Assignment 2: Article Critique

Essentially the paper "Knee stability assessment on anterior cruciate ligament injury: Clinical and biomedical approaches" discusses the prominence of ACL injuries in sports and the severity of such an injury to a players ability to return to their profession. The idea is that ACL injuries are very difficult to diagnose in severity and the course of action for treating such an injury is not always clear. So therefore, based upon the different diagnosing techniques discussed in the paper either operative or non-operative treatments followed by a rehabilitation program are advised to the injured patients before they can safely return to sports. This paper identifies that knee stability assessments contribute three main roles in the management model for ACL injury. First the clinical assessment provides a quick and reliable way for the diagnosis of ACL injury. Second the intra-operative assessment evaluates immediate effect of operative treatment and compares different reconstruction techniques. Finally the functional assessment acts as long term guidelines during or after rehabilitation program. Within each of these three different stages of assessment there are techniques and procedures that are performed to properly treat the ACL injury.

1. Clinical Assessment (Diagnosis of ACL injury)
(i) Lachman Test - is performed by the patient lays down supine and the knee is flexed 30 degrees. The examiner stabilizes the femur and applies an anterior force on tibia without restraining axial rotation. A positive result for a torn ACL is proprioceptive or visible anterior translation of the tibia
(ii) Pivot Shift Test - is a difficult test to perform and must be done by an experienced examiner. Knee is fully extended and then flexed to 40 degrees. A positive test is defined as the forward subluxation of tibia during sudden change in direction.
(iii) KT-1000 - this is an instrument that has been developed where the patient lies in a supine position and the knee is flexed about 20-30 degrees and the arthrometer is strapped to the tibia where it is pulled back and through the calculation of pounds of force and anterior displacement an accurate assessment of the injury can be compiled.

2. Intra-Operative Assessment (Operation treatment evaluation)
Essentially this type of assessment involves the utilization of computers, cameras and computer programs. Different navigation systems drastically improve the accuracy of surgical procedures and provides information to the surgeons. Fluoroscopic navigation and image-free navigation are both used here and with both the kinematics data in sagittal, coronal and transverse plane can accurately be measured.

3. Functional Assessment (Long term evaluation after rehabilitation)
(i) Passive and active motion - with passive motion an examiner applies force to the knee in an examination room and assessing the amount of laxity in one knee to the other. This however is not considered as an efficient method as that of active motion. During active motion the patient is required to undergo physical movements and analysis of the performance and the viewing the dynamic movement of the patients knee an accurate assessment of the recovery of the patient can be made.
(ii) Optical motion analysis with reflective skin marker - in this procedure three high-speed cameras are set up with fifteen markers stuck on to the lower extremities. Here the patient is asked to do a series of movements that require the utilization of the ACL for proper movement. After the films are reviewed and analysed and an assessment on patient recovery can be made.
(iii) Dynamic Movement - the patient is requested to undergo a series of rigorous motions that would put stress on the ACL if a comfortable completion of these movements is attained then the patient is subsequently cleared to return to sporting activities.

Conclusion
In essence the paper itself investigates each method for ACL injury assessment protocols thoroughly and shows how each has its negatives and positives. The idea that many different techniques are available for the diagnosis of such a prolific injury is understandable due to many athletes who depend on the proper diagnosis and treatment due to this area of medicine having such a profound affect on their careers. The article gives testament to the technology and the advances in sports medicine. Essentially if an individual is interested in investigating diagnosis of ACL injuries at different stages of the injury this paper would be sufficient.

References
Mak-Ham, L., Fong, D., (2009), Knee stability assessment on anterior cruciate ligament injury: Clinical and biomechanical approaches, Sports Med Arthrosc Rehabil Ther Technol. doi: 10.1186/1758-2555-1-20