Experimental Execution of the Simulated Pivot-Shift Test: A Systematic Review of Techniques

The Pivot Shift: Current Experimental Methodology and Clinical Utility for Anterior Cruciate Ligament Rupture and Associated Injury

“…The pivot shift can be inherently difficult to perform, and significant variability can exist between different examiners [18,19]. The most commonly cited method of performing the pivot shift is: flexing the knee from 0°(full extension) to 90°of knee flexion while applying an external rotation stress to the tibia and a valgus stress to the knee [20]. A positive test is seen with a rapid anterior subluxation of the tibia at 20-30°of flexion as it reduces under the femoral condyles.…”

“…Study methodology varies frequently in outcome measure, manual versus mechanized testing, awake versus anesthetized testing, gravity-assisted pivot shift testing, or other subtle nuances in leg positioning while achieving the pivot shift. A number of in vitro cadaveric studies have been performed to simulate the pivot shift using a variety of different outcome measures including internal rotation torque, valgus torque, and iliotibial tract tension [20]. The outcomes most frequently reported are lateral compartment translation and tibial internal rotation.…”

Regarding “Experimental Execution of the Simulated Pivot-Shift Test: A Systematic Review of Techniques”

“…We also read with great interest their recent paper regarding simulation of the pivot-shift test, but unfortunately this paper was not available when we performed the literature review. 1 To elicit a pivot-shift phenomenon, clinicians apply complex and changing loads throughout the range of flexion. However, these loading conditions have not been elucidated yet to serve as inputs to robotic testing systems.…”

“…I would like to provide a comment on the article "Experimental Execution of the Simulated Pivot-Shift Test: A Systematic Review of Techniques" by Arilla et al 1 and a different viewpoint on the authors' conclusions for recommended techniques for in vitro simulation of the pivot-shift test.…”

In situ force in the anterior cruciate ligament, the lateral collateral ligament, and the anterolateral capsule complex during a simulated pivot shift test

“…The objective of this study was to determine the in situ forces in the ACL, the anterolateral capsule, the lateral collateral ligament (LCL), and the forces transmitted between each region of the anterolateral capsule in response to a simulated pivot shift test with an intact knee. The simulated pivot shift test is a well‐established research method of simulating the loads applied during the pivot shift test using a robotic testing system (or custom‐built device) . However, the simulated pivot shift test is not necessarily the same motion or loading profile as the clinical pivot shift test.…”