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Lampart et al: Evaluation of the accuracy and intra‐ and interobserver reliability of three manual laxity tests for canine cranial cruciate ligament rupture—An ex vivo kinetic and kinematic study
Veterinary Surgery 5, 2023

🔍 Key Findings

  • Cranial drawer (CD), tibial compression (TCT), and tibial pivot compression test (TPCT) showed 100% sensitivity and specificity in differentiating intact from CCL-deficient stifles in this ex vivo model.
  • TPCT elicited the highest cranial tibial translation (CTT) and internal tibial rotation, though differences in rotation did not reach statistical significance.
  • Inter- and intraobserver agreement for CTT was excellent across all tests (ICC >0.9).
  • Rotation and force application had greater variability, particularly with less experienced observers and during CD.
  • Forces applied during CD were significantly higher in intact limbs and correlated with observer experience.
  • Subjective CTT estimates strongly correlated with objective kinematic measurements (r = 0.895), with a median absolute error of 1.31 mm.
  • TPCT may be particularly useful for assessing rotational instability, mimicking the pivot-shift test used in human ACL exams.
  • Study supports development of a grading system for manual laxity testing, especially in acute CCLR cases.

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← Articles

Lampart et al: Evaluation of the accuracy and intra‐ and interobserver reliability of three manual laxity tests for canine cranial cruciate ligament rupture—An ex vivo kinetic and kinematic study
Veterinary Surgery 5, 2023

🔍 Key Findings

  • Cranial drawer (CD), tibial compression (TCT), and tibial pivot compression test (TPCT) showed 100% sensitivity and specificity in differentiating intact from CCL-deficient stifles in this ex vivo model.
  • TPCT elicited the highest cranial tibial translation (CTT) and internal tibial rotation, though differences in rotation did not reach statistical significance.
  • Inter- and intraobserver agreement for CTT was excellent across all tests (ICC >0.9).
  • Rotation and force application had greater variability, particularly with less experienced observers and during CD.
  • Forces applied during CD were significantly higher in intact limbs and correlated with observer experience.
  • Subjective CTT estimates strongly correlated with objective kinematic measurements (r = 0.895), with a median absolute error of 1.31 mm.
  • TPCT may be particularly useful for assessing rotational instability, mimicking the pivot-shift test used in human ACL exams.
  • Study supports development of a grading system for manual laxity testing, especially in acute CCLR cases.

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Multiple Choice Questions on this study

In Lampart 2023 et al., on manual laxity testing, what clinical utility does the TPCT potentially provide compared to other tests?

A. It assesses tarsal instability
B. It is easier for novices
C. It measures caudal tibial thrust
D. It reveals rotational instability
E. It avoids the need for imaging

Answer: It reveals rotational instability

Explanation: TPCT includes a rotational and valgus stress component, allowing assessment of rotational laxity.
In Lampart 2023 et al., on manual laxity testing, which test showed the greatest interobserver variability in compressive force applied?

A. Tibial pivot compression test
B. Tibial compression test
C. Cranial drawer test
D. Posterior drawer test
E. Lachman test

Answer: Cranial drawer test

Explanation: CD showed poor interobserver agreement for force application (ICC = 0.44), likely due to examiner experience and hand positioning.
In Lampart 2023 et al., on manual laxity testing, which test elicited the highest cranial tibial translation (CTT) in CCL-deficient stifles?

A. Cranial drawer test
B. Tibial compression test
C. Tibial pivot compression test
D. Modified cranial drawer test
E. Posterior drawer test

Answer: Tibial pivot compression test

Explanation: TPCT produced the greatest tibial translation, likely due to added rotational and valgus stress.
In Lampart 2023 et al., on manual laxity testing, how did subjective estimates of cranial tibial translation (CTT) compare with objective values?

A. No correlation
B. Weak correlation
C. Moderate correlation
D. Strong correlation
E. Overestimated by 5mm

Answer: Strong correlation

Explanation: Subjective estimates showed strong correlation (r = 0.895) with objective kinematic data.
In Lampart 2023 et al., on manual laxity testing, what was the interobserver agreement for cranial tibial translation (CTT) across all manual laxity tests?

A. Poor
B. Moderate
C. Good
D. Excellent
E. Variable

Answer: Excellent

Explanation: CTT had an ICC > 0.9 across all tests, indicating excellent interobserver reliability.

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