Quantifying the pivot shift test: a systematic review

Abstract

Several methodologies have been identified and developed to quantify pivot shift test. However, clinical professionals are still lacking a 'gold standard' method for the quantification of knee joint dynamic laxity. A widespread adoption of a standardized pivot shift manoeuvre and measurement method to allow objective comparison of the results of ACL reconstructions is therefore desirable. Further development of measurement methods is indeed required to achieve this goal in a routine clinical scenario.

In-vivo pivot-shift test measured with inertial sensors correlates with the IKDC grade

“…Several reviews have highlighted the importance, in present-day clinical practice, of quantifying the PS during the assessment of ACL injuries,18–20 also underlining the different technologies that have been developed to this end 21…”

No proof for the best instrumented device to grade the pivot shift test: a systematic review

“…The latter systems, using electromagnetic fields to three-dimensionally locate the position of specific sensors placed on the skin (and therefore showing no clinical invasiveness when compared with navigation), were the first ones used in the outpatients settings. Owing to their lower costs, encumbrance and easiness of use, the second wave of research led to the use of accelerometers21 34 (ie, devices able to quantify the acceleration of an object which they are attached to), gyroscopes21 35 (ie, devices able to quantify the angular velocity of an object which they are attached to) and combined solutions—like the inertial measurement unit (IMU)21 36–38—which are able to read at the same time both acceleration and angular velocity and—through data fusion—to estimate the orientation of the limb in space. From the most technical point of view, electromagnetic systems are able to provide all the six degrees of freedom of a rigid body in a global reference system.…”

“…Different technologies and parameters used to quantify the pivot shift test were reported 21. The most frequently employed tracking systems include navigation systems, electromagnetic systems, acceleration devices, image-based analysis and medical imaging systems.…”

Basic biomechanic principles of knee instability

“…For the purpose of objective quantification of the pivot shift in both in vivo and in vitro settings, a variety of methods have been identified and described. These include electromagnetic tracking, surgical navigation, two-dimensional image analysis, and inertial sensors [18]. The techniques provide output that has historically been divided into four general categories, (1) translations, (2) rotations, (3) acceleration/velocity, and (4) calculated indexes, which aim to provide a standardized value for knee stability based on kinematic output.…”