Patients with high-grade pivot-shift phenomenon are associated with higher prevalence of anterolateral ligament injury after acute anterior cruciate ligament injuries

Song, Gonghua; Zhang, Hui; Guan, Wei; Zhang, Jin; Liu, Xin; Xue, Zhe; Qian, Yi; Feng, Hao

doi:10.1007/s00167-017-4492-z

Cited by 30 publications

(29 citation statements)

References 20 publications

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“…In this context, the Lachman's and pivot shift tests are unequivocally the most prominent tests, which have proven to have a high sensitivity and specificity. 7,[18][19][20] However, both tests and especially the pivot shift test, which is the key tool in diagnosing a noncompensable ACL insufficiency requires a special training of the assessor, and more importantly a relaxed patient, without muscular resistance. Anxious patients or pains interfere with a correctly performed test, which could lead to false-negative results.…”

Section: Discussionmentioning

confidence: 99%

The Forced Active Buckling Sign: A New Clinical Test for the Diagnosis of ACL Insufficiency

et al. 2018

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Although insufficiency of the anterior cruciate ligament (ACL) is a frequent result of an injury, validated tests are associated with unsatisfying validity. Moreover, some of these tests are not easy to perform and patient's muscular resistance often limits their reliability. Therefore, with this study, we want to design an accurate test to diagnose an ACL insufficiency, which is independent of the assessor's skills and overcome any muscular resistance. Fifty patients with an isolated ACL rupture (group A; age 26.4 years ± 14.9 standard deviation [SD]; female, n = 15) and additional 50 patients with an intact ACL but meniscal lesions (group B; age 45.4 years ± 12.9 SD; female, n = 23) were consecutively included in this study. The integrity of the ACL and the menisci were evaluated by magnetic resonance imaging and verified arthroscopically. Two orthopaedic surgeons performed a pivot shift test, a Lachman's test, and our new “forced active buckling” (FAB)-sign test in all patients. The surgeons were blinded for the pathology of the knee and we randomized the tests for each patient and examiner. The sensitivity, specificity, positive predictive value, negative predictive value, and positive and negative likelihood ratios with confidence intervals were calculated and compared. With a prevalence of 0.5, the FAB-sign test revealed the best overall sensitivity of 0.78 compared with the Lachman's and pivot shift tests of 0.74 and 0.46, respectively. Also, the overall specificity of the FAB-sign test of 0.95 was higher than the Lachman's test of 0.83, however, comparable to the pivot shift test of 0.96. The FAB-sign test demonstrated the best positive and negative predictive values of 0.94 and 0.81. There was no significant difference between the two examiners concerning the accuracy of results in each test (p = 0.83). This study shows that the introduced FAB-sign test can detect an ACL insufficiency more sensitive and more specific compared to the pivot shift and Lachman's tests in the subacute phase. This is a randomized controlled diagnostic study, level 1b.

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Section: Discussionmentioning

confidence: 99%

The Forced Active Buckling Sign: A New Clinical Test for the Diagnosis of ACL Insufficiency

et al. 2018

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“…Patients with ACL tears with lateral femoral and tibial bone contusion on MRI more frequently presented with ALL abnormalities. 37 , 56 , 57 Bone contusions are related to higher grades of joint laxity, which may justify the association with ALL tears. 37 ALL abnormalities in ACL-injured knees were also associated with peripheral ligament injuries and ITB tears.…”

Section: Allmentioning

confidence: 99%

An Overview of Anatomy and Imaging of the Anterolateral Structures of the Knee

Helito

2018

Techniques in Orthopaedics

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Despite several previous articles in the literature, never before have so many studies with regard to anterolateral knee structures been performed. The anterolateral knee complex consists briefly of the iliotibial band, with its proximal and distal attachments, the joint capsule, and the anterolateral ligament (ALL). The recently introduced ALL has several different descriptions, making it difficult to build a consensus with regard to its anatomy. An extensive description of these structures, particularly the iliotibial band and the ALL, with regard to anatomy and imaging, will be provided in this article.

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“…Así, varios autores han intentado esclarecer este concepto, analizando la alteración del LAL con el grado de pivot shift aprecia-do, demostrando que un alto grado de pivot shift está relacionado con la lesión de dicho ligamento (22)(23)(24)(25)(26) . Song et al (62) reportaron que, en el 78,7% de las lesiones del LAL objetivadas mediante RM en lesiones concomitantes al LCA, se apreciaba un pivot shift de grado II-III, al igual que en otras publicaciones (18,63,64) .…”

Section: Clínicaunclassified

“…Parece ser que presenta mayor tensión en grados cercanos a la extensión (1,(8)(9)(10)13,16,17) , pero estudios recientes defienden su control a mayor flexión de rodilla (15,(18)(19)(20)(21) . Para el diagnóstico de esta lesión se ha puesto de manifiesto ser el causante del pivot shift en la exploración, aunque este concepto es controvertido (22)(23)(24)(25)(26) . La fractura de Segond se puede justificar como una avulsión de este ligamento en su inserción tibial (9,27,28) .…”

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