The Pivot Shift

Lane, Clayton G.; Warren, Russell F.; Pearle, Andrew D.

doi:10.5435/00124635-200812000-00001

Cited by 145 publications

(144 citation statements)

References 45 publications

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“…This includes the following maneuvers: Lachman test [11] at 258 flexion; Pivot-shift phenomenon [13] evaluated according to Hughston's Jerk test [7]; anterior drawer at 708 with foot in neutral, maximal internal and maximal external rotation. Each was graded from 0 to 3?…”

Section: Methodsmentioning

confidence: 99%

Assessment of rotatory laxity in anterior cruciate ligament-deficient knees using magnetic resonance imaging with Porto-knee testing device

Espregueira-Mendes

Pereira

Sevivas

et al. 2012

Knee Surg Sports Traumatol Arthrosc

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Purpose Objective evaluation of both antero-posterior translation and rotatory laxity of the knee remains a target to be accomplished. This is true for both preoperative planning and postoperative assessment of different ACL reconstruction emerging techniques. The ideal measurement tool should be simple, accurate and reproducible, while enabling to assess both ''anatomy'' and ''function'' during the same examination. The purpose of this study is to evaluate the clinical effectiveness of a new in-housedeveloped testing device, the so-called Porto-knee testing device (PKTD). The PKTD is aimed to be used on the evaluation of both antero-posterior and rotatory laxity of the knee during MRI exams. Methods Between 2008 and 2010, 33 patients with ACLdeficient knees were enrolled for the purpose of this study. All patients were evaluated in the office and under anesthesia with Lachman test, lateral pivot-shift test and anterior drawer test. All cases were studied preoperatively with KT-1000 and MRI with PKTD, and examinations performed by independent observers blinded for clinical evaluation. During MRI, we have used a PKTD that applies antero-posterior translation and permits free tibial rotation through a standardized pressure (46.7 kPa) in the proximal posterior region of the leg. Measurements were taken for both knees and comparing side-to-side. Five patients with partial ruptures were excluded from the group of 33. Results For the 28 remaining patients, 3 women and 25 men, with mean age of 33.4 ± 9.4 years, 13 left and 15 right knees were tested. No significant correlation was noticed for Lachman test and PKTD results (n.s.). Pivot-shift had a strong positive correlation with the difference in anterior translation registered in lateral and medial tibia plateaus of injured knees (cor. coefficient = 0.80; p \ 0.05), and with the difference in this parameter as compared to side-to-side (cor. coefficient = 0.83; p \0.05). Considering the KT-1000 difference between injured and healthy knees, a very strong positive correlation was found for side-to-side difference in medial (cor. coefficient = 0.73; p \ 0.05) and lateral (cor. coefficient = 0.5; p \ 0.05) tibial plateau displacement using PKTD. Conclusion The PKTD proved to be a reliable tool in assessment of antero-posterior translation (comparing with KT-1000) and rotatory laxity (compared with lateral pivotshift under anesthesia) of the ACL-deficient knee during MRI examination. Level of evidence Therapeutic studies, Level IV.

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Section: Methodsmentioning

confidence: 99%

Assessment of rotatory laxity in anterior cruciate ligament-deficient knees using magnetic resonance imaging with Porto-knee testing device

Espregueira-Mendes

Pereira

Sevivas

et al. 2012

Knee Surg Sports Traumatol Arthrosc

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“…In our series, injuries while playing soccer made up 38%, skiing 33%, motocross 16%, tennis 10%, and karate 3%. All of the patients clinically presented with an ACLdeficient knee with a positive Lachman test [45] and pivot shift [22], both of which were confirmed with a complete ACL rupture on MRI. Associated knee injuries included first-and second-degree medial collateral ligament sprain in 11%, meniscal lesions in 30%, Grade I or II chondropathy in 7%, and a combined meniscal and chondropathy lesion in 15%.…”

Section: Methodsmentioning

confidence: 99%

Single- versus Double-bundle ACL Reconstruction: Is There Any Difference in Stability and Function at 3-year Followup?

Gobbi¹,

Mahajan²,

Karnatzikos³

et al. 2012

Clinical Orthopaedics &Amp; Related Research

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Background Despite a number of studies comparing postoperative stability and function after anatomic doublebundle and single-bundle anterior cruciate ligament reconstruction (ACLR), it remains unclear whether double-bundle reconstruction improves stability or function. Questions/purposes We therefore asked whether patients having single-and double-bundle ACLR using semitendinosus (ST) alone differed with regard to (1) postoperative stability; (2) ROM; and (3) five functional scores. Methods We prospectively followed 60 patients with an isolated anterior cruciate ligament (ACL) injury. Thirty patients underwent single-bundle and 30 patients underwent double-bundle ACL reconstruction. Clinically we assessed stability and range of motion (ROM); anteroposterior stability was assessed by Rolimeter and rotational stability by a pivot shift test. Function was assessed by IKDC, Noyes, Lysholm, Marx, and Tegner activity scales.The minimum followup was 36 months (mean, 46.2 months; range, 36-60 months). Results Residual anteroposterior laxity at 3 years postoperatively was similar in both groups: 1.4 ± 0.3 mm versus 1.4 ± 0.2 mm, respectively. We observed no difference in the pivot shift test. ROM was similar in both groups, although double-bundle patients required more physical therapy sessions to gain full ROM. IKDC, Noyes, Lysholm, Marx, and Tegner scores were similar at final followup. Conclusion Double-bundle reconstruction of the ACL did not improve function or stability compared with singlebundle reconstruction.

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“…We found no impingement or notching and did not perform a notch plasty in any patient of either group. At preoperative assessment all patients suffered from clinically unstable knees with "giving way" and positive Lachman and pivot shift tests [17] but without positive dial tests [17]. Magnetic resonance imaging (MRI) definitely confirmed ACL rupture.…”

Section: Semitendinosus-gracilis Double Bundle (Stg-db) Reconstructiomentioning

confidence: 99%

Reconstruction of the anterior cruciate ligament: a clinical comparison of bone-patellar tendon-bone single bundle versus semitendinosus and gracilis double bundle technique

Sadoghi

Müller

Jansson

et al. 2010

International Orthopaedics (SICOT)

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The study hypothesis was that the outcome of semitendinosus gracilis double bundle (STG-DB) anterior cruciate ligament (ACL) reconstruction is advantageous in terms of clinical results and restoration of anterior-posterior and rotational laxity in comparison to bone-patellar tendonbone single-bundle (PTB-SB) ACL reconstruction. We analysed 41 PTB-SB and 51 STG-DB patients using the Tegner, IKDC and WOMAC scores preoperatively and at a minimum follow-up of two years. At follow-up, there was no significant difference in the clinical scores. The KT 1000 side-to-side measurement showed no significant difference between groups. The STG-DB group was significantly superior in terms of the pivot-shift sign and anterior knee pain. We conclude that the outcome of STG-DB reconstruction in the mid-term was not advantageous in terms of clinical scores and anterior-posterior laxity evaluated by the KT 1000. Nevertheless, the restored rotational laxity measured by the pivot shift test was significantly superior in the STG-DB technique.

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The Pivot Shift

Cited by 145 publications

References 45 publications

Assessment of rotatory laxity in anterior cruciate ligament-deficient knees using magnetic resonance imaging with Porto-knee testing device

Assessment of rotatory laxity in anterior cruciate ligament-deficient knees using magnetic resonance imaging with Porto-knee testing device

Single- versus Double-bundle ACL Reconstruction: Is There Any Difference in Stability and Function at 3-year Followup?

Reconstruction of the anterior cruciate ligament: a clinical comparison of bone-patellar tendon-bone single bundle versus semitendinosus and gracilis double bundle technique

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