An Analysis of Articles Relating to the Lachman Test - Literature review Example

Introduction This discussion will attempt to analyze two specific articles relating to the Lachman test, a physiotherapy method used predominately totreat athletic injuries. It will critically assess them, both of which will be identified in the following section of the analysis. Upon giving some background information on each article, they will be dissected and discussed in terms of sequential content. This particular method of analysis allows for a reliable and accurate way to examine each article before critically evaluating them. The sole purpose will be to conduct not only a critical evaluation, but also to proclaim a sound analysis on the implications and investigations regarding the Lachman test from a methodological perspective. The investigative section will aim to provide further information regarding the Lachman test, and will attempt to identify the work of others, and how they compare to the studies of the authors being discussed. After this segment, a conclusion will then be drawn upon highlighting the various points previously discussed, as well as conclude with an overall position on the effectiveness of each article in terms of how well it represents the use of the Lachman test in its proper physiological context. Background Both articles are similar in that they each take an individualized look at the Lachman test and apply it to a specific set of circumstances. The objective for Hurley and McGuire (2003) was to examine the influences of clinician technique on performance and interpretation of the Lachman test. The article established that clinician grip configuration was found to relate to performance and interpretation of the Lachman test. It also concluded that clinicians demonstrating proximal tibia-hand placement were more likely to correctly perform and interpret the Lachman test than clinicians demonstrating distal tibia-hand placement (Hurley & McGuire 2003, p.41). On the other hand, the purpose of the Hurley, Boros and Challis (2003) study was to examine the influence of the Lachman test performance technique on tibia displacement and strain in the anterior cruciate ligament. The results of this particular study found that tibia translation and strain behavior of the anterior cruciate ligament during the Lachman test appears to have been influenced by clinician hand positioning used in the application of force to the tibia (Hurley, Boros & Challis 2003, p.97). Each study tends to follow the same pattern while analyzing the uses of the Lachman test, yet they differ in terms of the content displayed. The following sections will attempt to break down the theoretical aspects of the impact that the Lachman test had on both studies. It is also important to note that in order to critically examine each article; one must look at the relative aspects of each test and treat them similarly while taking into account their evaluative characteristics. Evaluation Hurley and McGuire (2003) begin by discussing the conventional ideas relating to clinician techniques with regards to the examination of athletic injuries. They even go so far as to call such knowledge with a talent in the examination as an art form (Hurley & McGuire 2003, p.34). It is through this section that sets the structure for the actual study, and provides vital background information on the Lachman test itself, which would be considerably useful in realizing the overall goals of the study. The article then begins to set into a suitable form, recognizable with most studies in such an analogous field. The methods section describes the subjects taking part in the study, as well as detailing the twelve undergraduate students who were considered as being the patients taking part (Hurley & McGuire 2003, p.35). The age and body mass of each participant is calculated and presented in a table form, as well as the tibia-hand measurements of the clinicians involved. Preparation, protocol and instrumentation are also discussed, emphasizing the fact that the KT1000 will be the primary mode of measurement for the duration of the study. It is then noted that the clinicians taking part in the study were tested individually in an athletic training laboratory, which could be considered as a controlled environment. It is also important to note that the histories of the patients’ knees were not disclosed and clinicians were not permitted to request information regarding them. Following this, the KT1000 was then used to conduct a statistical analysis, which was performed according to the manufacturer’s specifications (MEDmetric Corp, 1994). Intended for the purpose of this study, the hand used by the clinician to relocate the patient’s tibia relative to the femur was selected as the tibia hand. The tibia hand used for the examination of left knees is the left hand if the clinician follows the correct Lachman test procedure (Torg, Conrad & Kalen, 1976 p.87). Due to the fact that not all clinicians demonstrated the correct Lachman technique during the study, the hand used to translate the tibia relative to the femur was coded as the tibia hand when determining grip configuration in the statistical analysis (Hurley & McGuire 2003, p.37). The remainder of the study discusses the results in an analytical context, while establishing some grounds for further research, considerations and more importantly, limitations that may affect the purpose as well as the effectiveness of such a study in the future. As with the previously discussed article, Hurley, Boros and Challis (2003) begin by discussing various tests relating to the examination of patients with knee injuries. In particular, they note that the Lachman test remains to be the basis of accurate and measurable knee injury evaluation (Torg et al., 1976). It is through this indication that the authors purposely justify the use of the Lachman test for their study. Once again, like the other study, the methods section is at the forefront of the article. This segment discusses some of the ways in which they will conduct their study, as well as information regarding the clinicians and patients to be involved in it. In this section, it is revealed that twenty-two certified athletic trainers performed evaluation of ACL integrity using the Lachman test for 12 patients; 5 male and 7 female (Hurley, Boros & Challis 2003, p.96). The model for the study, as well as the protocol and a statistical analysis then proceed to follow. The results subsequently conclude that clinician grip configuration was classified into two predominant categories according to clinician thumb placement of their tibia hand in reference to the patients knee; thumb on knee joint space (category A); thumb on or distal to tibia (category B). These categories represent the principal grip configuration used for at least 80% of the Lachman trials (Hurley, Boros & Challis 2003, p.97). Unlike the previously discussed article, this one contains colored images that illustrate exactly how the typical grip configurations below the knee joint are carried out. While the use of extensive statistical data is featured comparatively less than the previous article, it is through pictures such as these that allows the reader to grasp the Lachman technique in a much more fundamental and insightful way. Criticism It is particularly important to note that each study followed the correct procedure for such a clinical examination. The use of the Lachman test played an imperative role in establishing the main function in aspiring for the desired outcome, or in the case of these studies, the intended results as described earlier on in the discussion. In terms of the critical aspects of each study, it is probably best to examine them from a methodological perspective. The statistical information obtained from each study is perhaps the best way to criticize each study. Initially, Hurley and McGuire (2003) concentrated on very specific aspects within their methods as well as their selection of subjects for the study. They noted that patients were asymptomatic by self-report with no physical complaints for a minimum of 3 months, regardless of their history with respect to knee injury (Hurley & McGuire 2003, p.35). This particular method ensured that an even balance of results was able to be acquired, and that clinicians could conduct the desired tests without physical meandering among patients. Through these methods, they were able to find that shank-length measurements were within the 50th percentile for both male and female subjects; body mass ranged from the 50th to the 95th percentile, and height was comparable with the 50th percentile for male subjects and the 90th percentile for female subjects (Pheasant, 1990). The methods used here by Hurley and McGuire (2003) would prove to be sound comparatively while being associated with their results and findings. Perhaps the only major weakness in their methodology would be the diversity of patients in which they used. If a number of patients with varied lifestyles and habits were to be examined, it would not only provide a much broader study, but also prove to be useful when considering future research with regards to the employment of the Lachman test. On the other hand, regarding their procedures, neither the tibia nor the femur of the model patient’s limb was in a fixed position during the physical examination, allowing clinicians to perform natural rather than constrained movement patterns as they performed the Lachman test (Hurley & McGuire 2003, p.38). It is through this point that while a broader study was in fact possible, the procedures in which they used were certainly precise and feasible within the functions of the test. Within the methodological elements of the study, it was apparent that the actual grip played an important role in the use of the Lachman test throughout. In accordance with previous studies on human grip configurations (Cesari & Newell, 1999), a grasp was defined as fixing the patient’s knee relative to the hand and relocating the patient’s knee from its initial place of presentation to the final location in the act of realizing the goal of the task. Clinician grip configuration was categorized according to the clinician’s thumb placement of the tibia hand with reference to the model patient’s tibia (Hurley & McGuire 2003, p.38). Overall, the article highlights the use of the Lachman test which was used well within the correct procedures, and within the guidelines from previously conducted studies relating to similar endeavors. The article that contained the study conducted by Hurley, Boros and Challis (2003) was much shorter in length, yet used a slightly different approach in realizing its final results. Emphasis was placed on the implications involved during the testing procedures. It was noted that the study suggests that the point of force application during the Lachman test influences ACL strain and tibia translation (Hurley, Boros & Challis 2003, p.97). While variably shorter in duration, this particular study focused on the attempt to produce results that were substantially more detailed and exact as compared to the previous article. As stated before, the use of colour pictures as diagrams is used in order to paint a vivid picture of how the Lachman procedure functions. The typical grip configurations were shown, as well as the distances in centimeters that were used to carry the test out. This idea is of particular notice because it shows the person viewing the article exactly how it works, as opposed to someone having to guess, or even assume, as the previous study indicated. This type of detail also assists in improving the quality of the article as a whole. Implications and Discussion The ACL is the primary restraint of anterior tibia translation relative to the femur (Girgis, Marshall & Monajem 1975, p.220). Following rupture of the ACL, most patients have detectable excess laxity of the knee and may suffer instability. In ACL rupture, increased anterior translation of the tibia relative to the femur is an important diagnostic clinical finding (Jonsson, Althoff & Peterson 1982, p.100). Anterior tibia translation in normal knees has been shown to vary widely between patients but to show very little difference between the right and left knee of each individual patient; in 95%of normal subjects, the difference is less than 2 mm (Jonsson, Althoff & Peterson 1982, p.101). Consequently, it is logical to use the patient’s contra-lateral normal knee as a control to assess the relative difference in laxity between normal and ACL-deficient knees. This signifies the overall implication of the Lachman test as a physiological tool. Performing the Lachman test is subjective and individual, varying between examiners (Lee, Yao & Phelps 1988, p.862). Furthermore, the moving hand, which pulls the tibia forward, is placed on the leg from the medial side. This would, if it produced axial rotation, have a tendency to cause tibia external rotation (Lee, Yao & Phelps 1988, p.862). The opposite was seen in the results of the previously discussed articles, and so if anything it makes all the more notable the study findings that the lateral compartment of the knee is more mobile than the medial compartment and that the impact of ACL deficiency is likely to be coupled with anterior tibia translation and tibia internal rotation. Instrumental features also play an important part in the ability to carry out the Lachman test. Performing the test in an MRI machine requires room for the examiner, and, hence, an open magnet configuration is needed. However, the more objective radio logic Lachman tests can be done in a conventional closed magnet (personal observation) and would be a useful adjunct to diagnostic MRI of the knee where rupture of the ACL is in doubt (Logan & Williams 2004, p.373). Conclusion In conclusion, both articles appear to have demonstrated the ways in which the Lachman test is able to function both within a clinical environment, as well as with regards to the certain procedures that must be followed if the test it to be undertaken successfully. This discussion has highlighted various areas within these articles and taken them apart to examine the strengths and weaknesses of them, while providing information about their intended results, as well as the results in which they actually achieved. Generally, it would be considered that the practical implications arising from the use of the Lachman test through a physiological perspective are acceptable and accurate. This discussion has shown that if conducted in the correct manner, the Lachman test is useful and constructive in its own approach. Moreover, each study has shown that the Lachman test is not only practical, but that it is also a productive method while utilizing it as a physiotherapy tool. The discussion has also revealed that the methodological aspects of the Lachman test are imperative in realizing exactly how a successful study may be undertaken. Through this aspect, it is believed that the Lachman test is a dynamically useful method that physiotherapists, as well as those undertaking training in the field, can use for many years to come. References Cesari P, Newell KM. The Scaling of Human Grip Configurations. J Exp. Psychol. Hum Percept Perform. 1999; 25: 927–935. Challis, J.H., (1999). Precision of the estimation of human limb inertial parameter .J. Appl. Biomech.15, 418-428. Garrett JW. (1971) the adult human hand: some anthropometric and biomechanical considerations. Hum Factors; 13:117–131. Girgis F, Marshall J, Monajem A (1975) The Cruciate Ligaments of the Knee Joint. ClinOrthop 106: 216 –231. Hooper GJ (1986): Radiological Assessment of Anterior Cruciate Ligament Deficiency. J Bone Joint Surg Br 68-B: 292 –296. Hurley, W.L., McGuire, D.T., (2003). Influence of Clinical Technique on Performance and Interpretation of the Lachman Test. J. Athl. Train. 38, 34-43. Hurley W, Boros R, Challis J. (2004) Influences of variation in force application on tibial displacement and strain in the anterior cruciate ligament during the Lachman test. Clinical Biomechanics 19, 95-98. Jonsson T, Althoff B, Peterson L, et al (1982): Clinical diagnosis of ruptures of the anterior cruciate ligament: A comparative study of the Lachman test and the anterior drawer sign. Am J Sports Med 10:100 –102. Lee JK, Yao L,Phelps CT, et al (1988): Anterior Cruciate Ligament Tears: MR imaging Compared with Arthroscopy and Clinical Tests. Radiology 166: 861–864. Logan M, Williams A, (2004) What Really Happens During the Lachman Test? The American Journal of Sports Medicine, Vol. 32, No. 2. MED metric Corporation (1994) KT1000 Knee Ligament Arthrometer User’s Guide. San Diego, CA: MED metric Corp. Pheasant ST (1990). Bodyspace: Anthropometry, Ergonomics and the Design of Work. 2nd ed. Bristol, PA: Taylor & Francis Inc. Torg, J.S., Conrad, W., Kalen, V., (1976).Clinical Diagnosis of Anterior Cruciate Ligament Instability in the Athlete. Am .J. Sports Med. 4, 84-93. 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