Risk Factors Associated With Grade 3 Pivot Shift After Acute Anterior Cruciate Ligament Injuries

Song, Gonghua; Zhang, Hui; Wang, Qianqian; Zhang, Jin; Li, Yue; Feng, Hao

doi:10.1177/0363546515613069

Cited by 95 publications

(96 citation statements)

References 36 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The findings of this most recent model state that ACL biomechanical forces increase with an increasing posterior tibial slope and are caused primarily by change in posterior tibial slope at the tibial plateau that carries a larger portion of joint contact force [70]. This report parallels recent studies that document a higher risk of ACL tear with increasing posterior tibial slope [71], as well as an increase risk factor for a high-grade pivot shift [72]. However, an additional recent biomechanical study demonstrated no increase in ACL strain with increasing posterior tibial slope (p < 0.05) and decreased internal rotation under combine flexion and internal rotation load with increasing posterior tibial slope [73].…”

Section: The Restoration Of Knee Kinematics; Individualized Acl Surgerysupporting

confidence: 71%

Basic biomechanic principles of knee instability

Zlotnicki

Naendrup

Ferrer

et al. 2016

Curr Rev Musculoskelet Med

View full text Add to dashboard Cite

Motion at the knee joint is a complex mechanical phenomenon. Stability is provided by a combination of static and dynamic structures that work in concert to prevent excessive movement or instability that is inherent in various knee injuries. The anterior cruciate ligament (ACL) is a main stabilizer of the knee, providing both translational and rotatory constraint. Despite the high volume of research directed at native ACL function, pathogenesis and surgical reconstruction of this structure, a gold standard for objective quantification of injury and subsequent repair, has not been demonstrated. Furthermore, recent studies have suggested that novel anatomic structures may play a significant role in knee stability. The use of biomechanical principles and testing techniques provides essential objective/quantitative information on the function of bone, ligaments, joint capsule, and other contributing soft tissues in response to various loading conditions. This review discusses the principles of biomechanics in relation to knee stability, with a focus on the objective quantification of knee stability, the individual contributions of specific knee structures to stability, and the most recent technological advances in the biomechanical evaluation of the knee joint.

show abstract

Section: The Restoration Of Knee Kinematics; Individualized Acl Surgerysupporting

confidence: 71%

Basic biomechanic principles of knee instability

Zlotnicki

Naendrup

Ferrer

et al. 2016

Curr Rev Musculoskelet Med

View full text Add to dashboard Cite

show abstract

“…This finding is supported by several other recent biomechanical studies [71, 87], which reported increased coupled internal rotation, and lateral tibia anterior displacement after ALL sectioning in ACL-deficient models. In the clinical setting, anterolateral capsule abnormalities are reported on MRI imaging in 20, 40 and 73% of patients with grade I, grade II and grade III pivot-shift, respectively [85]. Great attention to the status of the ALL should thus be given in the evaluation of rotatory laxity in the ACL-deficient knee.…”

Section: Clinical Diagnosismentioning

confidence: 99%

Anterolateral Ligament Expert Group consensus paper on the management of internal rotation and instability of the anterior cruciate ligament - deficient knee

et al. 2017

View full text Add to dashboard Cite

Purpose of this paper is to provide an overview of the latest research on the anterolateral ligament (ALL) and present the consensus of the ALL Expert Group on the anatomy, radiographic landmarks, biomechanics, clinical and radiographic diagnosis, lesion classification, surgical technique and clinical outcomes. A consensus on controversial subjects surrounding the ALL and anterolateral knee instability has been established based on the opinion of experts, the latest publications on the subject and an exchange of experiences during the ALL Experts Meeting (November 2015, Lyon, France). The ALL is found deep to the iliotibial band. The femoral origin is just posterior and proximal to the lateral epicondyle; the tibial attachment is 21.6 mm posterior to Gerdy’s tubercle and 4–10 mm below the tibial joint line. On a lateral radiographic view the femoral origin is located in the postero-inferior quadrant and the tibial attachment is close to the centre of the proximal tibial plateau. Favourable isometry of an ALL reconstruction is seen when the femoral position is proximal and posterior to the lateral epicondyle, with the ALL being tight upon extension and lax upon flexion. The ALL can be visualised on ultrasound, or on T2-weighted coronal MRI scans with proton density fat-suppressed evaluation. The ALL injury is associated with a Segond fracture, and often occurs in conjunction with acute anterior cruciate ligament (ACL) injury. Recognition and repair of the ALL lesions should be considered to improve the control of rotational stability provided by ACL reconstruction. For high-risk patients, a combined ACL and ALL reconstruction improves rotational control and reduces the rate of re-rupture, without increased postoperative complication rates compared to ACL-only reconstruction. In conclusion this paper provides a contemporary consensus on all studied features of the ALL. The findings warrant future research in order to further test these early observations, with the ultimate goal of improving the long-term outcomes of ACL-injured patients. Level of evidence Level V—Expert opinion.

show abstract

“…Clási-camente, se pensaba que limitaba la rotación interna en grados cercanos a la extensión (8)(9)(10)16,17) ; sin embargo, otros estudios ponen de manifiesto una limitación rotacional a grados altos de flexión de la rodilla (15,19,21,49) . Dada la importancia del LAL en el control del pivot shift (62)(63)(64)66) , se ha retomado el interés en las reconstrucciones de estas estructuras asociadas a la cirugía del LCA en un intento de disminuir el pivot shift residual y mejorar la estabilidad.…”

Section: Discussionunclassified

“…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) . Sin embargo, otros estudios (50,51,54,65) , en los que se secciona el LAL, no encuentran un aumento significativo del pivot shift con un LCA intacto, obteniendo un mayor aumento de la rotación interna a 60° de flexión.…”

Section: Clínicaunclassified