference (MDD)].
International Journal of Sports Physical Therapy
Background Stability of the knee is dependent on multiple factors including integrity of the anterior cruciate ligament (ACL). Greater knee joint laxity appears to negatively affect dynamic joint function and therefore reliable and valid measures of ACL stiffness and laxity are clinically valuable. Purpose The aim of this study was to investigate the reliability of the GENOUROB, (GNRB®) knee arthrometer device in measuring both stiffness and laxity of the ACL, and to provide information on sample size calculation for future clinical trials. Study Design Cross-sectional test-retest study Method Twelve healthy student participants (age 24-30 years; 6 females and 6 males) completed testing on two different testing dates. Anterior tibial translation and stiffness were measured using the GNRB® device at forces of 134N and 200N. Reliability analyses were performed using intraclass correlation coefficients (ICC). SEM, MDC, and sample size calculations were also determined. Results Average ...
Journal of Orthopaedic & Sports Physical Therapy, 1989
The purpose of this study was to determine the reliability of a quantitative measure of knee ligament laxity in vivo. The testing device simultaneously measures applied forces and resulting displacement at the knee through use of a multidimensional electrogoniometer, dynamometer, and a computer-assisted analysis system. Subjects were 30 females and 20 males, ranging in age from 18-32 years. Laxity tests were performed in the anteriorlposterior (AIP) plane at 90 and 30' of knee flexion, and the varuslvalgus (V/V) plane at 20 and 0' of knee flexion. Test-retest (N = 4 1) and intertester (N = 78) repeatability was assessed in all test positions by ANOVA and by coefficients of correlation and variability. No significant differences were found within testers for AIP or V/V tests 1 week apart at any angle tested. There were significant differences between testers for A/P and V/V tests. No significant differences were found between left and right sides, or between malelfemale values. Comparisons to other in vitro and in vivo studies are made.
Clinicians often rely on physical examination tests to guide them in the diagnostic process of knee disorders. However, reliability of these tests is often overlooked and may influence the consistency of results and overall diagnostic validity. Therefore, the objective of this study was to systematically review evidence on the reliability of physical examination tests for the diagnosis of knee disorders. A structured literature search was conducted in databases up to January 2016. Included studies needed to report reliability measures of at least one physical test for any knee disorder. Methodological quality was evaluated using the QAREL checklist. A qualitative synthesis of the evidence was performed. Thirty-three studies were included with a mean QAREL score of 5.5+/-0.5. Based on low to moderate quality evidence, the Thessaly test for meniscal injuries reached moderate inter-rater reliability (k=0.54). Based on moderate to excellent quality evidence, the Lachman for anterior cruciate ligament injuries reached moderate to excellent inter-rater reliability (k=0.42 to 0.81). Based on low to moderate quality evidence, the Tibiofemoral Crepitus, Joint Line and Patellofemoral Pain/Tenderness, Bony Enlargement and Joint Pain on Movement tests for knee osteoarthritis reached fair to excellent inter-rater reliability (k=0.29 to 0.93). Based on low to moderate quality evidence, the Lateral Glide, Lateral Tilt, Lateral Pull and Quality of Movement tests for patellofemoral pain reached moderate to good inter-rater reliability (k=0.49 to 0.73). Many physical tests appear to reach good inter-rater reliability, but this is based on lowquality and conflicting evidence. High-quality research is required to evaluate the reliability of knee physical examination tests.
A new knee arthrometer, the GNRB®: Experience in ACL complete and partial tears
Orthopaedics & Traumatology: Surgery & Research, 2009
Introduction.-Clinical diagnosis of anterior cruciate ligament (ACL) tears (Lachman test and Pivot shift test in valgus and internal rotation) is reliable in case of complete ACL tear but reveals elusive in case of partial tears. Quantitative assessment of anterior tibial translation proves to be imprecise, subjective and poorly reproducible especially with the KT-1000 arthrometer. We developed the GNRB ® , an alternative original anterior knee laxity measurement device. The lower limb is placed in a rigid support with the knee at 0 • of rotation, the restraining power being recorded. A 0-250 N thrust force is transmitted by a jack to the upper segment of the calf. This force is only applied in the absence of hamstring muscles contraction. Displacement of the anterior tibial tubercle is recorded using a sensor with a 0.1 mm precision. Hypothesis.-We hypothesize that this knee laxity measurement device is more reliable and reproducible than other currently available arthrometers. Material and methods.-During a first validation study, the GNRB ® was compared to the KT-1000 arthrometer, in 20 pairs of healthy knees, measurements being performed by two investigators. Variance analyses were carried out at 134 N. In a second clinical study, 21 complete ACL tears (the notch is devoid of ACL) and 24 partial ACL tears (anterior or posterior bundle tear and cicatricial ACL remnant in continuity) were tested with these arthrometers to exact a differential laxity threshold value between both knees at 250 N. Statistical analysis was subsequently performed using variance and ROC curves analysis.
The relationship between grading and instrumented measurements of anterior knee joint laxity
Journal of sport rehabilitation, 2008
The relationship between clinical judgments of anterior knee laxity and instrumented measurement of anterior tibial translation is unclear. To examine the relationship between certified athletic trainers'grading of anterior knee laxity and instrumented measurements of anterior tibial translation. Randomized, blinded, clinical assessment. Laboratory. Model patients receiving evaluation of anterior knee laxity. Twelve model patients were evaluated using a MEDmetric KT1000 knee ligament Arthrometer to establish instrumented measurements of anterior translation values at the tibio-femoral joint. Twenty-two certified athletic trainers were provided with operational definitions of potential laxity grades and examined the model patients to make judgments of anterior knee laxity. Correlation between clinical judgments and instrumented measurements of anterior tibial translation. Clinical judgments and instrumented measurements were mutually independent. Anterior tibial translation gradi...
Rotational knee laxity: reliability of a simple measurement device in vivo
BMC Musculoskeletal Disorders, 2008
Background: Double bundle ACL reconstruction has been demonstrated to decrease rotational knee laxity. However, there is no simple, commercially-available device to measure knee rotation. The investigators developed a simple, non-invasive device to measure knee rotation. In conjunction with a rigid boot to rotate the tibia and a force/moment sensor to allow precise determination of torque about the knee, a magnetic tracking system measures the axial rotation of the tibia with respect to the femur. This device has been shown to have acceptable levels of test re-test reliability to measure knee rotation in cadaveric knees.
Journal of Manual & Manipulative Therapy, 2016
Objective: The purpose of this thesis was to investigate the inter-rater reliability of the McKenzie System of Mechanical Diagnosis and Therapy (MDT) when classifying patients with musculoskeletal knee pain using clinical vignettes. Methods: This study was divided into two phases. First, ten clinicians experienced in the use of MDT were randomly recruited to write a total of 60 clinical vignettes based upon the initial assessment of past patients with knee pain. Second, six different MDT raters were recruited to rate 53 selected vignettes and reliability was determined using Fleiss Kappa. Results: There was "substantial agreement" among six MDT raters classifying the clinical vignettes into one of four categories (kappa=0.72). There was no statistically significant difference between therapists with different levels of training. Significance: These findings indicate that the McKenzie System of MDT is a reliable method of classifying patients presenting with musculoskeletal knee pain when using clinical vignettes.
Knee Surgery, Sports Traumatology, Arthroscopy, 2005
The Rolimeter device can provide measurements of anterior/ posterior tibial displacement using maximal manual force. The Rolimeter reliability is still under research when used as an independent knee tester. The purpose of this study is to determine the inter-rater reliability of the Rolimeter measurements between anterior cruciate ligament (ACL) injured and normal contra lateral knees. Twelve male patients with ACL deficiency participated in this study. Three physical therapists (PT) performed the Rolimeter measurements in supine position with an approximate 25°fl exion of the knees. Each therapist performed three trials on each knee and the difference in results in millimeters between injured knee and normal contra lateral knee was determined. Spearman's rho correlations showed weak relationships between the PT 1, 3 and 2, 3 (PT 1 vs. PT 3 r=0.55, PT 2 vs. PT 3 r=0.57) and the high relation between 1, 2 (PT 1 vs. PT 2 r=0.96) of Rolimeter measurements. Intraclass correlation coefficient showed no significant reliability coefficients among the three PT Rolimeter measurements between ACL injured and normal contra lateral knees (R=0.24, p=0.05). These results reflect the variations among the means of the three physical therapists' Rolimeter measurements between ACL injured and normal contra lateral knees.