Abstract
Purpose
The purpose of this study was to evaluate the correlation between tibial acceleration parameters measured by the KiRA device and the clinical grade of pivot shift. The secondary objective was to report the risk factors for pre-operative high-grade pivot shift.
Methods
Two-hundred and ninety-five ACL deficient patients were examined under anesthesia. The pivot shift tests were performed twice by an expert surgeon. Clinical grading was performed using the International Knee Documentation Committee (IKDC) scale and tibial acceleration data was recorded using a triaxial accelerometer system (KiRA). The difference in the tibial acceleration range between injured and contralateral limbs was used in the analysis. Correlation coefficients were calculated using linear regression. Multivariate logistic regression was used to identify risk factors for high grade pivot shift.
Results
The clinical grade of pivot shift and the side-to-side difference in delta tibial acceleration determined by KiRA were significantly correlated (r = 0.57; 95% CI 0.513–0.658, p < 0.0001). The only risk factor identified to have a significant association with high grade pivot shift was an antero-posterior side to side laxity difference > 6 mm (OR = 2.070; 95% CI (1.259–3.405), p = 0.0042).
Conclusion
Side-to-side difference in tibial acceleration range, as measured by KiRA, is correlated with the IKDC pivot shift grade in anaesthetized patients. Side-to-side A–P laxity difference greater than 6 mm is reported as a newly defined risk factor for high grade pivot shift in the ACL injured knee.
Diagnostic study
Level II.
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References
Ahldén M, Araujo P, Hoshino Y, Samuelsson K, Middleton KK, Nagamune K, Karlsson J, Musahl V (2012) Clinical grading of the pivot shift test correlates best with tibial acceleration. Knee Surg Sports Traumatol Arthrosc 20:708–712
Altman DG, Royston P (2006) The cost of dichotomising continuous variables. BMJ 332:1080
Amis AA, Cuomo P, Rama RBS, Giron F, Bull AMJ, Thomas R, Aglietti P (2008) Measurement of knee laxity and pivot-shift kinematics with magnetic sensors. Oper Tech Orthop 18:196–203
Bach BR, Warren RF, Wickiewicz TL (1988) The pivot shift phenomenon: results and description of a modified clinical test for anterior cruciate ligament insufficiency. Am J Sports Med 16:571–576
Bedi A, Musahl V, Lane C, Citak M, Warren RF, Pearle AD (2010) Lateral compartment translation predicts the grade of pivot shift: a cadaveric and clinical analysis. Knee Surg Sports Traumatol Arthrosc 18:1269–1276
Berruto M, Uboldi F, Gala L, Marelli B, Albisetti W (2013) Is triaxial accelerometer reliable in the evaluation and grading of knee pivot-shift phenomenon? Knee Surg Sports Traumatol Arthrosc 21:981–985
Bignozzi S, Zaffagnini S, Lopomo N, Fu FH, Irrgang JJ, Marcacci M (2010) Clinical relevance of static and dynamic tests after anatomical double-bundle ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 18:37–42
Branch T, Stinton S, Sharma A, Lavoie F, Guier C, Neyret P (2017) The impact of bone morphology on the outcome of the pivot shift test: a cohort study. BMC Musculoskelet Disord 18:463
Brandon ML, Haynes PT, Bonamo JR, Flynn MI, Barrett GR, Sherman MF (2006) The association between posterior and inferior tibial slope and anterior cruciate ligament insufficiency. Arthroscopy 22:894–899
Bull AMJ, Earnshaw PH, Smith A, Katchburian MV, Hassan ANA, Amis AA (2002) Intraoperative measurement of knee kinematics in reconstruction of the anterior cruciate ligament. J Bone Joint Surg Br 84:1075–1081
Colombet P, Robinson J, Christel P, Franceschi J-P, Djian P (2007) Using navigation to measure rotation kinematics during ACL reconstruction. Clin Orthop Relat Res 454:59–65
Dejour D, Pungitore M, Valluy J, Nover L, Saffarini M, Demey G (2018) Preoperative laxity in ACL-deficient knees increases with posterior tibial slope and medial meniscal tears. Knee Surg Sports Traumatol Arthrosc 27:564–572
van Eck CF, van den Bekerom MPJ, Fu FH, Poolman RW, Kerkhoffs GMMJ (2013) Methods to diagnose acute anterior cruciate ligament rupture: a meta-analysis of physical examinations with and without anaesthesia. Knee Surg Sports Traumatol Arthrosc 21:1895–1903
Espregueira-Mendes J, Pereira H, Sevivas N, Passos C, Vasconcelos JC, Monteiro A, Oliveira JM, Reis RL (2012) Assessment of rotatory laxity in anterior cruciate ligament-deficient knees using magnetic resonance imaging with Porto-knee testing device. Knee Surg Sports Traumatol Arthrosc 20:671–678
Feucht MJ, Salzmann GM, Bode G, Pestka JM, Kühle J, Südkamp NP, Niemeyer P (2015) Posterior root tears of the lateral meniscus. Knee Surg Sports Traumatol Arthrosc 23:119–125
Galano GJ, Suero EM, Citak M, Wickiewicz T, Pearle AD (2012) Relationship of native tibial plateau anatomy with stability testing in the anterior cruciate ligament-deficient knee. Knee Surg Sports Traumatol Arthrosc 20:2220–2224
Garth WP, Greco J, House MA (2000) The lateral notch sign associated with acute anterior cruciate ligament disruption. Am J Sports Med 28:68–73
Grassi A, Signorelli C, Urrizola F, Raggi F, Macchiarola L, Bonanzinga T, Zaffagnini S (2018) Anatomical features of tibia and femur: influence on laxity in the anterior cruciate ligament deficient knee. Knee 25:577–587
Hoshino Y, Kuroda R, Nagamune K, Araki D, Kubo S, Yamaguchi M, Kurosaka M (2012) Optimal measurement of clinical rotational test for evaluating anterior cruciate ligament insufficiency. Knee Surg Sports Traumatol Arthrosc 20:1323–1330
Hoshino Y, Kuroda R, Nagamune K, Yagi M, Mizuno K, Yamaguchi M, Muratsu H, Yoshiya S, Kurosaka M (2007) In vivo measurement of the pivot-shift test in the anterior cruciate ligament-deficient knee using an electromagnetic device. Am J Sports Med 35:1098–1104
Hoshino Y, Miyaji N, Nishida K, Nishizawa Y, Araki D, Kanzaki N, Kakutani K, Matsushita T, Kuroda R (2018) The concomitant lateral meniscus injury increased the pivot shift in the anterior cruciate ligament-injured knee. Knee Surg Sports Traumatol Arthrosc 27:646–651
Huang W, Zhang Y, Yao Z, Ma L (2016) Clinical examination of anterior cruciate ligament rupture: a systematic review and meta-analysis. Acta Orthop Traumatol Turc 50:22–31
Ishibashi Y, Tsuda E, Yamamoto Y, Tsukada H, Toh S (2009) Navigation evaluation of the pivot-shift phenomenon during double-bundle anterior cruciate ligament reconstruction: is the posterolateral bundle more important? Clin Orthop Relat Surg 25:488–495
Jakob RP, Stäubli HU, Deland JT (1987) Grading the pivot shift. Objective tests with implications for treatment. J Bone Joint Surg Br 69:294–299
Jonsson H, Riklund-Ahlström K, Lind J (2004) Positive pivot shift after ACL reconstruction predicts later osteoarthrosis: 63 patients followed 5–9 years after surgery. Acta Orthop Scand 75:594–599
Kaplan N, Wickiewicz TL, Warren RF (1990) Primary surgical treatment of anterior cruciate ligament ruptures. A long-term follow-up study. Am J Sports Med 18:354–358
Kocher MS, Steadman JR, Briggs KK, Sterett WI, Hawkins RJ (2004) Relationships between objective assessment of ligament stability and subjective assessment of symptoms and function after anterior cruciate ligament reconstruction. Am J Sports Med 32:629–634
Kujala UM, Nelimarkka O, Koskinen SK (1992) Relationship between the pivot shift and the configuration of the lateral tibial plateau. Arch Orthop Trauma Surg 111:228–229
Kuroda R, Hoshino Y, Kubo S, Araki D, Oka S, Nagamune K, Kurosaka M (2012) Similarities and differences of diagnostic manual tests for anterior cruciate ligament insufficiency: a global survey and kinematics assessment. Am J Sports Med 40:91–99
Kuroda R, Hoshino Y, Nagamune K, Kubo S, Nishimoto K, Araki D, Yamaguchi M, Yoshiya S, Kurosaka M (2008) Intraoperative measurement of pivot shift by electromagnetic sensors. Oper Tech Orthop 18:190–195
Labbe D, Deguise J, Godbout V, Fernandes J, Hagemeister N (2008) Development of an objective measurement tool for the pivot shift phenomenon of the knee. J Biomech 41:S207
Lane C, Warren R, Stanford F (2008) In vivo analysis of the pivot shift phenomenon during computer navigated ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 16:487–492
Logan MC, Williams A, Lavelle J, Gedroyc W, Freeman M (2004) What really happens during the Lachman test? A dynamic MRI analysis of tibiofemoral motion. Am J Sports Med 32:369–375
Lopomo N, Signorelli C, Bonanzinga T, Marcheggiani Muccioli GM, Visani A, Zaffagnini S (2012) Quantitative assessment of pivot-shift using inertial sensors. Knee Surg Sports Traumatol Arthrosc 20:713–717
Lopomo N, Signorelli C, Rahnemai-Azar AA, Raggi F, Hoshino Y, Samuelsson K, Musahl V, Karlsson J, Kuroda R, Zaffagnini S, PIVOT Study Group (2017) Analysis of the influence of anaesthesia on the clinical and quantitative assessment of the pivot shift: a multicenter international study. Knee Surg Sports Traumatol Arthrosc 25:3004–3011
Magnussen RA, Reinke EK, Huston LJ, Hewett TE, Spindler KP, MOON Group (2016) Factors associated with high-grade Lachman, pivot shift, and anterior drawer at the time of anterior cruciate ligament reconstruction. Arthroscopy 32:1080–1085
Monaco E, Ferretti A, Labianca L, Maestri B, Speranza A, Kelly MJ, D’Arrigo C (2012) Navigated knee kinematics after cutting of the ACL and its secondary restraint. Knee Surg Sports Traumatol Arthrosc 20:870–877
Muccioli GMM, Signorelli C, Grassi A, di Sarsina TR, Raggi F, Carbone G, Macchiarola L, Vaccari V, Zaffagnini S (2018) In-vivo pivot-shift test measured with inertial sensors correlates with the IKDC grade. J ISAKOS Jt Disord Orthop Sports Med 3:89–93
Muller B, Hofbauer M, Rahnemai-Azar AA, Wolf M, Araki D, Hoshino Y, Araujo P, Debski RE, Irrgang JJ, Fu FH, Musahl V (2016) Development of computer tablet software for clinical quantification of lateral knee compartment translation during the pivot shift test. Comput Methods Biomech Biomed Eng 19:217–228
Musahl V, Ayeni OR, Citak M, Irrgang JJ, Pearle AD, Wickiewicz TL (2010) The influence of bony morphology on the magnitude of the pivot shift. Knee Surg Sports Traumatol Arthrosc 18:1232–1238
Musahl V, Burnham J, Lian J, Popchak A, Svantesson E, Kuroda R, Zaffagnini S, Samuelsson K, PIVOT Study Group (2018) High-grade rotatory knee laxity may be predictable in ACL injuries. Knee Surg Sports Traumatol Arthrosc 26:3762–3769
Musahl V, Citak M, O’Loughlin PF, Choi D, Bedi A, Pearle AD (2010) The effect of medial versus lateral meniscectomy on the stability of the anterior cruciate ligament-deficient knee. Am J Sports Med 38:1591–1597
Musahl V, Kopf S, Rabuck S, Becker R, van der Merwe W, Zaffagnini S, Fu FH, Karlsson J (2012) Rotatory knee laxity tests and the pivot shift as tools for ACL treatment algorithm. Knee Surg Sports Traumatol Arthrosc 20:793–800
Musahl V, Voos J, O’Loughlin PF, Stueber V, Kendoff D, Pearle AD (2010) Mechanized pivot shift test achieves greater accuracy than manual pivot shift test. Knee Surg Sports Traumatol Arthrosc 18:1208–1213
Nagai K, Hoshino Y, Nishizawa Y, Araki D, Matsushita T, Matsumoto T, Takayama K, Nagamune K, Kurosaka M, Kuroda R (2015) Quantitative comparison of the pivot shift test results before and after anterior cruciate ligament reconstruction by using the three-dimensional electromagnetic measurement system. Knee Surg Sports Traumatol Arthrosc 23:2876–2881
Noyes FR, Grood ES, Cummings JF, Wroble RR (1991) An analysis of the pivot shift phenomenon. The knee motions and subluxations induced by different examiners. Am J Sports Med 19:148–155
Okazaki K, Miura H, Matsuda S, Yasunaga T, Nakashima H, Konishi K, Iwamoto Y, Hashizume M (2007) Assessment of anterolateral rotatory instability in the anterior cruciate ligament-deficient knee using an open magnetic resonance imaging system. Am J Sports Med 35:1091–1097
Ouanezar H, Blakeney WG, Fernandes LR, Borade A, Latrobe C, Temponi EF, Sonnery-Cottet B (2018) Clinical outcomes of single anteromedial bundle biologic augmentation technique for anterior cruciate ligament reconstruction with consideration of tibial remnant size. Arthroscopy 34:714–722
Pearle AD, Kendoff D, Musahl V, Warren RF (2009) The pivot-shift phenomenon during computer-assisted anterior cruciate ligament reconstruction. J Bone Joint Surg Am 91(Suppl 1):115–118
Pfeiffer TR, Kanakamedala AC, Herbst E, Nagai K, Murphy C, Burnham JM, Popchak A, Debski RE, Musahl V (2018) Female sex is associated with greater rotatory knee laxity in collegiate athletes. Knee Surg Sports Traumatol Arthrosc 26:1319–1325
Plaweski S, Grimaldi M, Courvoisier A, Wimsey S (2011) Intraoperative comparisons of knee kinematics of double-bundle versus single-bundle anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 19:1277–1286
Rahnemai-Azar AA, Abebe ES, Johnson P, Labrum J, Fu FH, Irrgang JJ, Samuelsson K, Musahl V (2017) Increased lateral tibial slope predicts high-grade rotatory knee laxity pre-operatively in ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 25:1170–1176
Saita Y, Schoenhuber H, Thiébat G, Ravasio G, Pozzoni R, Panzeri A, Galli M, Nagao M, Takazawa Y, Ikeda H, Kaneko K (2018) Knee hyperextension and a small lateral condyle are associated with greater quantified antero-lateral rotatory instability in the patients with a complete anterior cruciate ligament (ACL) rupture. Knee Surg Sports Traumatol Arthrosc 27:868–874
Song G, Zhang H, Wang Q, Zhang J, Li Y, Feng H (2016) Risk factors associated with grade 3 pivot shift after acute anterior cruciate ligament injuries. Am J Sports Med 44:362–369
Song G-Y, Zhang H, Liu X, Zhang J, Xue Z, Qian Y, Feng H (2017) Complete posterolateral meniscal root tear is associated with high-grade pivot-shift phenomenon in noncontact anterior cruciate ligament injuries. Knee Surg Sports Traumatol Arthrosc 25:1030–1037
Tanaka T, Hoshino Y, Miyaji N, Ibaragi K, Nishida K, Nishizawa Y, Araki D, Kanzaki N, Matsushita T, Kuroda R (2018) The diagnostic reliability of the quantitative pivot-shift evaluation using an electromagnetic measurement system for anterior cruciate ligament deficiency was superior to those of the accelerometer and iPad image analysis. Knee Surg Sports Traumatol Arthrosc 26:2835–2840
Yamamoto Y, Ishibashi Y, Tsuda E, Tsukada H, Maeda S, Toh S (2010) Comparison between clinical grading and navigation data of knee laxity in ACL-deficient knees. Sports Med Arthrosc Rehabil Ther Technol SMARTT 2:27
Zaffagnini S, Lopomo N, Signorelli C, Marcheggiani Muccioli GM, Bonanzinga T, Grassi A, Visani A, Marcacci M (2013) Innovative technology for knee laxity evaluation: clinical applicability and reliability of inertial sensors for quantitative analysis of the pivot-shift test. Clin Sports Med 32:61–70
Zaffagnini S, Signorelli C, Grassi A, Yue H, Raggi F, Urrizola F, Bonanzinga T, Marcacci M (2016) Assessment of the pivot shift using inertial sensors. Curr Rev Musculoskelet Med 9:160–163
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One or more of the authors has declared the following potential conflict of interest or source of funding: B.S.-C. receives royalties from, is a paid consultant for, receives research support from, and has made presentations for Arthrex Inc. M.T. is a paid consultant for, receives research support from, and has made presentations for Arthrex. J-M.F. is a paid consultant, receives research support and has made presentations for Arthrex. A.S. is a paid consultant for Arthrex.
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Institutional review board approval (COS-RGDS-2018-07-002) was granted for this study. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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Helfer, L., Vieira, T.D., Praz, C. et al. Triaxial accelerometer evaluation is correlated with IKDC grade of pivot shift. Knee Surg Sports Traumatol Arthrosc 28, 381–388 (2020). https://doi.org/10.1007/s00167-019-05563-7
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DOI: https://doi.org/10.1007/s00167-019-05563-7