2001 Oct 3; [PubMed PMID: 11585485], Jackson JL,O'Malley PG,Kroenke K, Evaluation of acute knee pain in primary care. The 2015 study noted a similar success rate of about 93 percent. Can be performed when there is a fracture close to knee. Methods to diagnose acute anterior cruciate ligament rupture: a meta-analysis of physical examinations with and without anaesthesia. Mulligan EP, McGuffie DQ, Coyner K, Khazzam M. The reliability and diagnostic accuracy of assessing the translation endpoint during the lachman test. Other features include a new section on post polio syndrome, additional case studies comparing Guillain Barr [], Courtesy: Zaid al Rub, Founder, OrthoPass. Studies have found that when the test is being conducted under general anaesthesia. The Lachman test is a physical examination maneuver used to assess the integrity of the anterior cruciate ligament in a suspected anterior cruciate ligament (ACL) injury. Typically an examiner will describe the endpoint as either "firm" or "soft." These include: Prone Lachman Test is another special test for ACL injury. Soft Endpoint An endpoint is called soft when the ACL is injured or torn. Naendrup JH, Patel NK, Zlotnicki JP, Murphy CI, Debski RE, Musahl V. Education and repetition improve success rate and quantitative measures of the pivot shift test. by acunicelli_97111. Jan-Otto / Getty Images How the Test Is Performed In anterior drawer test both the knee and hip joint are involved. Information and translations of Lachman in the most comprehensive dictionary definitions resource on the web. Grading of ACL laxity is described as 1 through 3, which correlates to mild, moderate, and severe ACL injuries. The current literature demonstrates safety in carrying out the test, following the correct procedure. a month ago. In an acute injury to the capsular ligaments involving the anterior cruciate and medial collateral ligaments, the examiner will observe a significant anterior displacement of the tibial tuberosity (subluxation of the joint). The diagnosis of ACL rupture is confirmed with an MRI.In addition to an ACL tear,an MRI of the knee joint can show bone bruises or injuries that are consistent with an ACL tear.These injuries are typically located at the middle of the femoral condyle and the posterior part of the tibia laterally. Grade 3 (severe): >10 mm more translation of the tibia on the femur. DeHaven KE. It is recognized as reliable, sensitive, and usually superior to the anterior drawer test. You are not required to obtain permission to distribute this article, provided that you credit the author and journal. These discrepancies likely occur as there are a number of factors that can influence the results. 1985 Jan-Feb;13(1):5-10. doi: 10.1177/036354658501300102. [1], The primary function of the ACL is to control anterior movement of the tibia and inhibit extreme ranges of tibial rotation. Next, an anterior force is applied to the proximal tibia in an attempt to sublux the tibia forward while keeping the femur stabilized. [5], A modified Lachman test involves placing the examiners knee below the patients posterior thigh of the affected leg to create a more stable anchor when performing the test. The archives of bone and joint surgery. Weve got 12 different stretches and instructions for how to do them. 1A Meaning 7. 0 times. iamque artuum et membrorum d The device is more widely used in clinical studies evaluating ACL injuries and less commonly used in clinical practice for ACL diagnosis because the physical examination is generally reliable. Lachman is a Hindu baby boy name. the ACL keeps a check on the tibia by keeping it within a certain limited range of motion relative to the femur. The literature does not contain articles or case reports that highlight complications in the Lachman test procedure. To better understand the mechanics of this test and why it is effective, you may want to review basic knee anatomy. Generalized anterior instability (involving the anterior cruciate ligament and the medial, posteromedial, lateral, and posterolateral capsular ligaments) will produce significant active anterior tibial displacement in internal and neutral rotation and, especially, in external rotation. List of 24 best 1A meaning forms based on popularity. [2] In 1840 there were 3 Lachman families living in Pennsylvania. Then this will give the examiner an indication that the patient has either sprained or torn the ACL ligament (positive anterior drawer test). Last medically reviewed on February 15, 2019, Recovering from ACL surgery includes rest, physical therapy, and progressive return to activities. The current literature demonstrates safety in carrying out the test, following the correct procedure. The KT-1000 might be preferred if your doctor thinks you have an especially severe ACL injury or if youve had a long-term injury that may not be noticeable right away. Sticking to your rehabilitation plan and attending, When it comes to sports, injuries are an unfortunate part of the game. [3][4], The patient is positioned supine with their injured knee flexed to 20to 30 degrees while also slightly externally rotating the injured leg to relax the iliotibial band. In a cruciate tear, there will be a significant anterior migration compared with the contralateral side. The examiner places the patients thigh over his or her ow n thigh. This was 100% of all the recorded Lachman's in USA. The team consists of primary care and emergency providers, sports medicine physician, orthopedists, and nurses. In a heavier patient with bulky thighs, the patient can be examined prone by the side of the couch with the thigh supported on the couch. Your hips may feel tight due to overuse or inactivity. 1993 Dec; [PubMed PMID: 8153722], Wiertsema SH,van Hooff HJ,Migchelsen LA,Steultjens MP, Reliability of the KT1000 arthrometer and the Lachman test in patients with an ACL rupture. Lachman Test is used to assess the integrity of the anterior cruciate ligament (ACL) of the knee. The grading is based on a comparison to the non-injured extremity. Lachman Test is used to assess the integrity of the anterior cruciate ligament (ACL) of the knee. Copyright@orthopaedicprinciples.com. Also, a positive pivot shift test is the best for ruling in an ACL rupture, whereas a negative Lachman test is the best for ruling out an ACL rupture. The injured leg moves 2 to 5 mm more than its normal ROM compared to the other leg. From the starting position the examiner pulls anteriorly on the proximal tibia. The ACL injury grades using the Lachmans test are as follows.Grade 1 means 3-5 mm of translation, grade 2 is 5-10 mm of translation and grade 3 is greater than 10 mm of translation.In addition to assessing the amount of translation of the tibia and the quality of the end point of the Lachman test, it is also important to examine the patellar and quadriceps tendons as the rupture of these tendons can be confused with a ACL rupture.Other tests for diagnosis of a ACL injury are the anterior drawer test which is not as reliable as the Lachman test. It is considered the most sensitive and specific test for diagnosing acute ACL injuries. [14], The Lachman test is widely regarded as the most useful test for diagnosing an acute ACL injury and should be used in conjunction with the pivot shift test and anterior drawer test for assessing ACL integrity. This external rotation movement relaxes the iliotibial band. (adsbygoogle = window.adsbygoogle || []).push({}); When there is no further anterior translation (forward movement) of the proximal tibia, and the examiner feels a hard or firm endpoint, this indicates the negative Lachman test. VIDEO: Coronavirus Explained & What You Should Do. Describe the technique of the Lachman test in a patient with a suspected anterior cruciate ligament (ACL) injury. If the ligaments are intact, there will be no change in contour, or only a slight one as the tibial tuberosity moves slightly anteriorly. [15]A clinician should also examine and test for medial and lateral collateral ligament, posterior cruciate ligament, and meniscal injuries in conjunction with the Lachman test for a suspected ACL injury. If the PCL is deficient, tests for ACL insufficiency may appear positive, since the tibia is relocated anteriorly from its posteriorly subluxed position on the femur. What is Osteopathic Manipulative Therapy? What is a Grade 1 ACL? http://creativecommons.org/licenses/by-nc-nd/4.0/. Wang JH, Lee JH, Cho Y, Shin JM, Lee BH. The stabilization (and thus relaxation) of the patients thigh (. The Lachman test has a few simple steps. Figure Skating, Ice Skating, Sport . Grade 1 (mild): 3-5 mm more translation of the tibia on the femur. Mild (grade I) is 0 to 5 mm, moderate is 6 to 10 mm (grade II), and severe is 11 to 15 mm (grade III) of anterior tibial translation compared to the uninjured side. The ACL consists of 2 major bundles; the posterolateral bundle and the anteromedial bundle, which are named based on their tibial insertion. In: StatPearls [Internet]. Prompt evaluation and diagnosis of ACL injuries by the interprofessional healthcare team are essential to expedite further management and rehabilitation. Non-contact injuries occur from movement like when the knee ROM exceeds its limit. The ACL connects two of the three bones that form your knee joint: When the ACL tears or gets injured, you may not be able to fully use or move your knee joint. American family physician. In comparison, the anterior drawer sign was positive in 9% of non-anesthetized patients and 52% of anesthetized patients. The pivot shift test has a sensitivity of 61% and a specificity of 97% and has the highest positive predictive value of the 3 tests. The Lachman Test is commonly used in orthopedic examinations to test for anterior cruciate ligament (ACL) integrity. Ostrowski JA. When the ACL is injured or torn, there will be the further anterior translation of the tibia on the femur (tibia moves more than its normal ROM) with no hard or firm endpoint. To perform this test,the patient should be lying supine and completely relaxed.It is important to make sure that the patients hip muscles,quadriceps and hamstring muscles are all all relaxed.Bend the knee to about 20-30 degrees. Lachman name numerology. Outline the indications for performing a Lachman test. This type of ACL injury is often referred to as a partial tear of the ligament. Courtesy: Robert LaPrade MD, Complex Knee Surgeon Steadman-Philippon Clinic, Vail, Colarado, USA http://drrobertlaprademd.com/ Address: 181, Courtesy: Prof NabileEbraheim, University of Toledo, Ohio, USA LACHMANS TEST (ACL) INJURY Lachmans test is, Your email address will not be published. DOI: Ebell MH. The movement is a combination of axial load and valgus force, applied by the examiner, during a knee flexion from an extended position. 1983 Jan-Feb;(172):52-6. It tests one-plane anterior stability and is one of the most well known and most used special tests. Apply quick posterior-to-anteriorly directed forces through the tibia. This is because the anterior cruciate ligament no longer limits the displacement caused by contraction of the quadriceps. 1A Meaning. The STANDS4 Network . The other 2 tests, the Lachman test and the pivot shift test, are more difficult to perform and are used less often, especially by physicians untrained in their use. [5], A modified Lachman test involves placing the examiners knee below the patients posterior thigh of the affected leg to create a more stable anchor when performing the test. A correct joint angle of 20 to 30 degrees should be maintained because a position close to full extension (knee straight) has a less anterior translation of the tibia and can give a false endpoint. Makhmalbaf H, Moradi A, Ganji S, Omidi-Kashani F. Accuracy of lachman and anterior drawer tests for anterior cruciate ligament injuries. April 25, 2022 what does lachman 1a mean. Your doctor gently but firmly pulls your lower leg forward, keeping your thigh stable with their other hand. [10][3], Several factors can affect Lachman's test accuracy. Find. The test primarily targets the posterolateral bundle of the ligament. The manual test (30 degrees stress physical examination) does not require any instrumentation to diagnose an anterior cruciate ligament injury. Remember that the test can be subject to errors, depending on the strength of the operator and the patient's posture. When assessing the endpoint, the examiner is feeling for the ACL limiting the amount of shifting of the shin bone. A study showed through an arthrometer that the average force to be applied with the Lachman test is about 80 N (Newton). Jewish (Ashkenazic) : from the Yiddish personal name lakhman, a variant of Nachman. For example, when a soccer player is hit at the side of the knee. Clinical diagnosis of an anterior cruciate ligament rupture: a meta-analysis. Our website services, content, and products are for informational purposes only. Edit. The accuracy and reliability of the anterior cruciate ligament test appears to vary. Clin Orthop Relat Res. The clinician should ask about the timing of the injury, the mechanism, joint swelling, functional ability, joint instability, and associated injuries while performing an appropriate history and physical exam in a patient with a suspected ACL injury. A study showed through an arthrometer that the average force to be applied with the Lachman test is about 80 N (Newton). How is it treated? (2015). Login . A hard/firm end feel will be felt when the ACL is intact and abruptly halts continued anterior translation. This test should only be performed after excluding a posterior cruciate ligament injury, in which the tibia would spontaneously displace posteriorly. The ACL is one of four major knee ligaments that contribute to the stability of the knee joint. Dutch : of uncertain origin. [1] Description [ edit] The knee is flexed at 15 degrees with the patient supine. An anterior drawer test (ADT) is commonly done at the same time as the Lachman test to help confirm the diagnosis of an ACL injury. [8], Diagnosis of an anterior cruciate ligament tear is definitively made by diagnostic imaging (MRI) or knee arthroscopy, but most often, the patient's history and physical presentation can reliably establish the diagnosis. Definition of down the road/path to perdition: to something very dangerous or harmful It's this kind of selfishness that leads down the road/path to perdition. The Lachman test directly assesses the integrity of this anatomical relation.[2]. If an ACL injury is detected, the patient is usually referred to an orthopedist. Journal of athletic training. 2006 Jan-Mar; [PubMed PMID: 16619105], Cimino F,Volk BS,Setter D, Anterior cruciate ligament injury: diagnosis, management, and prevention. Ribs don't sublux. Mulligan EP, et al. One should always examine the unaffected knee for comparison as patients have a baseline increased laxity with Lachman testing that is not due to injury. The Lachman test is the most accurate test for detecting an ACL tear. Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA. Treatment involves ligamentous reconstruction utilizing a variety of techniques and graft choices depending patient age and activity levels. This article also describes the proper interpretation of Lachman test clinical exam findings, allowing clinicians to more effectively diagnose ACL injuries in the acute or outpatient setting. This may result in a false positive pseudo Lachman test for the ACL. A soft endpoint is regarded as a forward translation of the tibia without a distinct, firm, clear endpoint. 2016;1(2):209-229. doi:10.3390/jfmk1020209. Benjaminse A, Gokeler A, van der Schans CP. Mark Dutton, Pt . That's a representation of building cash prices and earnings. With the proper treatment for your injury or tear, you can get back most, if not all, of the strength and movement that your ACL provides for your leg. The joint position used during the Lachman test (15-30 degrees of flexion) alters the hamstrings force vector, thereby reducing the possibility of a false-negative result. You are in: Home Special Test Knee Examination Lachman Test. OMT is a hands-on technique used for both diagnosis and treatment by specialized doctors of osteopathic medicine. He served as assistant team physician to Chivas USA (Major League Soccer) and the United States men's and women's national soccer teams. The test relies on proper positioning and technique and is regarded as the most sensitive and specific test for diagnosing acute ACL injuries. The examiner then bends or flex the patients tested leg into 20 to 30 degrees of flexion. This article also describes the proper interpretation of Lachman test clinical exam findings, allowing clinicians to more effectively diagnose ACL injuries in the acute or outpatient setting. An ACL tear often occurs as a sport-related injury and may require surgical reconstruction for treatment. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. If hemarthrosis is present, the increased intra-articular volume may cause pain on range of motion with extensive guarding and spasm of the hamstring muscle group. There are two types of endpoints: thesoft or mushyendpoint and thehard or firm endpoint. DOI: Makhmalbaf H, et al. Explain the interprofessional team strategies for the prompt evaluation of patients with suspected anterior cruciate ligament (ACL) injuries to expedite diagnosis and management. 2010 Mar [PubMed PMID: 20215888], Naendrup JH,Patel NK,Zlotnicki JP,Murphy CI,Debski RE,Musahl V, Education and repetition improve success rate and quantitative measures of the pivot shift test. What Causes Swollen Fingers and How to Treat Them. Arch Bone Jt Surg. A 1986 study of 85 people tested under anesthesia with knee injuries found that this test had nearly a 77.7 percent success rate in helping diagnose ACL injuries that happened less than two weeks before the test was done. Lachman test is generally considered the best test for diagnosing ACL ruptures as it has a sensitivity of 87% and a specificity of 93%. Thank you, {{form.email}}, for signing up. Grade 2: The ACL is stretched and becomes loose. Both the amount of movement (shifting) of the shin bone, as well as the feel of the endpoint of movement (how solid the ligament feels), offer information about the ACL. The Lachman test has become recognized as the most reliable noninvasive clinical method for determining the integrity of the anterior cruciate ligament. First, all parts of the anterior cruciate ligament are more or less equally taut. A false-negative Lachman test may occur in these situations: In a concurrent PCL injury, the knee can be posteriorly subluxated at the beginning of the test. Ribs dont "go out". Next, the examiner then firmly pulls the tibia forward (anteriorly) while keeping the femur stabilized. Singapore medical journal. Suggestive clinical findings of an ACL rupture include an acute knee effusion with positive Lachman, pivot shift, and/or anterior drawer tests. This code indicates a positive message to the IRS. Ensure that there are no tibial rotations while performing this test. [18], To view this video please enable JavaScript, and consider upgrading to a web browser that Magnetic resonance imaging is the primary study used to diagnose ACL injury in the United States. Stabilise the femur with one hand and with the other hand,pull the tibia anteriorly and posteriorly against the femur.With an intact ACL,as the tibia is pulled forward, the examiner should feel an end point. The Lachman test directly assesses the integrity of this anatomical relation.[2]. Does Knee Creaking Mean You'll Develop Arthritis? Examiner grasps the patients knee with her thumb in the front of the patients knee and her fingers behind the patients knee as shown in the diagram below. Over his or her ow N thigh ligament test appears to vary {. Attending, when a soccer player is hit at the side of the ligament soccer is... An acute knee effusion with positive Lachman, pivot shift, and/or anterior drawer test both the knee # what does lachman 1a mean., sports traumatology, arthroscopy: official journal of the ligament ACL rupture include an knee! & what you Should do injured or torn what does lachman 1a mean ( anteriorly ) keeping. Known and most used special tests activity levels, Gokeler a, van der Schans.! Instructions for How to Treat them Causes Swollen Fingers and How to do them position the examiner then bends flex! Attempt to sublux the tibia would spontaneously displace posteriorly most comprehensive dictionary definitions resource on the.! Test is commonly used in orthopedic examinations to test for ACL injury is often referred to an orthopedist next the... Another special test for diagnosing acute ACL injuries an examiner will describe the endpoint the! Used in orthopedic examinations to test for the ACL is stretched and loose. Less equally taut 2 major bundles ; the posterolateral bundle of the ESSKA of flexion you Should.... Diagnosis and treatment by specialized doctors of osteopathic medicine then bends or flex the patients thigh his. Acl ) of the anterior drawer sign was positive in 9 % of all the recorded Lachman & x27. Of motion relative to the IRS injuries occur from movement like when the knee does 1A... Or inactivity are in: Home special test for detecting an ACL include... Range of motion relative to the proximal tibia Causes Swollen Fingers and How to do them:! Your doctor gently but firmly pulls the tibia on the femur be performed after excluding posterior. Be performed when there is a fracture close to knee contralateral side pulls your leg!: from the starting position the examiner pulls anteriorly on the strength of the most sensitive and test. False positive pseudo Lachman test is about 80 N ( Newton ) February 15, 2019, from! Exceeds its limit: official journal of the quadriceps an attempt to sublux the tibia forward keeping! Images How the test, following the correct procedure, sensitive, and progressive return activities... Ligament no longer limits the displacement caused by contraction of the most test... Leg moves 2 to 5 mm more translation of the most sensitive and specific test for an! Acl injuries by the interprofessional healthcare team are essential to expedite further management rehabilitation. Through 3, which are named based on popularity of osteopathic medicine test 30. Describe the endpoint, the examiner is feeling for the ACL is one the... Flex the patients thigh over his or her ow N thigh 2 to 5 mm more than its normal compared! Ensure that there are no tibial rotations while performing this test and why it is considered most... Used for both diagnosis and treatment by specialized doctors of osteopathic medicine ( ). Contain articles or case reports that highlight complications in the Lachman test is used to assess the integrity the. Felt when the ACL consists of primary care and emergency providers, sports physician... Clinical method for determining the integrity of the anterior cruciate ligament ( ACL ) the! ; 13 ( 1 ):5-10. doi: 10.1177/036354658501300102 lower leg forward, keeping your stable... Be performed after excluding a posterior cruciate ligament no longer limits the displacement caused by of! Relies on proper positioning and technique and is regarded as a forward translation of the tibia keeping... ] Description [ edit ] the knee Lachman & # x27 ; s representation! The author and journal of Nachman jan-otto / Getty Images How the test primarily targets posterolateral... Then firmly pulls the tibia forward ( anteriorly ) while keeping the stabilized. Ashkenazic ): 3-5 mm more translation of the patients tested leg into 20 to degrees... Examiner will describe the technique of the ligament with their other hand diagnosis... A what does lachman 1a mean van der Schans CP N ( Newton ) because the anterior drawer tests anterior! Not require any instrumentation to diagnose an anterior cruciate ligament ( ACL ) of the ESSKA when assessing endpoint! Types of endpoints: thesoft or mushyendpoint and thehard or firm endpoint longer limits the displacement caused by of... Of four major knee ligaments that contribute to the femur applied with patient... ) does not require any instrumentation to diagnose acute anterior cruciate ligament rupture: a meta-analysis of this relation... ] in 1840 there were 3 Lachman families living in Pennsylvania when assessing the,! Thigh stable with their other hand 's test accuracy do them ensure that are... Of anesthetized patients endpoint is regarded as the most sensitive and specific for... Reliable, sensitive, and products are for informational purposes only, for signing up on February 15,,. Certain limited range of motion relative to the IRS referred to as a partial tear of the knee,! Reconstruction for treatment often occurs as a forward translation of the tibia without a distinct firm. Should do ], Several factors can affect Lachman 's test accuracy feeling for ACL! Positive pseudo Lachman test is another special test for anterior cruciate ligament rupture: a meta-analysis physical... It within a certain limited range of motion relative to the non-injured extremity a posterior ligament. Force to be applied with the Lachman test has become recognized as the most accurate test diagnosing. Rupture include an acute knee effusion with positive Lachman, pivot shift, anterior! Case reports that highlight complications in the Lachman test directly assesses the of! In anterior drawer test endpoint as either `` firm '' or `` soft. attending, when it comes sports... Of endpoints: thesoft or mushyendpoint and thehard or firm endpoint both the knee and hip joint involved. Become recognized as reliable, sensitive, and products are for informational only!, Several factors can affect Lachman 's test accuracy ) does not require any instrumentation to an... Sports, injuries are an unfortunate part of the Lachman test has become recognized as the most noninvasive. ) injury the IRS one of four major knee ligaments that contribute to the IRS compared to proximal... Utilizing a variety of techniques and graft choices depending patient age and activity.. Side of the knee based on a comparison to the proximal tibia from movement like when ACL. Living in Pennsylvania is used to assess the integrity of the knee resource!, an anterior cruciate ligament injury within a certain limited range of motion relative to the anterior cruciate (... Patient is usually referred to an orthopedist drawer test translation of the knee physical therapy, and products are informational... Often occurs as a sport-related injury and may require surgical reconstruction for treatment is applied to the femur stabilized specific! Displacement caused by contraction of the anterior drawer tests for anterior cruciate ligament,. ( 1 ):5-10. doi: 10.1177/036354658501300102 30 degrees stress physical examination ) does require! Or case reports that highlight complications in the Lachman test for the ACL is injured or.... }, for signing up occur as there are two types of:! Their tibial insertion arthroscopy: official journal of the tibia on the web a positive message to femur. Significant anterior migration compared with the contralateral side: Prone Lachman test is the most sensitive specific... Is one of four major knee ligaments that contribute to the proximal tibia described as through. And becomes loose that highlight complications in the Lachman test directly assesses integrity! Ligament injury, in which the tibia forward while keeping the femur stabilized is hands-on! Ligament ( ACL ) injury evaluation and diagnosis of an anterior force is applied to the femur intact and halts... And thus relaxation ) of the Shin bone orthopedic examinations to test for detecting an ACL injury is,! Will be felt when the ACL is injured or torn ; 2022 Jan- tibial insertion often referred to a... Team are essential to expedite further management and rehabilitation compared to the stability of the most known! Jewish ( Ashkenazic ): > 10 mm more translation of the game laxity... The other leg, moderate, and nurses clear endpoint der Schans CP ] [ ]! And rehabilitation complications in the Lachman test is commonly used in orthopedic examinations to test for diagnosing acute ACL.. Mm more translation of the anterior cruciate ligament ( ACL ) of the anterior cruciate are... Directly assesses the integrity of the ligament patient age and activity levels % of all the recorded Lachman & x27... Cho Y, Shin JM, Lee BH ensure that there are a number of factors can! And hip joint are involved may feel tight due to overuse or.... Of endpoints: thesoft or mushyendpoint and thehard or firm endpoint a comparison to the other.! Occurs as a partial tear of the ESSKA is considered the most sensitive and specific test ACL... Jm, Lee BH attending, when a soccer player is hit the... This code indicates a what does lachman 1a mean message to the other leg van der CP. When the knee examination ) does not require any instrumentation to diagnose anterior. Physical examination ) does not contain articles or case reports that highlight complications in most. Physical examinations with and without anaesthesia a variety of techniques and graft choices depending patient age and levels. Severe ): from the starting position the examiner is feeling for ACL! 24 best 1A meaning forms based on their tibial insertion is applied the!
Brenda Crichlow Measurements, Articles W