Biomed Tech 2012; 57 (Suppl. 1) © 2012 by Walter de Gruyter · Berlin · Boston. DOI 10.

1515/bmt-2012-4299

Instrumented Arthrometry of the anterior cruciate ligament

A comparison
A. Krautter1, L. Rohnstock1, K. Moeller1, Z. Zhao1, G. Felmet2
1
Hochschule Furtwwangen University, Villingen-Schwenningen, Germany, anja.krautter@hs-furtwangen.de
2
Artico Sportklinik, Villingen-Schwenningen, Germany

Abstract
Objective The analogue Rolimeter is a widely used manually operated arthrometer. The Articometer is a
modification of the Rolimeter with digitized gauge. The aim of this study was to examine the effect of digitization by
comparing the precision, the handling and the reliability of these two arthrometers.
Methods 50 subjects were divided into three different groups: (1) with treated anterior cruciate ligament (ACL)
ruptures, (2) with acute ACL ruptures, (3) with healthy knees. The subjects were observed by one examiner with
maximum manual force. To evaluate the measurements, the respective maximum was assessed and the side-to-side
difference was calculated.
Results On average, measurements within maximum manual force with the Articometer indicated a larger anterior
translation of the tibia, than measurements with the Rolimeter. A significant difference between the side-to-side
difference of ACL was revealed in group 1 with treated ACL ruptures. A higher precision of measurements with the
Articometer was found.
Conclusion The Articometer provides a quick and easy method of arthrometry of ACL. The digitized gauge
simplifies and accelerates the measurement process and increases precision.

1 Introduction effect of digitization by comparing precision, handling

In the therapeutic and post-operative treatment of
arterior cruciate ligament (ACL) ruptures, instrumented
arthrometry has been established. The devices are used to
verify the functionality and stability of the anterior
cruciate ligament, by measuring of the anterior tibia
translation. Reliability, validity and objectivity of
arthrometers are prerequisites for the quality of results.
Furthermore simplicity and rapidness of the measurement
procedure and the price of the equipment are decisive
factors for success.
Among different arthrometers, the manually operated
Rolimeter (Aircast, Germany) represents an arthrometer
which meets most of the prerequisites [2,6,9]. It is simple,
rapid, compact, able to be sterilized and easily
transported. The Rolimeter was compared with
widespread automatic devices in previous studies [2,6,9],
such as the KT 1000. It was reported, that the affordable,
simple and easily sterilizable arthrometer performed
comparable reliable and precise measurements just as the
KT-1000.
However, precision and reliability of the measurement
of the Rolimeter are questioned due to the analogue gauge
of the device. The Articometer (Artico Sportklinik,
Germany) is a modification of the Rolimeter with
digitized gauge. The aim of this study was to examine the
and reliability of these two manually operated
arthrometers.
2 Materials and Methods
2.1 Subjects
Totally 50 (36 male, 14 female; mean age 29.4 years,
range from 18 to 55) were recruited and divided into three
groups. Group 1 comprises of subjects with treated ACL
ruptures (n = 24). The patients were treated in the
ARTICO SPORTKLINIK with the foreign material free
All-press-fit-Method [4,5].
Group 2 was formed by 9 patients with acute ACL
ruptures (including possible additional injuries), who have
not been treated yet.
Seventeen subjects with healthy knees were
considered as control group (group 3).
2.2 Protocol
The Rolimeter is a non-invasive, simple and rapid
manual arthrometer for measuring the laxity of cruciate
ligaments. In previous studies, the manual device
Rolimeter was compared to more expensive automatic
devices. The result indicated that applying Rolimeter was

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 Biomed Tech 2012; 57 (Suppl. 1) © 2012 by Walter de Gruyter · Berlin · Boston. DOI 10.1515/bmt-2012-4299
a quicker and more uncomplicated procedure, whereas no
significant differences occurred in reliability and validity
[2,6,9].
The device measures the anterior or posterior tibial
translation. It is compromised by two connected convex
pads, the proximal pad and the distal pad fixed with a
rubber strap, and a calibrated bar with 2 mm marks with a
feeler (stylus foot). During the measurement the device is
positioned on the patient's leg so that the proximal plate is
placed medial on the patella, the stylus at the level of
tibial tuberosity and the tibia pad is fixed with the rubber
strap on the tibia (Figure 1). The feeler can be moved up
and down when the tibia is displaced. A white indicator, a
movable plastic ring pushes vertically on the bar while
tibial translation and remains at the position of tibial
displacement on the bar. Counting the number of mark
lines all being 2 mm apart indicates the amount of tibial
displacement in millimeters. For an easier and more
precise gauge reading, a ruler is hold in position against
the gauge.
Figure 1 Mechanical figure of the Rolimeter (adapted
from [7]) 1. plastic nut for reference 2. knurled nut for
fixation at the tuberositas tibia, 3. gauge (2mm scale), 4.
feeler at the tuberositas tibiae, 5. patella plate, 6. middle of
the patella, 7. middle of the tuberositas tibiae
To conclude the measurement of tibial displacement a
modified Lachmann test was performed [10]. The patient
was first asked to relax. Then the tibia was pulled anterior
with maximal manual force by the examiner. With the
“Lower-leg-hand” (for right leg, right hand and
conversely) the tibia was pulled ventral, while the
“Upper-leg-hand” fixed the proximal plate on the medial
patella. The procedure was repeated three times, with the
maximal value being noted.
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The Articometer is a digitized modification of the
Rolimeter. The analogue gauge is replaced by a digital
display with an accuracy of two decimal places (Figure
2). Construction and function remained the same.
Nevertheless, the handling of the device changed to
facilitate measurements and improve precision. During
the measurement, the tibia was pulled forward with both
hands and the proximal plate was fixed with both thumbs.
Figure 2 Articometer positioned on the patient’s thigh in
about 25° knee flexion with digital gauge.
Three measurements of anterior tibial translation were
performed with both devices on both knees of the patient
by an experienced doctor. All measurements were
obtained under identical conditions. The patients position
is lying and supine, while the examined leg is positioned
in 20° to 30° flexion.
2.3 Data analysis
Measurements of the anterior tibial translation on one
healthy leg of all subjects (n = 50) using Rolimeter and
Articometer were compared.
Further, maximal tibial translations of each knee of
the patient in each group, measured with Rolimeter and
Articometer, were compared.
The side-to-side difference (the difference of anterior
tibial translation between two knees of a subject) was
calculated and again in each group compared.
In group 1 the side-to-side difference was calculated
by translation of the knee with treated ACL rupture minus
translation of the healthy knee. The side-to-side difference
of group 2 was computed by translation of the knee with
acute ACL rupture minus translation of the healthy knee.
In group 3, with two healthy knees, the difference was
calculated by translation of the right knee minus
translation of the left knee.
 Biomed Tech 2012; 57 (Suppl. 1) © 2012 by Walter de Gruyter · Berlin · Boston. DOI 10.1515/bmt-2012-4299

Normal distribution of all measurements and each test

group was verified. Means and standard deviations (SD)
were calculated.
Measurements of Rolimeter and Articometer were
compared by using paired t test. P < 0.05 was regarded as
significant. Information about age and sex were not taken
into account in the analysis of the measurements.

3 Results

No significant difference was found between the

measurements with Articometer and with Rolimeter when
observing all 50 healthy knees.
For more exact observations of measurements, the
means and standard deviations of the measured anterior
tibial translation were compared. Therefore, the
measurements with the Articometer and the Rolimeter of
the healthy and the injured knee of the subjects of group 1
and 2, in group 3 measurements of the right and the left
knee, were compared.
Measurements of the tibial translation of the injured
leg of group 1 (treated ACL rupture) showed a high
significant difference (P < 0.01) when comparing the
Articometer and the Rolimeter.
In group 2 no significant difference was recognizable
by comparing injured, as well as healthy knees.
Similarly, no significant differences between two
devices was found in group 3 (reference group) with the
right knee or with the left knee
Side-to-side differences (Table 1) confirm the actual
statement about stability and functionality of cruciate
ligaments.
Table 1 comparison of side-to-side differences in average
[mm]
Articometer Rolimeter P
Group 1 0.59 ± 1.59 -0.19 ± 1.24 < 0.01
Group 2 3.64 ± 2.19 3.39 ± 2.17 > 0.5
Group 3 0.28 ± 0.97 0.28 ± 0.63 > 0.4
When comparing the three test groups (Figure 3), only
group 1 showed a highly significant difference (P < 0.01).
Group 2 and 3 were unobtrusive. The difference
between the two devices of the side-to-side differences in
group 2 was only 0.25 ± 0.02 mm. In group 3 the value
was almost identical.
Figure 3 comparison of the side-to-side differences of the
three different examination groups (left, red =
Articometer, right, blue = Rolimeter). *, P<0.01,
significant difference of measurements between
Articometer and Rolimeter.
4 Discussion
In the present study, we compared two manually
operated arthrometer, Articometer and Rolimeter.
Examination of healthy knees presented no significant
difference. However, a significant difference was found in
group 1, which showed a higher precision of Articometer
in examinations of knees with treated ACL ruptures.
The Rolimeter was compared with widespread
automatic devices in previous studies [2,6,9], such as the
KT 1000. It was reported, that the affordable, simple and
easily sterilizable arthrometer performed comparable
reliable and provided precise measurements just as the
KT-1000. Schuster et al reported, that the Rolimeter
measured a 1mm lower translation within maximal
manual power compared to the KT-1000, but obtained a
higher accuracy [9].
Therefore, the Rolimeter is considered to be an
important device in the therapeutic and orthopedic
everyday work.
However, handling the analogue gauge is problematic,
e.g. difficult and faulty reading of the 2 mm scaled bar.
Although the accuracy of reading can be improved with
help of the ruler, the precision of repeated measurements
is low. Also the overcoming of the contraction of the
hamstring muscles presents a difficulty. The result of the
actual maximal tibial translation can be affected.
The digitization of the gauge may overcome the
problems by a faster and more precise (two decimal
places) reading.
In comparison of the side-to-side differences
measured by the both arthrometers in all 3 test groups,

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 Biomed Tech 2012; 57 (Suppl. 1) © 2012 by Walter de Gruyter · Berlin · Boston. DOI 10.1515/bmt-2012-4299
only in group 1 a highly significant difference (P < 0.01)
was found. The measurements of the Articometer showed
up a higher tibial translation, which militates for the
distinctly better overcoming of hamstring muscles. Due to
the fact, that operated patients present an extreme
sensibility for touches at the treated knee, they develop a
distinct protective mechanism by a high muscle
contraction. Hence the overcoming of this muscle
contraction is especially important for validity of
measurements.
Although the Articometer does not promise a secure
overcoming of this contraction. By placing a pillow
underneath the patient’s knee joint, the muscle contraction
can be reduced.
However, a complete relaxation of the hamstring
muscles requires narcotized condition of the patient.
In healthy condition of ACLs (group 3), the tibial
translation was the same on both knees of the subjects as
expected, which indicated comparable good reliability of
both devices. However, the Rolimeter has a precision of
0.1 mm while the Articometer offers precision to two
decimal places (higher precision).
Another important factor is the positioning of both
devices on the limb, as well as flexion of the knee joint. If
the flexion of the leg does not account to about 25 degrees
Lachmann position, in which actual laxity of ACL can be
measured, the results of ACL laxity are faulty high or
faulty low.
In case the devices are positioned too high or too low,
the proximal plate is not positioned medial on the patella
and the stylus is not based on the tibia tuberosity. Thus
not the actual laxity of the ACL is measured, but rather a
different movement of the ACL is obtained.
Thus another influence factor could be an
inexperienced examiner. To assess the objectivity of the
device, examiners with different experience and
knowledge could achieve comparable measurements
within identical, standardized conditions in the further
studies.
5 Conclusion
The digitized Articometer offers easier, faster and
more precise measurements. Especially in postoperative
examinations of ACL reconstructions. Furthermore the
examination procedure itself is faster and more
comfortable for examiner, as well as for patient.
Despite of manually applied force, the Articometer
offers an objective assessment of the functional laxity of
the cruciate ligaments.
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