Gravity-assisted pivot-shift test can predict the function of the reconstructed anterior cruciate ligament

2010 ◽  
Vol 19 (4) ◽  
pp. 572-578 ◽  
Author(s):  
Hiroya Sakai ◽  
Hisatada Hiraoka ◽  
Motohisa Yashiki
Keyword(s):  
Anterior Cruciate Ligament ◽  
Pivot Shift ◽  
Cruciate Ligament ◽  
Pivot Shift Test ◽  
Anterior Cruciate

Augmentation of Anatomic Anterior Cruciate Ligament Reconstruction With Lateral Extra-articular Tenodesis Does Not Significantly Affect Rotatory Knee Laxity: A Time Zero, In Vivo Kinematic Analysis

2020 ◽  
Vol 48 (14) ◽  
pp. 3495-3502
Author(s):  
Andrew J. Sheean ◽  
Jayson Lian ◽  
Robert Tisherman ◽  
Sean J. Meredith ◽  
Darren de SA ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Pivot Shift ◽  
Cruciate Ligament ◽  
Knee Laxity ◽  
Lateral Compartment ◽  
Categorical Variables ◽  
Pivot Shift Test ◽  
Contralateral Knee ◽  
Rotatory Knee Laxity ◽  
Anterior Cruciate

Background: The pivot-shift test is used to assess for rotatory knee laxity in the anterior cruciate ligament (ACL)-deficient knee and ACL-reconstructed knee; however, the pivot shift uses a subjective grading system that is limited by variability between examiners. Consequently, quantified pivot shift (QPS) test software (PIVOT iPad application) has been developed and validated to measure the magnitude of rotatory knee laxity during the positive pivot-shift test. Purpose: To employ intraoperative QPS (iQPS) to assess for differences in residual rotatory knee laxity after ACL reconstruction (ACLR) versus ACLR augmented with lateral extra-articular tenodesis (ACLR + LET), and to employ iQPS to determine if ACLR and/or ACLR + LET result in overconstrained knee kinematics when compared with the contralateral knee. Study Design: Cohort study; Level of evidence, 2. Methods: iQPS was performed in 20 patients by a single surgeon on both the operative and contralateral knees before ACLR. ACLR was augmented with a LET if the lateral compartment tibial translation measured during QPS was greater than or equal to double the amount of lateral tibial compartment translation measured for the contralateral knee. After each reconstruction (ACLR or ACLR + LET), iQPS measurements were performed. iQPS data were compared with the preoperative QPS measurements of the operative and contralateral knees. Postoperative iQPS data were compared with both the preoperative QPS measurements of the operative and contralateral knees with paired samples t tests. Categorical variables were compared using the Fisher exact test. Results: The mean age in the cohort was 17.3 years (range, 15-24 years). There were no significant differences between the groups in terms of the proportion of male patients (ACLR: 5 male, 5 female vs ACLR + LET: 4 male, 6 female) or age (ACLR: 17.7 ± 3.3 years; 95% CI, 15.4-24.0 vs ACLR + LET: 16.8 ± 2.8 years, 95% CI, 14.8-22.0; P = .999). There were no significant differences between the groups with respect to preoperative QPS performed during examination under anesthesia (ACLR: 4.7 ± 2.0 mm; 95% CI, 3.3-6.1 vs ACLR + LET: 3.6 ± 1.8 mm; 95% CI, 2.3-4.9; P = .2). Both ACLR and ACLR + LET resulted in significant decreases in rotatory knee laxity when compared with preoperative QPS measurements (ACLR: –3.4 ± 1.7 mm; 95% CI, −4.6 to −2.2; P < .001: ACLR + LET: –2.6 ± 1.9 mm; 95% CI, −3.9 to −1.3; P < .002). Moreover, when compared with isolated ACLR, ACLR + LET did not result in a significantly smaller magnitude of change in iQPS between the pre- and postoperative states ( P = .3). Conclusion: Both ACLR and ACLR + LET resulted in significant decreases in rotatory knee laxity. The augmentation of ACLR with LET did not change the constraint of the knee with respect to lateral compartment translation as measured during iQPS.

Partial Tears of the Anterior Cruciate Ligament in Children and Adolescents

2002 ◽  
Vol 30 (5) ◽  
pp. 697-703 ◽  
Author(s):  
Mininder S. Kocher ◽  
Lyle J. Micheli ◽  
David Zurakowski ◽  
Anthony Luke
Keyword(s):  
Anterior Cruciate Ligament ◽  
Children And Adolescents ◽  
Pivot Shift ◽  
Cruciate Ligament ◽  
Rehabilitation Program ◽  
Skeletal Age ◽  
Pivot Shift Test ◽  
Scale Scores ◽  
Anterior Cruciate ◽  
Cruciate Ligament Tears

Background: The functional outcome after partial anterior cruciate ligament tears in children and adolescents treated without reconstruction has not been established. Hypothesis: Nonreconstructive management of partial anterior cruciate ligament tears can be effective in certain pediatric patients. Study Design: Prospective cohort study. Methods: We studied 45 skeletally mature and immature patients 17 years of age or less who had an acute hemarthrosis, magnetic resonance imaging signal changes, grade A or B Lachman and pivot shift result, and an arthroscopically documented partial anterior cruciate ligament tears. All patients were treated without reconstruction, underwent a structured rehabilitation program, and were followed up for a minimum of 2 years. Results: Fourteen patients (31%) underwent subsequent reconstruction. Significant associations with subsequent reconstruction included tears that were greater than 50%, predominantly posterolateral tears, a grade B pivot shift test result, and older chronologic and skeletal age. Among patients who did not require reconstruction, those with tears that were greater than 50% or predominantly posterolateral had significantly lower Lysholm, satisfaction, and Cincinnati Knee Scale scores. Conclusions: Nonreconstructive management is recommended for partial anterior cruciate ligament tears in children and adolescents 14 years of skeletal age or younger with normal or near-normal Lachman and pivot shift results. Reconstruction is recommended in older athletes or in those with greater than 50% or predominantly posterolateral tears.

scholarly journals Non-anatomical Anterior Cruciate Ligament Remnants Do Not Contribute Dynamic Knee Stability ˜Quantitative Measurement Of The Pivot Shift Test˜

2014 ◽  
Vol 2 (7_suppl2) ◽  
pp. 2325967114S0010
Author(s):  
Kanto Nagai ◽  
Ryosuke Kuroda ◽  
Daisuke Araki ◽  
Yuichiro Nishizawa ◽  
Takehiko Matsushita ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Quantitative Measurement ◽  
Pivot Shift ◽  
Cruciate Ligament ◽  
Pivot Shift Test ◽  
Knee Stability ◽  
Anterior Cruciate

Quantitative Assessment of Rotatory Instability after Anterior Cruciate Ligament Reconstruction

2009 ◽  
Vol 37 (5) ◽  
pp. 909-916 ◽  
Author(s):  
Yasutaka Tashiro ◽  
Ken Okazaki ◽  
Hiromasa Miura ◽  
Shuichi Matsuda ◽  
Takefumi Yasunaga ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Anterior Cruciate Ligament ◽  
Pivot Shift ◽  
Cruciate Ligament ◽  
Pivot Shift Test ◽  
Resonance Imaging ◽  
Rotatory Instability ◽  
Open Magnetic Resonance Imaging ◽  
Anterior Cruciate ◽  
Tibial Translation

Background Anterior cruciate ligament reconstruction successfully reduces anterior knee instability, but its effect on rotatory stability is not fully understood. In addition, a definitive method for the quantitative evaluation of rotatory instability remains to be established. Hypothesis Measurement of anterolateral tibial translation by open magnetic resonance imaging could positively correlate with the clinical grading of the pivot-shift test and would clarify residual rotatory abnormalities not shown by conventional methods for measurement of anterior stability. Study Design Controlled laboratory study. Methods An anterior cruciate ligament—reconstructed group (n = 21) and an anterior cruciate ligament—deficient group (n = 20) were examined using a Slocum anterolateral rotatory instability test in open magnetic resonance imaging. Anterior tibial translation was measured at the medial and lateral compartments by evaluating sagittal images. Clinical knee stability was evaluated before the above measurement using the pivot-shift test, KT-2000 arthrometer, and stress radiography. A cutoff value for anterolateral tibial translation relating to pivot-shift was determined using a receiver operating characteristic curve. Results Side-to-side differences of anterolateral tibial translation correlated with clinical grade of the pivot-shift test and stress radiography but not with KT-2000 arthrometry in both groups. The cutoff value was established as 3.0 mm. Although the mean anterolateral translation showed no difference, 9 reconstructed knees revealed greater than 3 mm of anterolateral tibial translation, whereas only 3 uninjured knees did. Conclusion Measurement using an open magnetic resonance imaging successfully quantified the remaining rotatory instability in anterior cruciate ligament—reconstructed knees. Clinical Relevance This method is a useful means for quantifying anterior cruciate ligament function to stabilize tibial rotation.

scholarly journals Inertial sensors to quantify the pivot shift test in the treatment of anterior cruciate ligament injury

Joints ◽  
2014 ◽  
Vol 02 (03) ◽  
pp. 124-129 ◽  
Author(s):  
Stefano Zaffagnini ◽  
Nicola Lopomo ◽  
Cecilia Signorelli ◽  
Giulio Maria Marcheggiani Muccioli ◽  
Tommaso Bonanzinga ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Clinical Practice ◽  
Anterior Cruciate Ligament Injury ◽  
Inertial Sensors ◽  
Pivot Shift ◽  
Cruciate Ligament ◽  
Ligament Injury ◽  
Pivot Shift Test ◽  
Technical Specifications ◽  
Anterior Cruciate

The main purpose of this article was to describe in detail, from the perspective of the clinical end user, a previously presented non-invasive methodology, applied in the treatment of anterior cruciate ligament injury, in which inertial sensors are used to quantify the pivot shift test. The outcomes obtained and relative considerations were compared with findings emerging from a review of the relevant updated literature.The detailed description here provided covers the system, the parameters identified and the testing procedure; it also includes the technical specifications of the hardware, the features introduced in the updated version of the software and the application of the system in clinical practice.The comparison of the technical considerations and clinical results with the updated literature confirmed the system’s optimal ergonomics, good reproducibility and clinical reliability.The novel approach here analyzed has been shown to overcome the weaknesses of other available devices and systems. Therefore, since it can be considered a new paradigm in the quantification of pivot shift test, we can recommend its routine use in clinical practice.

Association Between Psychological Readiness and Knee Laxity and Their Predictive Value for Return to Sport in Patients With Anterior Cruciate Ligament Reconstruction

2021 ◽  
pp. 036354652110218
Author(s):  
Anne Gro Heyn Faleide ◽  
Liv Heide Magnussen ◽  
Bård Erik Bogen ◽  
Torbjørn Strand ◽  
Ingunn Fleten Mo ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Pivot Shift ◽  
Cruciate Ligament ◽  
Return To Sport ◽  
Knee Laxity ◽  
Pivot Shift Test ◽  
Lachman Test ◽  
Anterior Tibial ◽  
Kt 1000 ◽  
Anterior Cruciate

Background: Deciding when patients are ready to return to sport (RTS) after an anterior cruciate ligament (ACL) reconstruction (ACLR) is challenging. The understanding of which factors affect readiness and how they may be related is limited. Therefore, despite widespread use of RTS testing, there is a lack of knowledge about which tests are informative on the ability to resume sports. Purpose: To examine whether there is an association between knee laxity and psychological readiness to RTS after ACLR and to evaluate the predictive value of these measures on sports resumption. Study Design: Cohort study; Level of evidence, 2. Methods: Patients aged ≥16 years engaged in physical activity/sports before injury were recruited at routine clinical assessment 9-12 months after ACLR. Exclusion criteria were concomitant ligament surgery at ACLR and/or previous ACL injury in the contralateral knee. At baseline, a project-specific activity questionnaire and the ACL–Return to Sport After Injury (ACL-RSI) scale were completed. Knee laxity was assessed by use of the Lachman test, KT-1000 arthrometer, and pivot-shift test. Two years after surgery, knee reinjuries and RTS status (the project-specific questionnaire) were registered. Associations between psychological readiness and knee laxity were evaluated with the Spearman rho test, and predictive ability of the ACL-RSI and knee laxity tests were examined using regression analyses. Results: Of 171 patients screened for eligibility, 132 were included in the study. There were small but significant associations between the ACL-RSI score and the Lachman test (rho = −0.18; P = .046) and KT-1000 arthrometer measurement (rho = −0.18; P = .040) but no association between the ACL-RSI and the pivot-shift test at the time of recruitment. Of the total patients, 36% returned to preinjury sport level by 2 years after surgery. Higher age, better psychological readiness, and less anterior tibial displacement (KT-1000 arthrometer measurement) were significant predictors of 2-year RTS (explained variance, 33%). Conclusion: Small but significant associations were found between measurements of psychological readiness and anterior tibial displacement, indicating that patients with less knee laxity after ACLR feel more ready to RTS. ACL-RSI and KT-1000 arthrometer measurements were independent predictors of 2-year RTS and should be considered in RTS assessments after ACLR.

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