badanie ultrasonograficzne jest powszechnie stosowane w diagnostyce ortopedycznej , jednake w ocenie przedniej niestabilnoci stawu kolanowego wykorzystuje si je w ograniczonym stopniu . celem pracy jest ocena przydatnoci diagnostycznej nowego testu przeprowadzonego pod kontrol ultrasonografii , ktry pomaga diagnozowa cakowit niewydolno wizada krzyowego przedniego . u 47 pacjentw z podejrzeniem jednostronnego urazu wizada krzyowego przedniego ( zdiagnozowanego na podstawie badania rezonansu magnetycznego ) wykonano test niestabilnoci przedniej kolana pod kontrol ultrasonografii . u 37 pacjentw z artroskopowo potwierdzonym cakowitym uszkodzeniem wizada krzyowego przedniego rednie przesunicie wyniosoci midzykykciowej wynosio 8,3 mm ( sd = 2,8 ) w kolanach po urazie w porwnaniu z 3 mm ( sd = 1,1 ) w kolanach bez urazu ( p < 0,001 ) . w grupie 10 pacjentw bez niewydolnoci wizada krzyowego przedniego rnice w przesuniciu wyniosoci midzykykciowej byy nieistotne ( 2,6 mm , sd = 1,4 w kolanie po urazie , w porwnaniu z 2,5 mm i sd = 1,1 w kolanie bez urazu , p < 0,7753 ) . zaprezentowany test to szybki i nieinwazyjny sposb mogcy uatwi diagnozowanie cakowitej niewydolnoci wizada krzyowego przedniego . in order to avoid damage to the meniscus , secondary degenerative disorders and proprioceptive gonarthrosis , accurate and non - invasive diagnosis of anterior cruciate ligament ( acl ) injury followed by the proper treatment are essential . complete acl rupture results in anterior knee instability , however tests evaluating this parameter depends on the subjective opinion and the experience of the examiner . mechanical devices evaluating translation between the femur and tibia ( ex . arthrometr kt-1000 , stryker knee laxity tester etc . ) might aid the diagnosis but they are not widely used by clinicians . magnetic resonance imaging ( mri ) is the gold standard modality for diagnosing knee pathologies , however ultrasound allows for dynamic clinical tests with visualization in real time . due to its wide availability it should allow for quantitative and objective instability assessment and it should characterise with steep learning curve . such a test might become an ideal first - line imaging technique when acl insufficiency is suspected . the aim of study is to present and assess the usefulness of a new , sonographically - guided examination of acl insufficiency . between the years 20082010 a sonographically - guided , dynamic test assessing anterior knee laxity was performed in 47 patients who : experienced acute knee trauma ; had a suspicion of acl injury ( based on clinical assessment and mr examination ) ; and were planned to undergo arthroscopy . in all patients it was the first - time injury of the knee that required medical attention . the group consisted of 31 men and 16 women with an average age of 32 years ( sd = 1 ) . the ge vivid 7 ultrasound machine , with a 614 mhz linear transducer ( 12 l ) , was used for the study . to prepare the start position for further examination , several push - pull movements of the lower leg were performed in the patient laying in a supine position with bent legs . this manoeuvre insured proper muscle relaxation , which allowed for further , more precise measurements . afterwards , the patient was seated and a elastic roll ( a diameter of about 20 centimeters ) was placed beneath the distal part of the thigh so that the lower leg of the patient hung freely from the edge of the examination couch . in this start - position the examiner sat opposite to the patient with his lower leg close to the patient 's shin . the transducer was placed onto the anterior aspect of the knee parallel to the patellar tendon . after identification of the anatomical landmarks ( intercondylar eminence , tibial tuberosity and patellar tendon ) , the examiner pushed backwards the lower leg of the patient with his foot , flexing the tibia in the knee joint ( a leverage mechanism ) ( fig . 1 ) . the translation of the intercondylar eminence with respect to the patellar tendon ( fig . force was applied till no further displacement of the tibia relative to the femur occurred . arrows indicate the direction of the force applied in moving the shin from a start ( a ) to an end ( b ) position anterior knee translation from the start position ( a , c ) to the end point ( b , d ) . representative ultrasonographs of patients with an intact acl ( a , b ) and the insufficient acl ( c , d ) . wilk test . to compare the difference of knee joint laxity between body sides , statistical analysis was performed using statistica for windows ( version 10.0 , statsoft , tulsa , ok , usa ) . between the years 20082010 a sonographically - guided , dynamic test assessing anterior knee laxity was performed in 47 patients who : experienced acute knee trauma ; had a suspicion of acl injury ( based on clinical assessment and mr examination ) ; and were planned to undergo arthroscopy . in all patients it was the first - time injury of the knee that required medical attention . the group consisted of 31 men and 16 women with an average age of 32 years ( sd = 1 ) . the ge vivid 7 ultrasound machine , with a 614 mhz linear transducer ( 12 l ) , was used for the study . to prepare the start position for further examination , several push - pull movements of the lower leg were performed in the patient laying in a supine position with bent legs . this manoeuvre insured proper muscle relaxation , which allowed for further , more precise measurements . afterwards , the patient was seated and a elastic roll ( a diameter of about 20 centimeters ) was placed beneath the distal part of the thigh so that the lower leg of the patient hung freely from the edge of the examination couch . in this start - position the examiner sat opposite to the patient with his lower leg close to the patient 's shin . the transducer was placed onto the anterior aspect of the knee parallel to the patellar tendon . after identification of the anatomical landmarks ( intercondylar eminence , tibial tuberosity and patellar tendon ) , the examiner pushed backwards the lower leg of the patient with his foot , flexing the tibia in the knee joint ( a leverage mechanism ) ( fig . 1 ) . the translation of the intercondylar eminence with respect to the patellar tendon ( fig . force was applied till no further displacement of the tibia relative to the femur occurred . arrows indicate the direction of the force applied in moving the shin from a start ( a ) to an end ( b ) position anterior knee translation from the start position ( a , c ) to the end point ( b , d ) . representative ultrasonographs of patients with an intact acl ( a , b ) and the insufficient acl ( c , d ) . the normality of data distribution was checked by the shapiro  wilk test . to compare the difference of knee joint laxity between body sides , the wilcoxon signed - rank test was applied . statistical analysis was performed using statistica for windows ( version 10.0 , statsoft , tulsa , ok , usa ) . the mean value of the anterior knee translation was 8.3 mm ( sd = 2.8 ) . in the not affected knees the mean translation was significantly lower ( 3 mm , sd = 1.1 ; p < 0.001 ) ( fig . 3 ) . in 10 patients with no signs of complete acl insufficiency in mri , difference in the anterior knee translation between injured and uninjured knees was not significant ( 2.6 mm , sd = 1.4 vs. 2.5 mm , sd = 1.1 , respectively ; p < 0.7753 ) . a box - and - whiskers diagram displaying the mean difference of the anterior knee translation between body sides in patients with positive and negative arthroscopy confirmation we have presented a sonographically - guided test that may aid the diagnosis of the anterior knee instability in patients with acl injury . all clinical tests , proposed to evaluate anterior knee instability , have some limitations : they are subjective , imprecise , rarely reproducible , and pain in a swollen joint or a muscle spasm can interfere with proper examination . the anterior drawer test has a good specificity ( up to 91% ) , however its sensitivity is lower ( 6871% ) . the presented test is a modification of the anterior drawer test , however due to applied leverage mechanism and evaluation of a quantitative parameter ( anterior translation ) may overreach diagnostic capability of classic method . the specificity and sensitivity of mri in detecting acl injuries is 94.4% ( 95% ci : 92.396.6 ) and 94.3% ( 95% ci : 92.795.9 ) respectively . nevertheless , mri evaluates only the structure of the ligament and a static subluxiation of the tibia plateau against the femur condyles , which do not correlate fully with the mechanical and functional stability of the knee . in addition , mri produces artefacts due to metallic implant placement ; is contraindicated in patients with heart stimulators and metallic foreign bodies in the eyeball ; it is expensive ; and sometimes unavailable as a routine diagnostic tool . on the contrary , ultrasound examination gives the ability to assess the dynamic range of motion in a quantitative manner . those techniques differ in : dorsal or ventral probe placement , force applied due to gravity or external source , and a number of required operators . the presented test has several advantages over those examinations . due to a leverage mechanism we eliminated the influence of the examiners posture and physical strength . moreover , the test depends on the application of constantly increased force rather than on the dynamic pull . hence , the pain symptoms due to examination can be diminished , and the displacement of the us probe during manoeuvre is reduced , enabling more precise diagnosis and improving test repeatability . the limitation of presented test concern its decreased diagnostic ability in acute phase after trauma . however , even the mri sensitivity is reduced in acute phase due to the presence of haematoma and/or oedema in the injured joint . the presented test in a quick and non - invasive manner allow for evaluation of complete acl insufficiency . due to its objectivity it holds the potential to become the first - line imaging technique when acl insufficiency is suspected . however , further research is required to determine the test reliability and a cut - off value of the anterior translation in patients with insufficient acl and also other knee pathologies .
aim of the studyultrasound examination is widely used in orthopedic diagnostics , however sonographic evaluation of traumatic anterior cruciate ligament insufficiency is still inadequate . 
 aim of this study is to evaluate diagnostic capability of a new sonographically - guided test for diagnosing complete anterior cruciate ligament insufficiency.material and methodsin 47 patients , with suspicion of unilateral anterior cruciate ligament injury ( based on magnetic resonance imaging ) , the sonographically - guided test for anterior instability was performed . 
 the translation of the intercondylar eminence against the patellar tendon was measured in both knees . 
 afterwards all patients underwent arthroscopy.resultsin 37 patients , with arthroscopically confirmed complete anterior cruciate ligament insufficiency , the mean anterior knee translation was 8.3 mm ( sd = 2.8 ) in affected knee vs. 3 mm ( sd = 1.1 ) in uninjured knee ( p < 0.001 ) . in 10 patients with no anterior cruciate ligament insufficiency 
 the difference between body sides was not significant ( 2.6 mm , sd = 1.4 in injured knee vs. 2.5 mm , sd = 1.1 in uninjured joint ; p 
 < 0.7753).conclusionsthe proposed test supports the clinician with fast and non - invasive examination that can facilitate evaluation of anterior knee instability .