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 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.

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 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

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

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.

scholarly journals Increased Rotatory Laxity after Anterolateral Ligament Lesion in Anterior Cruciate Ligament- (ACL-) Deficient Knees: A Cadaveric Study with Noninvasive Inertial Sensors

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Alberto Grassi ◽  
Tommaso Roberti di Sarsina ◽  
Stefano Di Paolo ◽  
Cecilia Signorelli ◽  
Tommaso Bonanzinga ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Anterolateral Ligament ◽  
Sensor Technology ◽  
Triaxial Accelerometer ◽  
Rotatory Laxity ◽  
Intact State ◽  
Anterior Cruciate ◽  
Acl Deficient ◽  
Deficient Knee

The anterolateral ligament (ALL) has been suggested as an important secondary knee restrain on the dynamic laxity in anterior cruciate ligament- (ACL-) deficient knees. Nevertheless, its kinematical contribution to the pivot-shift (PS) phenomenon has not been clearly and objectively defined, and noninvasive sensor technology could give a crucial contribution in this direction. The aim of the present study was to quantify in vitro the PS phenomenon in order to investigate the differences between an ACL-deficient knee and an ACL+ALL-deficient knee. Ten fresh-frozen paired human cadaveric knees ( n = 20 ) were included in this controlled laboratory study. Intact, ACL-deficient, and ACL+ALL-deficient knees were subjected to a manual PS test quantified by a noninvasive triaxial accelerometer (KiRA, OrthoKey). Kinematic data (i.e., posterior acceleration of the tibial lateral compartment) were recorded and compared among the three statuses. Pairwise Student’s t -test was used to compare the single groups ( p < 0.05 ). Intact knees, ACL-deficient knees, and ACL+ALL-deficient knees showed an acceleration of 5.3 ± 2.1  m/s2, 6.3 ± 2.3  m/s2, and 7.8 ± 2.1  m/s2, respectively. Combined sectioning of ACL and ALL resulted in a statistically significant acceleration increase compared to both the intact state ( p < 0.01 ) and the ACL-deficient state ( p < 0.01 ). The acceleration increase determined by isolated ACL resection compared to the intact state was not statistically significant ( p > 0.05 ). The ALL sectioning increased the rotatory laxity during the PS after ACL sectioning as measured through a user-friendly, noninvasive triaxial accelerometer.

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