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Studies ACL: Anterior cruciate ligament
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    ACL TEST - ADAPTED TO X-RAY TECHNOLOGY

    Automated anterior drawer test for ACL analysis adapted to x-ray technology - GNRB Radio

    The anterior cruciate ligament was for Genourob the first knee ligament intended to be studied using the GNRB. This medical device has quickly become the reference in the orthopaedic field for studying the state and performance of the ACL by applying an automated Lachman Test.

    The GNRB Radio uses the exact same technology as the GNRB only the materials used during the manufacturing are specially designed for x-ray technology.

    GNRB Radio video - Anterior cruciate ligament (ACL) assessment coupled to x-ray technology

    GNRB Radio - Automated anterior drawer test for ACL assessment coupled with x-ray technology

    Presently, it is the device that provides the best precision and it is the only arthrometer able to objectively evaluate knee stability because of the dynamic tests it does. User friendliness has also been taken into account while designing this arthrometer leading to several parameters and sensors being installed in order guide the users while running dynamic tests. Because of these parameters and sensors, precise test reproducibility has also become an attribute of the GNRB Radio.

    The LDA® Method is an integral part of the GNRB Radio and it is perhaps what makes the GNRB Radio leader on the market for anterior cruciate ligament (ACL) analysis. The results provided after running tests are shown under the form of a graph with compliance curves (=opposite of the stiffness curves) accompanied by a table chart. This makes the tests easy to understand and to reproduce.

    Example of an anterior cruciate ligament assessment using the GNRB Radio

    Graph 1

    Graph 1

    Graph 1 shows the results obtained after performing tests on both knees of a same patient with the GNRB Radio. The graph shows the compliance curves (=opposite of stiffness curves) obtained after applying several forces on the tibia of the patient (anterior tibial translation).

    This is called a dynamic analysis because calculation of the displacements of the tibia is done while applying different forces which put the anterior cruciate ligament under stress. Therefore, the bigger the displacement differential, the higher the chances of an ACL tear.

    In comparison, other arthrometers (Laximeters)  collect data at a certain force which can be described as a static evaluation. Consequently, it is against this background that Genourob created the GNRB, the first automated tibial translation arthrometer for dynamic assessment of the anterior cruciate ligament that collects data while  applying various forces on the knee.

    Click on the title below to learn more about dynamic assessment of the ACL.

    Why is the GNRB arthrometer more accurate than any other arthrometer?

    The two graphs below show the results obtained on the knees of two different patients having suffered from knee ligament injuries after a GNRB test. The green curves show the test results of the healthy knees whereas the red curves show the results of the pathological knees.

    Graph Results of two patients

    Graph Results of two patients

    As 134 N became the international reference force for assessing the ACL thanks to the KT1000, the GNRB Radio provides the displacement for this given force. However, we can see that the displacements at this point are the same for both patients. This is problematic, as a false ACL diagnosis would be put forward. Yet, it is exactly here that the GNRB shows innovation & precision as an additional diagnosis may be performed through the analysis of the slope of the curves.

    In fact, we can determine that Patient 1 has a stable knee while Patient 2 is unstable. Why?

    Because on the graph of patient 1, the ACL compliance curves (=opposite of stiffness curves) are parallel and on the graph of patient 2 the ACL compliance curves (=opposite of stiffness curves) diverge.

    Consequently, this shows that patient 1 has two stable knees with a slight side-to-side difference in laxity, which remains the same. However, patient 2 clearly shows signs of an increasing side-to-side difference in laxity correlated with the increase of force applied on the knees, hence the diagnosis of an unstable knee.

    This example purely states the efficiency of running dynamics tests against static tests on the knee. Considering the slope differential between both compliance (=opposite of stiffness) curves on behalf of the displacement differential between both knees ultimately leads to a much more accurate analysis of the state of the ACL present in the knee.

    The GNRB is therefore nowadays the most advanced arthrometer (Laximeter) for evaluating the state of the anterior cruciate ligament following knee injuries. Besides, it is also the only device capable of assessing ACL laxity after surgery without any risk thanks to its controlled tibial translation. 

    Doctors are thus able to follow the behaviour of the ACL graft over time, which is the key to guarantee knee stability. Today's surgical techniques indeed require a lot of time of recovering therefore making the GNRB indispensable during anterior cruciate ligament rehabilitation (ACL Rehab).

    If you are curious in knowing how a test is performed, click on the title below to see a video of a GNRB Radio test.

    How to assess the anterior cruciate ligament (ACL) with the GNRB Radio

    GNRB Radio - Patient Positioning Tutorial

    To run a precise diagnosis on the ACL of a patient using Genourob's GNRB Radio, it is required to follow these steps:

    1) Position the patient on the GNRB Radio.

    2) Run the tests on both legs.

    3) Read the results on the graph and its table chart.

    1) Position the patient on the GNRB Radio

    Patient positioning is the first step to run tests of the ACL of the patient. First, two separate marks shall be placed with a pencil on the apex of the patella and the anterior tibial tuberosity. The leg of the patient shall then be placed on the GNRB with the mark of the apex of the patella being located in the hole of the knee cup. The objective here is to block the patella against the femur so that when tests are run, the femur/patella stay locked in position while the tibia undergoes anterior translation. Following this, the foot is to be locked to avoid any vertical movements and a displacement sensor in placed on the anterior tibial tuberosity.

    2) Run the tests

    Once patient positioning is achieved, a patient file is to be created on the computer that is provided with the GNRB Radio and the tests shall begin. As soon as a push force is chosen (134, 150, 200 N...), the user can choose to run the tests:

    The cup located under the calf starts applying the force on the tibia leading to an anterior translation. When the chosen force is detected, the cup under the calf stops and goes back to its initial position. This ultimately makes the displacement sensor move upwards/downwards calculating the displacement of the tibia against the force applied. In addition, X-ray pictures of the knee can be taken at different forces. This can be done because the LDA Software of the GNRB Radio is programmed to maintain the tibial displacements at when certain forces are detected. This therefore allows the user to take x-ray pictures. The data collected is then stored in a table chart with a graph.

    Repeat this on the other knee.

    3) Results:


    When the tests are done, the user will find in the results tab the data collected from these tests. They are under the form of a graph showing the compliance curves (=opposite of the stiffness curves) accompanied by a table chart showing the numerical values.

    GNRB main characteristics for optimal ACL assessment

    • Device using LDA® Method applying anterior tibial translation (Lachman's Test) for ACL and knee stability objective evaluation
    • Adapted to x-ray technology
    • Dynamic and none-invasive tests
    • Automatic tibial displacement differential and compliance durves slope differential calculation
    • Registration of the patellar fixation force and patient foot / Base of the machine distance for reproducibility
    • Delivery with PC and LDA® Software
    • Thrust force from 1 to 200 N
    • Patient data automatically saved, results exportable as xls. files, pdf. format for great communication
    • Dimensions : 845 x 270 x 400mm / 15kg

    GNRB Radio additionnal options

    • Over time, Genourob created several options that could be added to the GNRB. Initially, this arthrometer was created for ACL objective assessment by applying anterior tibial translation.
    • The last option is the Rotab Option and was created to analyze the ACL with more precision by taking into account the calculation of the medial rotation that occurs when applying anterior tibial translation.
    • Finally, other remaining accessories available are the LDA®Couch which provides the patient with great comfort and is specially designed for our products, the biofeedback option that allows controlling of the hamstring muscular activity, the LDA®Trolley for storage of the GNRB and the printer for printing the results.