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Table of Contents
Summary of Contents for Sport Tech LigMaster
- Page 1 LigMaster by Sport Tech, Inc. User’s Manual March 4, 2003...
- Page 2 Any claim or dispute between you and Sport Tech or against any agent, employee, successor or assign of Sport Tech related to this Agreement or the Software shall be resolved by binding arbitration in Charlottesville, VA, by and under the rules of the American Arbitration Association. Any award of the arbitrator(s) may be entered as a judgment in any court of competent jurisdiction.
- Page 3 If Sport Tech receives notice of such defects during the warranty period, Sport Tech will, at its option, either repair or replace products that prove to be defective.
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Page 4: Table Of Contents
4.10.1 Setting up the stress device ....................39 4.10.2 Positioning the patient ......................40 4.10.3 Entering positioning information in the L ™ software..........41 ASTER 4.10.4 Acquiring Joint Force/response data..................42 LigMaster™ User’s Manual - Sport Tech Inc. Page 4... - Page 5 What kind of computer should I get? ..................84 11.2 How do I integrate the L ™ PC into the office network?..........84 ASTER 11.3 How Does L ™ Work? ....................84 ASTER LigMaster™ User’s Manual - Sport Tech Inc. Page 5...
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Page 6: Introduction
To perform an examination, the technician positions the joint under investigation in the stress device and turns a knob to apply a gentle measured force. The sensors measure force-induced changes in the joint’s position and the software compares the result with LigMaster™ User’s Manual - Sport Tech Inc. Page 6... -
Page 7: Lig Master ™ Advanced Diagnostics
1.4 About Sport Tech Since 1995, Sport Tech, Inc. has worked to develop novel products in the field of sports medicine through the diagnosis, treatment, monitoring and rehabilitation of sports injuries. The company is blending sports medicine and the nation’s interest in physical fitness with engineering and computer disciplines to become a unique and integrated biotechnology company. -
Page 8: Getting Started
™ requires as ASTER little as 10Meg of free hard drive space and can run in 2Meg of memory. Sport Tech recommends at least a 200Mhz processor for best performance. ™ does not need an external power supply. Many laptop computers can... -
Page 9: Setting Up And Connecting The Stress Device
Pressure Actuator Pressure head extension Ankle holder Stress device Frame 80mm extension rotary encoder Cable Counterbearings Wrist supports USB Cable Wrist support Frame LigMaster™ User’s Manual - Sport Tech Inc. Page 9... - Page 10 Once the positions of the side arms and the pressure actuator have been chosen for your specific exam and befitting the patient's anatomy, the locking mechanisms should be engaged to secure the components of the stress device. LigMaster™ User’s Manual - Sport Tech Inc. Page 10...
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Page 11: Getting Familiar With The Lig Master ™ Software
The Plot view shows a full resolution plot of the test data, while the summary view shows a smaller version of the plot with diagnostic information Plot view Summary View LigMaster™ User’s Manual - Sport Tech Inc. Page 11... -
Page 12: Selecting Tests
Then click on either the Test or Comparison button to identify the highlighted test. When you hit the OK button, the new test (and comparison if applicable) will be displayed. LigMaster™ User’s Manual - Sport Tech Inc. Page 12... -
Page 13: Evaluating The Tests
The figure below shows a stress exam for the shoulder, in which the test has about 7% more laxity than the comparison (which indicates no significant injury in clinical terms). Appendix C shows the screen shots for the various grades of injury for all ligaments. LigMaster™ User’s Manual - Sport Tech Inc. Page 13... -
Page 14: Viewing The Raw Test Data
Excel spreadsheet. Once the data is in this format, it can be manipulated by Excel or by any other program that can read an Excel file. LigMaster™ User’s Manual - Sport Tech Inc. Page 14... -
Page 15: Using The Patient Database
When you’ve entered all of the patient’s information that you need, hit OK. You are now ready to take test data for the patient. LigMaster™ User’s Manual - Sport Tech Inc. Page 15... -
Page 16: Selecting A Patient
Patient dialog box, the current patient file is closed and the selected patient file is opened. When a patient is selected, all tests performed previously on the selected patient become available from the “Test” menu. New tests can be added and compared with previous tests. LigMaster™ User’s Manual - Sport Tech Inc. Page 16... -
Page 17: Measuring Ligament Function
The first dialog box lets you select the type of test. Select the ligament(s) to be tested from the drop down menu. Once you have selected the ligament, select the right or left side. LigMaster™ User’s Manual - Sport Tech Inc. Page 17... - Page 18 ™ uses to model the joint and ligament interaction. This is done by clicking ASTER the “Advanced” button in the test select dialog box. Note: Setting patient anatomy values is for advanced users only. Improper values for patient anatomy will cause invalid results. LigMaster™ User’s Manual - Sport Tech Inc. Page 18...
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Page 19: Selecting The Comparison
The next step is to select a comparison test. Using a previous test as a comparison will speed up the setup somewhat as the settings for the stress device are usually constant from test to test for any particular patient. LigMaster™ User’s Manual - Sport Tech Inc. Page 19... -
Page 20: Describing The Test
When working with a new patient, it is usually helpful to repeat the first test on the patient's comparison/healthy joint so as to render him/her familiar enough with the examination procedure to relax properly (which aids in getting reproducible results) before proceeding with the test joint. LigMaster™ User’s Manual - Sport Tech Inc. Page 20... -
Page 21: Acquiring Stress Data
Check your connections and refer to the troubleshooting guide if necessary. The next steps will depend on whether you are using the Manual or Auto Acquire method. LigMaster™ User’s Manual - Sport Tech Inc. Page 21... -
Page 22: Manual Method
6. Once you have released pressure, check the data display to make sure that the data was acquired correctly. If the data looks good, hit the Accept button to accept the test data. If not, hit the Cancel button and repeat the test as necessary. LigMaster™ User’s Manual - Sport Tech Inc. Page 22... -
Page 23: Auto Acquire Method
5. Once you have released pressure, check the data display to make sure that the data was acquired correctly. If the data looks good, hit the Accept button to accept the test data. If not, hit the Cancel button and repeat the test as necessary. LigMaster™ User’s Manual - Sport Tech Inc. Page 23... -
Page 24: Knee - Acl
(this is done automatically if you select a previous test as a reference). Care should be taken that the patient relaxes his/her leg muscles during the exam. The knee should be in neutral LigMaster™ User’s Manual - Sport Tech Inc. Page 24... -
Page 25: Entering Positioning Information In The Lig Master ™ Software
™ settings will be recalled and can ASTER be used as a starting point for positioning the patient. Once you have entered these numbers you must check the box on the right to verify the numbers. LigMaster™ User’s Manual - Sport Tech Inc. Page 25... -
Page 26: Acquiring Joint Force/Response Data
ACL. The second parts of the force-strain lines will then run parallel, intersecting the x- axis at different points. This difference equals the slack in mm. The diagnostic dialog box summarizes the results in the left-hand column. LigMaster™ User’s Manual - Sport Tech Inc. Page 26... -
Page 27: Knee Pcl
L ™ settings will be ASTER recalled and can be used as a starting point for positioning the patient.: Figure 4.7.1 Stress device settings for PCL exam LigMaster™ User’s Manual - Sport Tech Inc. Page 27... -
Page 28: Positioning The Patient
Once you have entered these numbers you must check the box on the right to verify the numbers. LigMaster™ User’s Manual - Sport Tech Inc. Page 28... -
Page 29: Acquiring Joint Force/Response Data
However, in clinical practice, large slack can occasionally be difficult to differentiate from complete tears. The diagnostic dialog box summarizes the results in the left-hand column. LigMaster™ User’s Manual - Sport Tech Inc. Page 29... -
Page 30: Knee Mcl
If the test is based on a previous comparison, the previous L ™ settings will be ASTER recalled and can be used as a starting point for positioning the patient LigMaster™ User’s Manual - Sport Tech Inc. Page 30... -
Page 31: Positioning The Patient
If the test is based on a previous comparison, the previous ™ settings will be recalled and can be used as a starting point for positioning ASTER the patient. LigMaster™ User’s Manual - Sport Tech Inc. Page 31... -
Page 32: Acquiring Joint Force/Response Data
Slack in the MCL can be quantified from the point of intersection of the line with the x-axis, but considerable slack may be difficult to distinguish from complete tear. LigMaster™ User’s Manual - Sport Tech Inc. Page 32... -
Page 33: How The Test Works
The Acquire Advanced box permits the examiner to do so. LigMaster™ User’s Manual - Sport Tech Inc. Page 33... -
Page 34: Knee Lcl
If the test is based on a previous comparison, the previous L ™ settings will be ASTER recalled and can be used as a starting point for positioning the patient LigMaster™ User’s Manual - Sport Tech Inc. Page 34... -
Page 35: Positioning The Patient
If the test is based on a previous comparison, the previous ™ settings will be recalled and can be used as a starting point for ASTER positioning the patient. LigMaster™ User’s Manual - Sport Tech Inc. Page 35... -
Page 36: Acquiring Joint Force/Response Data
Once you have entered and verified the patient positioning data, you are ready to apply force to the joint and to collect data on the resulting joint response. See section 4.4 on acquiring test data. 4.9.5 Interpreting the diagnostic data LigMaster™ User’s Manual - Sport Tech Inc. Page 36... - Page 37 Slack in the LCL can be quantified from the point of intersection of the line with the x-axis, but considerable slack may be difficult to distinguish from complete tear. LigMaster™ User’s Manual - Sport Tech Inc. Page 37...
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Page 38: How The Test Works
The Acquire Advanced box permits the examiner to do so. LigMaster™ User’s Manual - Sport Tech Inc. Page 38... -
Page 39: Elbow Mucl
For the left MUCL, set C at 420 and proceed with B and A as described above. If the test is based on a previous comparison, the previous L ™ settings will be ASTER recalled and can be used as a starting point for positioning the patient LigMaster™ User’s Manual - Sport Tech Inc. Page 39... -
Page 40: Positioning The Patient
Figure 4.10.2 – Right Elbow mounted in stress device for MUCL exam Figures 4.10.2a-c – sequence of fixating wrist in stress device for MUCL exam LigMaster™ User’s Manual - Sport Tech Inc. Page 40... -
Page 41: Entering Positioning Information In The Lig Master ™ Software
Once you have entered these numbers you must check the box on the right to verify the numbers. LigMaster™ User’s Manual - Sport Tech Inc. Page 41... -
Page 42: Acquiring Joint Force/Response Data
Disabling the points under 6dN can be useful to ignore interfering data dominated by soft tissue compression. Sport Tech recommends increasing the applied force to no more than 12dN to allay discomfort to the patient. 4.10.6 How the test works By applying force to the lateral aspect of the elbow joint, the medial joint space widens and confers a stretching force to the MUCL. -
Page 43: Shoulder Anterior Without External Rotation
If the test is based on a previous comparison, the previous L ™ ASTER settings will be recalled and can be used as a starting point for positioning the patient LigMaster™ User’s Manual - Sport Tech Inc. Page 43... -
Page 44: Positioning The Patient
™ settings will be recalled and can be used as a starting point for ASTER positioning the patient. Once you have entered these numbers you must check the box on the right to verify the numbers. LigMaster™ User’s Manual - Sport Tech Inc. Page 44... -
Page 45: Acquiring Joint Force/Response Data
However, their similarity to the ACL stress exams provides some indication that the above criteria may well be correct. See our website at www.ligmaster.com for updates on shoulder stress exams. LigMaster™ User’s Manual - Sport Tech Inc. Page 45... -
Page 46: How The Test Works
However, these positions should be registered and recalled for any subsequent or comparison exam in order to validate diagnostic interpretation. LigMaster™ User’s Manual - Sport Tech Inc. Page 46... -
Page 47: Shoulder Anterior With External Rotation
™ settings will be recalled and can be used as a ASTER starting point for positioning the patient Figure 4.12.1 Stress device settings for left anterior shoulder exam with 80mm extension LigMaster™ User’s Manual - Sport Tech Inc. Page 47... -
Page 48: Positioning The Patient
™ software ASTER Once you have positioned the patient in the stress device, you must enter the positions of each side arm and the pressure actuator. Follow the procedures described under 4.11.3. LigMaster™ User’s Manual - Sport Tech Inc. Page 48... -
Page 49: Acquiring Joint Force/Response Data
See under 4.11.5 4.12.6 How the test works The shoulder test with external rotation works in a fashion identical to the shoulder test without external rotation as described under 4.11.6. LigMaster™ User’s Manual - Sport Tech Inc. Page 49... -
Page 50: Shoulder Posterior
90 degrees and the elbow flexed 90 degrees. The counterbearing closest to the patient and mounted on the extension piece, is positioned on the scapular spine. The pressure plate is positioned at anterior aspect of the proximal humerus and the LigMaster™ User’s Manual - Sport Tech Inc. Page 50... -
Page 51: Entering Positioning Information In The Lig Master ™ Software
90 degrees, internally rotated and the elbow flexed 90 degrees. LigMaster is not capable of stressing the shoulder in that position, but the above described technique examines instead the overall posterior stability including the contribution of the posterior aspect of the labrum. -
Page 52: Acquiring Joint Force/Response Data
However, these positions should be registered and recalled for any subsequent or comparison exam in order to validate diagnostic interpretation. LigMaster™ User’s Manual - Sport Tech Inc. Page 52... -
Page 53: Ankle Lateral Ligaments
When examining the opposite ankle for comparison, always make sure to begin the exam with the comparison ankle. LigMaster™ User’s Manual - Sport Tech Inc. Page 53... -
Page 54: Entering Positioning Information In The L Master ™ Software
™ settings will be recalled and can be ASTER used as a starting point for positioning the patient. Once you have entered the numbers you must check the box on the right to verify the numbers. LigMaster™ User’s Manual - Sport Tech Inc. Page 54... -
Page 55: Acquiring Joint Force/Response Data
(grade I) or, at fifty percent, a complete rupture of the ATF (grade II), whereas a further reduction would involve an additional partial tearing of the CF (grade III). This latter grade is, however, a rare LigMaster™ User’s Manual - Sport Tech Inc. Page 55... - Page 56 In these cases, Sport Tech recommends using the positive predictive value (ppv) of finding a particular grade of ligament injury, based on the apparent talar tilt angle at 15daN by LigMaster, as a source of information on the patient's ligament status.
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Page 57: How The Test Works
X-ray examinations. Research by Sport Tech’s clinical staff has shown that talar tilt angles by ™ exceed those by X-rays by a factor of about 2.5. This discrepancy is not a... -
Page 58: Ankle Medial Deltoid
Note - Do not forget to connect the rotary encoder cable! Figure 4.15.1 Stress device settings for left medial ankle exam LigMaster™ User’s Manual - Sport Tech Inc. Page 58... -
Page 59: Positioning The Patient
™ settings will be recalled and can be ASTER used as a starting point for positioning the patient. Once you have entered the numbers you must check the box on the right to verify the numbers. LigMaster™ User’s Manual - Sport Tech Inc. Page 59... -
Page 60: Acquiring Joint Force/Response Data
Acquire Advanced box. LigMaster™ User’s Manual - Sport Tech Inc. Page 60... -
Page 61: Ligmaster Repeatability And Accuracy
Studies performed by Sport Tech’s own clinical staff have shown that test results in the hands of beginners are accurate to within 10%, but this improves to 4-5% after several trial runs. - Page 62 To get a smooth, consistent plot, the patient should be relaxed and force applied slowly and consistently by the operator. LigMaster™ User’s Manual - Sport Tech Inc. Page 62...
- Page 63 A vertical series of points at the beginning of this test indicate that this test should be rejected. Repeat testing usually helps the patient to relax and avoid tensing during testing. LigMaster™ User’s Manual - Sport Tech Inc. Page 63...
- Page 64 The examiner should always make sure that the joint under examination is able to move freely during the exam. LigMaster™ User’s Manual - Sport Tech Inc. Page 64...
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Page 65: Diagnostic Aids
As a result, the test data for the ankle under examination are not presented and interpreted in absolute terms, but only relative to that for the adjusted, ‘normal’ comparison. LigMaster™ User’s Manual - Sport Tech Inc. Page 65... -
Page 66: Troubleshooting
6 Troubleshooting Sport Tech has made every effort to make using L ™ as effortless and trouble ASTER free as possible. If you have any difficulty using L ™, please see the list of ASTER common user problems below. If your problem does not appear on this list, please contact Sport Tech from the www.ligmaster.com... -
Page 67: Lig Master ™ Support
Here you will find the most up-to-date information on using L ™. You can also address questions to ASTER Sport Tech’s top technical and clinical staff or compare notes with other L ™ ASTER users. 8 LigMaster Research... -
Page 68: Appendix A
2- Unlike conventional stress exams that yield information on joint laxity only, ™ provides full details on the extent of ligament tear using the graded ASTER stress technique (GST). This technique can distinguish complete rupture from partial LigMaster™ User’s Manual - Sport Tech Inc. Page 68... - Page 69 Both anterior and posterior laxity with the shoulder in neutral, internal or external rotation can be quantitatively determined. The clinical actuality of this diagnostic exam renders this unique and unmatched capability one of the finest features of the ™ system. ASTER LigMaster™ User’s Manual - Sport Tech Inc. Page 69...
- Page 70 LigMaster™ User’s Manual - Sport Tech Inc. Page 70...
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Page 71: Appendix B
Therefore, a plot of (α -1/α against is expected to produce a straight line with a slope LigMaster™ User’s Manual - Sport Tech Inc. Page 71... - Page 72 Partial Versus Complete Anterior Cruciate Ligament Tears. AM. J.Sports Med. Vol 22- 2:, 1994 Rijke AM, Goitz HT, McCue FC, Andrews JR, Berr, SS; Stress Radiography of the Medial Elbow Ligaments.; Radiology Vol 199: 1994 LigMaster™ User’s Manual - Sport Tech Inc. Page 72...
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Page 73: Appendix C - Patterns Of Ligament Injury
Tear for ACL ligament injury. Figure C-1: Partial ACL Tear Normal ACL Figure C-2: Complete ACL Tear Complete ACL Tear Normal ACL Figure C-3: Slack in ACL Slack in ACL LigMaster™ User’s Manual - Sport Tech Inc. Page 73... - Page 74 PCL ligament injury Partial Tear Figure C-4: Partial Tear PCL Normal PCL Complete Tear PCL Figure C-5: Complete Tear PCL Normal PCL Slack in PCL Figure C-6: Slack in PCL LigMaster™ User’s Manual - Sport Tech Inc. Page 74...
- Page 75 MCL ligament injury Partial Tear Figure C-7: Partial Tear MCL Normal MCL Complete Tear MCL Figure C-8: Complete Tear MCL Normal MCL Slack in MCL Figure C-9: Slack in MCL LigMaster™ User’s Manual - Sport Tech Inc. Page 75...
- Page 76 LCL ligament injury Partial Tear Figure C-10: Partial Tear LCL Normal LCL Complete Tear LCL Figure C-11: Complete Tear LCL Normal LCL Slack in LCL Figure C-12: Slack in LCL LigMaster™ User’s Manual - Sport Tech Inc. Page 76...
- Page 77 MUCL ligament injury Partial Tear MUCL Figure C-13: Partial Tear in MUCL Normal MUCL Figure C-14: Complete Tear in MUCL Complete Tear MUCL Normal MUCL Slack in Figure C-15: Slack in MUCL MUCL LigMaster™ User’s Manual - Sport Tech Inc. Page 77...
- Page 78 Shoulder anterior ligament injury Partial tear caps/ligs Figure C-16: Partial tear in caps/ligs Normal caps/ligs Figure C-17: Complete tear in caps/ligs Complete tear caps/ligs Normal caps/ligs Slack in caps/ligs Figure C-18: Slack in caps/ligs LigMaster™ User’s Manual - Sport Tech Inc. Page 78...
- Page 79 Shoulder anterior ligament injury Partial tear caps/ligs Figure C-19: Partial tear in caps/ligs Normal caps/ligs Figure C-20: Complete tear in caps/ligs Complete tear caps/ligs Normal caps/ligs Slack in caps/ligs Figure C-21: Slack in caps/ligs LigMaster™ User’s Manual - Sport Tech Inc. Page 79...
- Page 80 Shoulder posterior ligament injury Partial tear caps/ligs Figure C-22: Partial tear in caps/ligs Normal caps/ligs Figure C-23: Complete tear in caps/ligs Complete tear caps/ligs Normal caps/ligs Slack in Figure C-24: Slack in caps/ligs caps/ligs LigMaster™ User’s Manual - Sport Tech Inc. Page 80...
- Page 81 CF intact Normal ATF ATF completely and CF ruptured, CF partially Figure C-27: Grade III injury torn 80% reduction in slope indicates complete tear of ATF, 60% tear of CF LigMaster™ User’s Manual - Sport Tech Inc. Page 81...
- Page 82 Diagrammatic examples of completely LigMaster diagnostics display ruptured for Lateral ankle ligament injury Figure C-28: Grade IV injury Normal ATF and CF Figure C-29: Slack in ligaments Slack in ATF and CF LigMaster™ User’s Manual - Sport Tech Inc. Page 82...
- Page 83 Figure C-30: Partial tear deltoid ligs Normal deltoid ligs Complete tear of deltoid ligs Figure C-31: Complete tear deltoid ligs Normal deltoid ligs Slack in Figure C-32: Slack in deltoid ligs deltoid ligs LigMaster™ User’s Manual - Sport Tech Inc. Page 83...
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Page 84: Commonly Asked Questions
™ requires as little as 10Meg ASTER of free hard drive space and can run in 2Meg of memory. Sport Tech recommends at least a 200Mhz processor for real time data display. If you have an existing computer that meets the above requirements, it will have no problems running L ™. - Page 85 Radiologica Acta, Orthopedics Today, Contemporary Diagnostic Radiology, The Physician and Sportsmedicine, The Journal of Bone and Joint Surgery and other journals. Interested readers are referred to Sport Tech’s website at www.ligmaster.com. LigMaster™ User’s Manual - Sport Tech Inc. Page 85...
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