Analysis of the influence of anaesthesia on the clinical and quantitative assessment of the pivot shift: a multicenter international study

Lopomo, N.; Signorelli, Cecilia; Rahnemai‐Azar, Amir A.; Raggi, Federico; Hoshino, Yuichi; Samuelsson, Kristian; Musahl, Volker; Karlsson, Jón; Kuroda, Ryosuke; Zaffagnini, Stefano

doi:10.1007/s00167-016-4130-1

Cited by 26 publications

(21 citation statements)

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“…On the other hand, when patients were under anesthesia, there was a significant difference in posterior tibial acceleration [45]. Similarly, Lopomo et al found significant differences in acceleration and anteroposterior translation when comparing awake and anesthetized patients [46]. Consequently, it is fair to assume that examinations performed under general anesthesia are more precise in the determination of rotatory knee laxity in patients.…”

Section: Discussionmentioning

confidence: 99%

Correlation between quantitative pivot shift and generalized joint laxity: a prospective multicenter study of ACL ruptures

Sundemo

Blom²,

Hoshino

et al. 2017

Knee Surg Sports Traumatol Arthrosc

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PurposeTo investigate whether an increased magnitude of quantitative rotatory knee laxity is associated with a greater level of generalized joint laxity in ACL-injured and contralateral knees.MethodsA total of 103 patients were enrolled across four international centers to undergo anatomic ACL reconstruction. Rotatory knee laxity was evaluated preoperatively, both in the awake state and under anesthesia, using the standardized pivot shift test. Two devices were used to quantify rotatory knee laxity; an inertial sensor, measuring the joint acceleration, and an image analysis system, measuring the lateral compartment translation of the tibia. The presence of generalized joint laxity was determined using the Beighton Hypermobility Score. The correlation between the level of generalized joint laxity and the magnitude of rotatory knee laxity was calculated for both the involved knee and the non-involved knee. Further, patients were dichotomized into low (0–4) or high (5–9) Beighton Score groups. Alpha was set at < 0.05.ResultsNinety-six patients had complete datasets, 83 and 13 in the low and high Beighton Score groups respectively. In anesthetized patients, there was a significant correlation between the degree of Beighton Score and quantitative pivot shift when analyzing the non-involved knee using the image analysis system (r = 0.235, p < 0.05). When analyzing the same knee, multivariate analysis adjusted for meniscal injury, age and gender revealed an increased odds ratio for patients with increased lateral compartment translation to be part of the high Beighton Score group (OR 1.86, 95% CI 1.10–3.17, p < 0.05). No other correlation was significant. When analyzing the dichotomized subgroups, no significant correlations could be established.ConclusionThe findings in this study suggest that there is a weak correlation between generalized joint laxity and the contralateral healthy knee, indicating increased rotatory knee laxity in these patients. Generalized joint laxity does not appear to correlate with rotatory knee laxity in ACL-injured knees.Level of evidenceProspective cohort study; level of evidence, 2.

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Section: Discussionmentioning

confidence: 99%

Correlation between quantitative pivot shift and generalized joint laxity: a prospective multicenter study of ACL ruptures

Sundemo

Blom²,

Hoshino

et al. 2017

Knee Surg Sports Traumatol Arthrosc

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“…This study was part of a multicenter, prospective, observational cohort study, the Prospective International Validation of Outcome Technology (PIVOT) trial, at 4 international centers using a published study protocol. 20,26 Patients between 14 and 50 years of age who presented with a primary ACL injury and underwent surgery between December 2012 and February 2015 were included. Further inclusion criteria were at least 1 injured ACL bundle (evaluated on MRI) with surgery performed within 1 year of injury.…”

Section: Methodsmentioning

confidence: 99%

“…With the patient under general anesthesia, a standardized pivot-shift test was performed at all centers preoperatively in the operating room ( Figure 2 ). 20 The pivot-shift test was repeated with nonsterile devices immediately after surgery with the patient still in the operating room and under general anesthesia. Both times, the pivot-shift test was performed on the injured and contralateral healthy sides by an experienced orthopaedic surgeon to determine the side-to-side difference.…”

Section: Methodsmentioning

confidence: 99%

“…19,25,27 The pivot-shift test has been used both preoperatively and immediately postoperatively with the patient under anesthesia to assess rotatory knee laxity. 20,39 Although many factors, such as bony morphology and soft tissue injuries, 16,28,29,31,32 influence rotatory stability, anatomic single-bundle ACL reconstruction (ACLR) is effective in restoring rotational stability as measured by the pivot-shift test. 39 A persistent increased pivot shift after ACLR may be associated with an increased risk of cartilage and meniscal lesions.…”

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confidence: 99%

“… 19 , 25 , 27 The pivot-shift test has been used both preoperatively and immediately postoperatively with the patient under anesthesia to assess rotatory knee laxity. 20 , 39 …”

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confidence: 99%

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Patient-Reported and Quantitative Outcomes of Anatomic Anterior Cruciate Ligament Reconstruction With Hamstring Tendon Autografts

Diermeier

Meredith

Irrgang

et al. 2020

Orthopaedic Journal of Sports Medicine

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Background: The pivot-shift test has become more consistent and reliable and is a meaningful outcome measurement after anterior cruciate ligament reconstruction (ACLR). Purpose/Hypothesis: The purpose of this investigation was to assess patient-reported outcomes (PROs) and the quantitative pivot shift (QPS) preoperatively, at time zero immediately after anatomic ACLR, and after 24 months as well as the relationship between PROs and the QPS. It was hypothesized that anatomic ACLR would restore rotatory stability measured by the pivot-shift test and that QPS measurements would be positively correlated with PROs. Study Design: Cohort study; Level of evidence, 2. Methods: The ACL-injured and contralateral uninjured knees from 89 of 107 (83.2%) enrolled patients at 4 international centers were evaluated using a standardized pivot-shift test. Tibial acceleration was assessed with an inertial sensor, and lateral compartment translation was measured using an image analysis system preoperatively, at time zero immediately postoperatively, and at follow-up after 2 years. PROs were assessed at 12 and 24 months postoperatively with the International Knee Documentation Committee (IKDC) subjective knee form, Cincinnati Knee Rating System (CKRS), Marx activity rating scale, and activity of daily living score (ADLS). Results: The mean patient age at surgery was 27 years (range, 15-45 years). A positive pivot shift preoperatively (side-to-side difference in tibial acceleration, 2.6 ± 4.0 m/s2; side-to-side difference in anterior tibial translation, 2.0 ± 2.0 mm) was reduced at time zero postoperatively (side-to-side difference in tibial acceleration, –0.5 ± 1.3 m/s2; side-to-side difference in anterior tibial translation, –0.1 ± 1.0 mm). All PROs improved from preoperatively to final follow-up at 24 months: from 56.5 to 85.5 points for the IKDC ( P = .0001), from 28.8 to 32.4 points for the CKRS ( P = .04), from 11.2 to 7.9 points for the Marx ( P < .0001), and from 75.7 to 91.6 points for the ADLS ( P < .0001). Neither preoperative nor time zero postoperative rotatory laxity assessed by the pivot-shift test correlated with PROs at 24-month follow-up. A graft retear was observed in 4 patients (4.5%) within 2 years of follow-up. Conclusion: Anatomic ACLR resulted in significantly improved and acceptable PROs at 2-year follow-up and a low failure rate. Anatomic ACLR restored QPS measurements of anterior tibial translation and tibial acceleration to those of the contralateral knee immediately after surgery while still under anesthesia, but there was no correlation between the QPS preoperatively or at time zero after ACLR and PROs at 2-year follow-up.

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Multicenter Study: How to Pull It Off? The PIVOT Trial

Svantesson

Senorski

Oostdyk

et al. 2019

Basic Methods Handbook for Clinical Orthopaedic Research

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Analysis of the influence of anaesthesia on the clinical and quantitative assessment of the pivot shift: a multicenter international study

Abstract: Prospective comparative study, Level II.

Cited by 26 publications

References 48 publications

Correlation between quantitative pivot shift and generalized joint laxity: a prospective multicenter study of ACL ruptures

Correlation between quantitative pivot shift and generalized joint laxity: a prospective multicenter study of ACL ruptures

Patient-Reported and Quantitative Outcomes of Anatomic Anterior Cruciate Ligament Reconstruction With Hamstring Tendon Autografts

Multicenter Study: How to Pull It Off? The PIVOT Trial

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