Implications of the Pivot Shift in the ACL-Deficient Knee

2005 ◽  
Vol &NA; (436) ◽  
pp. 229-236 ◽  
Author(s):  
Zachary Leitze ◽  
Ron E Losee ◽  
Peter Jokl ◽  
Thomas R Johnson ◽  
John A Feagin
Keyword(s):  
Pivot Shift ◽  
Acl Deficient ◽  
Deficient Knee

scholarly journals Effect of meniscal root tear on pivot shift test after anterior cruciate ligament-deficient

2020 ◽  
Vol 8 (9_suppl7) ◽  
pp. 2325967120S0052
Author(s):  
Ming Zhou
Keyword(s):  
Pivot Shift ◽  
Cruciate Ligament ◽  
Lateral Meniscus ◽  
Pivot Shift Test ◽  
High Grade ◽  
Posterior Root ◽  
Meniscal Root Tear ◽  
Tibial Translation ◽  
Acl Deficient ◽  
Deficient Knee

Introduction: A review of the literature demonstrates that injury of the lateral meniscus, anterolateral capsule, and iliotibial(IT ) band or small lateral tibial plateau aggravate the instability of knee and contributes to a high-grade pivot shift in the ACL-deficient knee. Hypotheses: The hypothesis was that disruption of posterior root of the lateral meniscus will further destabilize the ACL-deficient knee and simulated a high-grade pivot shift but posterior root of medial meniscal not. Methods: 6 fresh-frozen cadaveric knees was performed the next test in a custom activity simulator.1.Determine the effect of PRLMT on the stability of ACL-deficient knee.In the pivot shift test, ITB force (50, 75, 100, 125, 150, and 175 N), internal rotation moments (1, 2, and 3 N.m),and valgus moments (5 and 7 N.m). tibial translation of front drawer test were performed by applying a 90-N anterior

Effect of Femoral Antetorsion on Tibiofemoral Translation and Rotation in the Anterior Cruciate Ligament Deficient Knee

2018 ◽  
Vol 32 (10) ◽  
pp. 960-965
Author(s):  
Mohamed Omar ◽  
Yousif Al Saiegh ◽  
Emmanouil Liodakis ◽  
Timo Stuebig ◽  
Daniel Guenther ◽  
...  
Keyword(s):  
Distal Femur ◽  
Pivot Shift ◽  
Cruciate Ligament ◽  
Anterior Tibial Translation ◽  
Tibial Rotation ◽  
Femoral Antetorsion ◽  
Anterior Drawer ◽  
Tibial Translation ◽  
Acl Deficient ◽  
Deficient Knee

AbstractWe aimed to investigate how increased or decreased femoral antetorsion would affect the biomechanics of the knee in an anterior cruciate ligament (ACL)-deficient cadaveric model. We hypothesized that external or internal rotation of the distal femur, achieved through a femoral osteotomy, would affect the magnitude of tibiofemoral translation and rotation. Navigated measurements of tibiofemoral translation and rotation during the anterior drawer, Lachman, and pivot shift tests were performed on six whole-body cadaveric specimens in each of the following four conditions: native, ACL-deficient knee, ACL-deficient knee and 20-degree internal distal femur rotation, and ACL-deficient knee and 20-degree external distal femur rotation. Increased femoral antetorsion significantly reduced anterior tibial translation in the ACL-deficient knee during the anterior drawer, Lachman, and pivot shift tests (p < 0.05). Conversely, decreasing femoral antetorsion resulted in an increase in anterior tibial translation in the anterior drawer (nonsignificant), Lachman (p < 0.05), and pivot shift (p < 0.05) tests. Internally rotating the distal femur significantly reduced the magnitude of tibial rotation during the pivot shift test in the ACL-deficient knee (p < 0.05), whereas external rotation of the distal femur significantly increased tibial rotation (p < 0.05). The magnitude of femoral antetorsion affects tibiofemoral translation in an ACL-deficient cadaveric mode. Internally rotating the distal femur 20 degrees reduced the magnitude of tibial translation and rotation similar to that of the native knee, whereas externally rotating the distal femur aggravated translational and rotational instability.

There Are No Kinematic Differences Between Inframeniscal and Suprameniscal Anterolateral Ligament Injury in the Anterior Cruciate Ligament–Deficient Knee

2018 ◽  
Vol 46 (14) ◽  
pp. 3391-3399 ◽  
Author(s):  
Timothy A. Burkhart ◽  
Manoj Matthew ◽  
W. Scott McGuffin ◽  
Alexandra Blokker ◽  
David Holdsworth ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Internal Rotation ◽  
Knee Flexion ◽  
Pivot Shift ◽  
Cruciate Ligament ◽  
Lateral Meniscus ◽  
Anterolateral Ligament ◽  
Anterior Cruciate ◽  
Acl Deficient ◽  
Deficient Knee

Background: Previous research demonstrated that the attachment of the anterolateral ligament (ALL) to the lateral meniscus is stiffer and stronger in its tibial attachment than its femoral attachment. How this relates to anterolateral knee stability and lateral meniscal function is unknown. Hypothesis/Purpose: The hypothesis was that the ALL acts as a peripheral anchor to the lateral meniscus, aiding in anterolateral rotatory stability, and that the inframeniscal fibers of the ALL will provide greater anterolateral rotatory stability because of their greater tensile properties. The purpose was therefore to compare the difference in kinematics of the anterior cruciate ligament (ACL)–deficient knee between the infra- and suprameniscal ALL-sectioned states. Study Design: Controlled laboratory study. Methods: Eight paired fresh-frozen cadaveric knees were tested in a 5–degree of freedom loading jig under the following loading conditions: 5-N·m internal rotation at 15° incremental angles of flexion and combined 5-N·m internal rotation moment, 10-N·m valgus moment, and 88-N anterior translation force representing a pivot shift test at 0°, 15°, and 30° of flexion. The knees were tested under intact, ACL-deficient, and ACL-/ALL-deficient conditions, with the pairs of knees being randomized to either supra- or inframeniscal ALL sectioning. Resultant joint kinematics and tibiofemoral translations were measured and compared with a 2-way mixed repeated measures analysis of variance. Results: Internal rotation increased by 3° after sectioning of the ACL at 0° of knee flexion ( P = .035). At 45° of knee flexion, internal rotation increased significantly by 2° between the ACL-deficient and the ACL-/ALL-deficient conditions ( P = .049). Secondary kinematics of valgus and anterior translation were observed in response to the 5-N·m load after ACL and ALL sectioning. Analysis of the pivot shift showed increases in tibiofemoral translation after sectioning of the ACL, with further translations after sectioning of the ALL. No differences were observed between supra- and inframeniscal ALL sectioning under any of the loading conditions. Conclusion: An injury to the ALL, coexisting with ACL deficiency, results in only minor increases in knee joint patholaxity. No differences in pivot-shift kinematics or tibiofemoral rotations were observed between the supra- and inframeniscal sectioning of the ALL in the ACL-deficient knee Clinical Relevance: Tears of the midbody and/or posterior root attachment of the lateral meniscus are often observed at the time of ACL reconstruction. Increased anterolateral rotatory laxity has been observed in both lateral meniscus– and ALL-deficient states in combination with an ACL injury. While no significant functional relationship was found between the ALL and lateral meniscus, ALL sectioning did result in increased knee joint patholaxity, as demonstrated by composite tibiofemoral rotations.

scholarly journals Comparison of the use of a laximeter and a triaxial accelerometer for Anterolateral ligament injury diagnosis in ACL deficient knee

2019 ◽  
Vol 7 (5_suppl3) ◽  
pp. 2325967119S0020
Author(s):  
Thomas Neri ◽  
Antoine Lamotte ◽  
Tommaso Bonanzinga ◽  
Frederic Farizon ◽  
Remi Philippot
Keyword(s):  
Pivot Shift ◽  
Anterolateral Ligament ◽  
Ligament Injury ◽  
Pivot Shift Test ◽  
Anterior Tibial Translation ◽  
Triaxial Accelerometer ◽  
Tibial Translation ◽  
Acl Deficient ◽  
Deficient Knee ◽  
Intact Knee

Objectives: The objective of this study was to compare the use of a laximeter and a triaxial accelerometer, for Anterolateral ligament injury diagnosis of in ACL deficient knee. We hypothesized that a triaxial accelerometer was more effective than a laximeter. Methods: A total of 11 cadaver knees were studied according to a new conservative dissection protocol without damage to the lateral structures. A GnRB® laximeter (Genourob, France) was used to determine anterior tibial translation (AP) of the tibia. Simultaneously, a KiRA® triaxial accelerometer (Kinetic Rapid Assessment) (OrthoKey, Italy) was used to determine two parameters: the AP translation and the Pivot Shift (PS). For each knee, 5 conditions were successively applied: intact knee (intact), knee with ALL (ALLsec) isolated section, knee with ALL and ACL section (ALL + ACLsec). Results: For the laximeter, the ACL and ALL sections led to a significant AP translation increase: + 2.1 mm for the ACL section, and + 0.9 mm for the ALL section. This difference was significant regardless of the level of force applied (p <0.05). For the triaxial accelerometer, the ACL and the ALL sections led to a significant AP translation increase: + 2.8 mm for ACL, and + 1.5 mm for ALL section. In contrast, for the PS, the increase was more consistent. There was a multiplier factor between the ACLsec condition and the ACL + ALLsec condition comparable to that between the intact condition and the ACLsec condition (P> 0.05). Conclusion: Whatever the device, the AP translation difference induced by the ALL injury, of the order of mm, remains too small to make the diagnosis of an ALL injury. The evaluation of the AP translation is therefore not a relevant to diagnostic an ALL injury. With greater increase, the evaluation of the rotatory laxity, through the PS test, is more relevant. In current practice, there is no clinical interest to use a laximeter or accelerometer on AP translation assessment to diagnosis an ALL injury in a deficient ACL knee. On the other hand, the use of a triaxial accelerometer to quantify the lateral tibial plateau acceleration in the pivot shift test appears to be relevant for detecting an ALL injury on a deficient ACL knee. These findings help provide clinical guidelines for more effective objective measures to diagnose ALL injury, and determine the most effective management for each patient.

Anterolateral Knee Extra-articular Stabilizers: A Robotic Sectioning Study of the Anterolateral Ligament and Distal Iliotibial Band Kaplan Fibers

2018 ◽  
Vol 46 (6) ◽  
pp. 1352-1361 ◽  
Author(s):  
Andrew G. Geeslin ◽  
Jorge Chahla ◽  
Gilbert Moatshe ◽  
Kyle J. Muckenhirn ◽  
Bradley M. Kruckeberg ◽  
...  
Keyword(s):  
Internal Rotation ◽  
Pivot Shift ◽  
Iliotibial Band ◽  
Anterior Tibial Translation ◽  
Tibial Internal Rotation ◽  
Anterior Tibial ◽  
Robotic Testing ◽  
Tibial Translation ◽  
Acl Deficient ◽  
Deficient Knee

Background: The individual kinematic roles of the anterolateral ligament (ALL) and the distal iliotibial band Kaplan fibers in the setting of anterior cruciate ligament (ACL) deficiency require further clarification. This will improve understanding of their potential contribution to residual anterolateral rotational laxity after ACL reconstruction and may influence selection of an anterolateral extra-articular reconstruction technique, which is currently a matter of debate. Hypothesis/Purpose: To compare the role of the ALL and the Kaplan fibers in stabilizing the knee against tibial internal rotation, anterior tibial translation, and the pivot shift in ACL-deficient knees. We hypothesized that the Kaplan fibers would provide greater tibial internal rotation restraint than the ALL in ACL-deficient knees and that both structures would provide restraint against internal rotation during a simulated pivot-shift test. Study Design: Controlled laboratory study. Methods: Ten paired fresh-frozen cadaveric knees (n = 20) were used to investigate the effect of sectioning the ALL and the Kaplan fibers in ACL-deficient knees with a 6 degrees of freedom robotic testing system. After ACL sectioning, sectioning was randomly performed for the ALL and the Kaplan fibers. An established robotic testing protocol was utilized to assess knee kinematics when the specimens were subjected to a 5-N·m internal rotation torque (0°-90° at 15° increments), a simulated pivot shift with 10-N·m valgus and 5-N·m internal rotation torque (15° and 30°), and an 88-N anterior tibial load (30° and 90°). Results: Sectioning of the ACL led to significantly increased tibial internal rotation (from 0° to 90°) and anterior tibial translation (30° and 90°) as compared with the intact state. Significantly increased internal rotation occurred with further sectioning of the ALL (15°-90°) and Kaplan fibers (15°, 60°-90°). At higher flexion angles (60°-90°), sectioning the Kaplan fibers led to significantly greater internal rotation when compared with ALL sectioning. On simulated pivot-shift testing, ALL sectioning led to significantly increased internal rotation and anterior translation at 15° and 30°; sectioning of the Kaplan fibers led to significantly increased tibial internal rotation at 15° and 30° and anterior translation at 15°. No significant difference was found when anterior tibial translation was compared between the ACL/ALL- and ACL/Kaplan fiber–deficient states on simulated pivot-shift testing or isolated anterior tibial load. Conclusion: The ALL and Kaplan fibers restrain internal rotation in the ACL-deficient knee. Sectioning the Kaplan fibers led to greater tibial internal rotation at higher flexion angles (60°-90°) as compared with ALL sectioning. Additionally, the ALL and Kaplan fibers contribute to restraint of the pivot shift and anterior tibial translation in the ACL-deficient knee. Clinical Relevance: This study reports that the ALL and distal iliotibial band Kaplan fibers restrain anterior tibial translation, internal rotation, and pivot shift in the ACL-deficient knee. Furthermore, sectioning the Kaplan fibers led to significantly greater tibial internal rotation when compared with ALL sectioning at high flexion angles. These results demonstrate increased rotational knee laxity with combined ACL and anterolateral extra-articular knee injuries and may allow surgeons to optimize the care of patients with this injury pattern.

Static anteroposterior knee laxity tests are poorly correlated to quantitative pivot shift in the ACL-deficient knee: a prospective multicentre study

2018 ◽  
Vol 3 (2) ◽  
pp. 83-88 ◽  
Author(s):  
Eleonor Svantesson ◽  
Eric Hamrin Senorski ◽  
Julia Mårtensson ◽  
Stefano Zaffagnini ◽  
Ryosuke Kuroda ◽  
...  
Keyword(s):  
Pivot Shift ◽  
High Grade ◽  
Static Tests ◽  
Anterior Drawer ◽  
Non Invasive ◽  
Kt 1000 ◽  
Quantitative Pivot Shift ◽  
Tibial Translation ◽  
Acl Deficient ◽  
Deficient Knee

ObjectiveTo determine the relationship between preoperative static knee joint laxity and non-invasive quantitative pivot shift (QPS) in patients with anterior cruciate ligament (ACL) rupture.MethodsPatients with an ACL injury participating in a multicentre trial were analysed if they had complete preoperative data on the following laxity tests: the rolimeter, the KT-1000 (134 N and manual maximum force), the Lachman, the anterior drawer and QPS. The QPS was assessed via a non-invasive inertial sensor system and an image analysis system for tibial acceleration and lateral tibial translation, respectively. Awake examination and examination under anaesthesia (EUA) were performed. Correlation between absolute values of static laxity and the QPS for each leg was assessed by Spearman’s rho. The Lachman and the anterior drawer were dichotomised into low- and high-grade, and differences between the groups in terms of continuous values of QPS were assessed.ResultsA total of 58 patients were included (41.4% women, mean age 27.1±9.8 years). Awake static laxity and QPS acceleration were negatively correlated in the ACL-deficient knee, meaning that a greater acceleration correlated to a lesser static tibial translation, and vice versa. The mean QPS acceleration correlated with the static tests as follows: the rolimeter r=−0.30 (P=0.024), the KT-1000 134 N r=−0.25 (P=0.06) and the KT-1000 manual maximum r=−0.37 (P=0.004). A negative correlation between awake QPS acceleration and the static tests was also shown for the non-involved knee. Patients with a high-grade Lachman’s test in the EUA had significantly greater QPS acceleration (P=0.0002) and QPS translation (P<0.001) compared with patients with a low-grade. The corresponding analysis for the anterior drawer showed a significantly greater QPS translation in the high-grade group (P=0.01), while no differences were found in the QPS acceleration.ConclusionStatic anteroposterior and dynamic knee laxities, as presented by QPS, are poorly correlated in the ACL-deficient knee and should therefore be considered as separate entities of the knee examination. These findings strengthen the implementation of non-invasive technology for quantification of the pivot shift when establishing treatment algorithms for ACL reconstruction.Level of evidenceLevel III, prospective cohort.

scholarly journals Elimination of the Pivot-Shift Sign After Repair of an Occult Anterolateral Ligament Injury in an ACL-Deficient Knee

2017 ◽  
Vol 5 (9) ◽  
pp. 232596711772887 ◽  
Author(s):  
Edoardo Monaco ◽  
Bertrand Sonnery-Cottet ◽  
Matt Daggett ◽  
Adnan Saithna ◽  
Camilo Partezani Helito ◽  
...  
Keyword(s):  
Pivot Shift ◽  
Anterolateral Ligament ◽  
Ligament Injury ◽  
Acl Deficient ◽  
Deficient Knee

scholarly journals Is the KiRA Device Useful in Quantifying the Pivot Shift in Anterior Cruciate Ligament–Deficient Knees?

2021 ◽  
Vol 9 (1) ◽  
pp. 232596712097786
Author(s):  
Richard J. Napier ◽  
Julian A. Feller ◽  
Brian M. Devitt ◽  
Jodie A. McClelland ◽  
Kate E. Webster ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Pivot Shift ◽  
Cruciate Ligament ◽  
Range Data ◽  
Output Data ◽  
Anterior Cruciate ◽  
Grade 3 ◽  
Injured Knee ◽  
Acl Deficient ◽  
Deficient Knee

Background: Various technologies have been developed to quantify the pivot shift, as it is regarded as a key indicator of anterolateral rotatory laxity of the knee. Purpose: To determine the usefulness of a commercially available triaxial accelerometer (Kinematic Rapid Assessment [KiRA]) in numerically quantifying the pivot shift in patients under anesthesia with an anterior cruciate ligament (ACL)–deficient knee. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: Both knees of 50 patients (26 male [mean age, 30.4 years], 24 female [mean age, 26.6 years]) under anesthesia were assessed immediately before unilateral ACL reconstruction by an orthopaedic fellow and 1 of 3 experienced knee surgeons. The pivot-shift grade and 2 KiRA outputs (range of acceleration and slope of acceleration change) were compared. Results: The surgeon and fellow recorded the same pivot-shift grade for 45 of 50 patients (90%). Data from the 5 patients with no agreement and 1 patient with extreme outlying data were excluded from subsequent analysis. Using the KiRA range and slope data, the surgeon identified the injured knee in 74% and 76% of patients, respectively, while the fellow’s rate of injured knee identification was 74% and 80%, respectively. A correlation could be found only between pivot-shift grade and surgeon-derived range data ( ρ = 0.40; P < .01) but not slope data or any fellow-derived outputs. Using the surgeon-derived range data, there was a significant difference between a grade 3 pivot (>5 m/s2) and a grade 1 or 2 pivot (<5 m/s2) ( P = .01). Conclusion: Although a correlation between KiRA output data and pivot-shift grade was found when the device was used by an experienced surgeon, there was no correlation when used by a well-trained but less experienced orthopaedic fellow. Furthermore, the KiRA output data identified the ACL-deficient knee correctly in only 74% of patients. Although a threshold acceleration range value could be identified, above which the value was associated with a grade 3 pivot shift, this was dependent on the examiner, and distinction between other grades could not be made.

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