{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T23:13:07Z","timestamp":1778886787904,"version":"3.51.4"},"reference-count":12,"publisher":"Georg Thieme Verlag KG","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Knee Surg"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Modern clinical practice has become increasingly reliant on imaging modalities to diagnose the extent of soft tissue injuries. We describe and then validate a novel bedside clinical test, the acute lower limb activation mechanism test (ALAM), that can be used to identify an extensor mechanism rupture in those unable to straight leg raise (SLR). Patients who presented with an acute knee injury and were unable to SLR were identified over a 6-year period. Patients meeting the inclusion criteria were examined utilizing the ALAM test and diagnosis subsequently confirmed with ultrasound, magnetic resonance imaging (MRI) or surgery. During the validation study, four surgeons independently examined 10 patients with unilateral soft tissue knee injuries. Surgeons were blinded to the type of injuries present and examined both the normal and pathological knee. Patient randomization followed and the examination was repeated 2-hour later to yield 40 examined knees each. A total of 113 patients (56 female, mean age 47.3 years) presented with unilateral knee pathology. In this original cohort, the ALAM test had high sensitivity (100%; 95% confidence interval: 94.5\u2013100%) and high specificity (93.8%; 82.8\u201398.7%). The positive predictive value was 95.6%. In the validation study, blinded prestudy MRI diagnoses showed: acute quadriceps rupture (n\u2009=\u20094), acute anterior cruciate ligament tear (n\u2009=\u20093), acute patellar dislocation (n\u2009=\u20091), and medial patellofemoral ligament injuries following recurrent dislocations (n\u2009=\u20092). The ALAM test had 100% sensitivity (95% confidence interval: 63.1\u2013100%), 97.0% specificity (83.8\u201399%), 100% negative predictive value, and 88.9% positive predictive value (53.8\u201398.2%). The significance of bedside examinations in conjunction with a detailed history cannot be overemphasized. This study adds to the literature by proposing a validated, noninvasive, highly sensitive and specific bedside test. We advocate the ALAM test be used as part of the orthopaedic surgeons' diagnostic armamentarium, in all patients unable to SLR to reliably detect soft tissue extensor mechanism ruptures.<\/jats:p>","DOI":"10.1055\/a-2851-0923","type":"journal-article","created":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T23:06:22Z","timestamp":1776121582000},"source":"Crossref","is-referenced-by-count":0,"title":["Validation of the Acute Lower Limb Activation Mechanism Test: A Reliable Bedside Diagnostic Tool for Extensor Mechanism Ruptures"],"prefix":"10.1055","author":[{"given":"William","family":"Nabulyato","sequence":"additional","affiliation":[{"name":"East Suffolk and North Essex NHS Foundation Trust, Colchester Hospital, Colchester, United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vivek","family":"Sharma","sequence":"additional","affiliation":[{"name":"East Suffolk and North Essex NHS Foundation Trust, Colchester Hospital, Colchester, United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Barbara","family":"Pierscionek","sequence":"additional","affiliation":[{"name":"Anglia Ruskin University, Cambridge, United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Timothy","family":"Parratt","sequence":"additional","affiliation":[{"name":"East Suffolk and North Essex NHS Foundation Trust, Colchester Hospital, Colchester, United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mahbub","family":"Alam","sequence":"additional","affiliation":[{"name":"East Suffolk and North Essex NHS Foundation Trust, Colchester Hospital, Colchester, United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2026,5,15]]},"reference":[{"issue":"12","key":"ref1","doi-asserted-by":"crossref","first-page":"1338","DOI":"10.1016\/j.injury.2008.06.021","article-title":"The epidemiology of musculoskeletal tendinous and ligamentous injuries","volume":"39","author":"R AE Clayton","year":"2008","journal-title":"Injury"},{"key":"ref2","doi-asserted-by":"crossref","first-page":"S67","DOI":"10.1016\/j.otsr.2012.12.002","article-title":"Acute and old ruptures of the extensor apparatus of the knee in adults (excluding knee replacement)","volume":"99","author":"D Saragaglia","year":"2013","journal-title":"Orthop Traumatol Surg Res"},{"issue":"02","key":"ref3","doi-asserted-by":"crossref","first-page":"140","DOI":"10.1136\/bjsm.2010.076695","article-title":"Get a kick out of this: the spectrum of knee extensor mechanism injuries","volume":"45","author":"B Tuong","year":"2011","journal-title":"Br J Sports Med"},{"issue":"03","key":"ref4","doi-asserted-by":"crossref","first-page":"736","DOI":"10.1148\/radiol.2253011578","article-title":"Acute lateral patellar dislocation at MR imaging: injury patterns of medial patellar soft-tissue restraints and osteochondral injuries of the inferomedial patella","volume":"225","author":"D A Elias","year":"2002","journal-title":"Radiology"},{"issue":"01","key":"ref5","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1007\/s00167-006-0133-7","article-title":"Bilateral, simultaneous rupture of the quadriceps tendon: a diagnostic pitfall? Report of three cases and meta-analysis of the literature","volume":"15","author":"T Neubauer","year":"2007","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"issue":"07","key":"ref6","doi-asserted-by":"crossref","first-page":"633","DOI":"10.1007\/s00167-008-0516-z","article-title":"Intra-articular knee injuries in patients with knee extensor mechanism ruptures","volume":"16","author":"B McKinney","year":"2008","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"issue":"02","key":"ref7","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1177\/1457496915598761","article-title":"Etiology, diagnosis and treatment of tendinous knee extensor mechanism injuries","volume":"105","author":"T Ibounig","year":"2016","journal-title":"Scand J Surg"},{"issue":"10","key":"ref8","doi-asserted-by":"crossref","first-page":"2065","DOI":"10.1016\/j.injury.2016.06.032","article-title":"Adult native knee extensor mechanism ruptures","volume":"47","author":"I P Pengas","year":"2016","journal-title":"Injury"},{"issue":"02","key":"ref9","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1016\/0736-4679(94)90703-X","article-title":"Radiographic diagnosis of quadriceps tendon rupture: analysis of diagnostic failure","volume":"12","author":"K Kaneko","year":"1994","journal-title":"J Emerg Med"},{"issue":"04","key":"ref10","doi-asserted-by":"crossref","first-page":"592","DOI":"10.1053\/apmr.2003.50026","article-title":"Physical examination of the knee: a review of the original test description and scientific validity of common orthopedic tests","volume":"84","author":"G A Malanga","year":"2003","journal-title":"Arch Phys Med Rehabil"},{"issue":"03","key":"ref11","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1007\/s10195-013-0238-y","article-title":"The loss of extension test (LOE test): a new clinical sign for the anterior cruciate ligament insufficient knee","volume":"14","author":"M Salvi","year":"2013","journal-title":"J Orthop Traumatol"},{"issue":"03","key":"ref12","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1308\/003588407X179044","article-title":"A new clinical test in diagnosing quadriceps tendon rupture","volume":"89","author":"B M Jolles","year":"2007","journal-title":"Ann R Coll Surg Engl"}],"container-title":["The Journal of Knee Surgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2851-0923.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T22:37:25Z","timestamp":1778884645000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2851-0923"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,13]]},"references-count":12,"URL":"https:\/\/doi.org\/10.1055\/a-2851-0923","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["1538-8506","1938-2480"],"issn-type":[{"value":"1538-8506","type":"print"},{"value":"1938-2480","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,4,13]]},"published":{"date-parts":[[2026,4,13]]}}}