Correlation between a 2D simple image analysis method and 3D bony motion during the pivot shift test

Arilla, Fabio V.; Rahnemai‐Azar, Amir A.; Yacuzzi, Carlos; Guenther, Daniel; Engel, Benjamin S.; Fu, Freddie H.; Musahl, Volker; Debski, Richard E.

doi:10.1016/j.knee.2016.06.003

Cited by 23 publications

(20 citation statements)

References 27 publications

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“…Previous studies have demonstrated this modality to be highly accurate, strongly correlated with 3-dimensional (3-D) osseous motion through the pivot-shift maneuver, and reliable between examinations and across multiple examiners. 3,17,31…”

Section: Methodsmentioning

confidence: 99%

“…Previous studies have demonstrated this modality to be highly accurate, strongly correlated with 3-dimensional (3-D) osseous motion through the pivotshift maneuver, and reliable between examinations and across multiple examiners. 3,17,31 To assess feasibility of performing iQPS under sterile conditions, the senior author (V.M.) performed 10 anatomic ACLRs using either a bone-patellar tendon-bone (n = 8) autograft or an all-soft tissue quadriceps tendon autograft (n = 2) among patients aged 15 to 24 years with isolated, complete ACL injuries.…”

Section: Methodsmentioning

confidence: 99%

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Augmentation of Anatomic Anterior Cruciate Ligament Reconstruction With Lateral Extra-articular Tenodesis Does Not Significantly Affect Rotatory Knee Laxity: A Time Zero, In Vivo Kinematic Analysis

et al. 2020

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Background: The pivot-shift test is used to assess for rotatory knee laxity in the anterior cruciate ligament (ACL)-deficient knee and ACL-reconstructed knee; however, the pivot shift uses a subjective grading system that is limited by variability between examiners. Consequently, quantified pivot shift (QPS) test software (PIVOT iPad application) has been developed and validated to measure the magnitude of rotatory knee laxity during the positive pivot-shift test. Purpose: To employ intraoperative QPS (iQPS) to assess for differences in residual rotatory knee laxity after ACL reconstruction (ACLR) versus ACLR augmented with lateral extra-articular tenodesis (ACLR + LET), and to employ iQPS to determine if ACLR and/or ACLR + LET result in overconstrained knee kinematics when compared with the contralateral knee. Study Design: Cohort study; Level of evidence, 2. Methods: iQPS was performed in 20 patients by a single surgeon on both the operative and contralateral knees before ACLR. ACLR was augmented with a LET if the lateral compartment tibial translation measured during QPS was greater than or equal to double the amount of lateral tibial compartment translation measured for the contralateral knee. After each reconstruction (ACLR or ACLR + LET), iQPS measurements were performed. iQPS data were compared with the preoperative QPS measurements of the operative and contralateral knees. Postoperative iQPS data were compared with both the preoperative QPS measurements of the operative and contralateral knees with paired samples t tests. Categorical variables were compared using the Fisher exact test. Results: The mean age in the cohort was 17.3 years (range, 15-24 years). There were no significant differences between the groups in terms of the proportion of male patients (ACLR: 5 male, 5 female vs ACLR + LET: 4 male, 6 female) or age (ACLR: 17.7 ± 3.3 years; 95% CI, 15.4-24.0 vs ACLR + LET: 16.8 ± 2.8 years, 95% CI, 14.8-22.0; P = .999). There were no significant differences between the groups with respect to preoperative QPS performed during examination under anesthesia (ACLR: 4.7 ± 2.0 mm; 95% CI, 3.3-6.1 vs ACLR + LET: 3.6 ± 1.8 mm; 95% CI, 2.3-4.9; P = .2). Both ACLR and ACLR + LET resulted in significant decreases in rotatory knee laxity when compared with preoperative QPS measurements (ACLR: –3.4 ± 1.7 mm; 95% CI, −4.6 to −2.2; P < .001: ACLR + LET: –2.6 ± 1.9 mm; 95% CI, −3.9 to −1.3; P < .002). Moreover, when compared with isolated ACLR, ACLR + LET did not result in a significantly smaller magnitude of change in iQPS between the pre- and postoperative states ( P = .3). Conclusion: Both ACLR and ACLR + LET resulted in significant decreases in rotatory knee laxity. The augmentation of ACLR with LET did not change the constraint of the knee with respect to lateral compartment translation as measured during iQPS.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Augmentation of Anatomic Anterior Cruciate Ligament Reconstruction With Lateral Extra-articular Tenodesis Does Not Significantly Affect Rotatory Knee Laxity: A Time Zero, In Vivo Kinematic Analysis

et al. 2020

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“…More recent advancements have introduced inertial sensors and image analysis systems. One study found that 2D simple image analysis method and the 3D bony motion of the knee during the pivot shift test had similar outcomes [15]. This study concluded that the 2D simple image analysis is a non-invasive and repeatable tool to quantify the motion of the lateral knee compartment during the pivot shift test.…”

Section: Quantitative Assessment Of the Pivot Shiftmentioning

confidence: 79%

“…The pivot shift is theoretically the ideal test to dynamically evaluate the ligamentous status of the knee, which is especially crucial in diagnosing ACL deficiency, evaluating reconstructive techniques, and constructing treatment algorithms for patients with ACL injury [13,14]. Currently, the pivot shift test is the most specific clinical test to detect ACL injury [15]. The methodology for standardizing the pivot shift has been described and shown to have improved accuracy [16].…”

Section: Introductionmentioning

confidence: 99%

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

Vaudreuil

Rothrauff

et al. 2019

Curr Rev Musculoskelet Med

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Purpose of Review The purpose of this manuscript is to (1) examine the history, techniques, and methodology behind quantitative pivot shift investigations to date and (2) review the current status of pivot shift research for its clinical utility for management of anterior cruciate ligament (ACL) rupture with associated injuries including the anterolateral complex (ALC). Recent Findings The pivot shift is a useful physical exam maneuver for diagnosis of rotatory instability related to ACL tear. Recent evidence suggests that the pivot shift is multifactorial and can be seen in the presence of ACL tear with concomitant injury to secondary stabilizers or with predisposing anatomical factors. Summary The presence of a pivot shift post-operatively is associated with poorer outcomes after ACL reconstruction. Recent clinical and biomechanical investigations can help guide clinicians in utilizing pivot shift in diagnosis and surgical planning. Further research is needed to clarify optimal management of ALC in addition to ACL injury.

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“…The change in position occurring during femoral reduction on the tibia, when the knee reaches its pivot point, is captured and the distance of the shift in position is presented in millimeters [37]. The image analysis system has shown excellent repeatability calculated by measuring intraobserver and interobserver intraclass correlation coefficients (ICCs > 90) [38, 39]. …”

Section: Clinical Assessments and Follow-upmentioning

confidence: 99%

Correlation between quantitative pivot shift and generalized joint laxity: a prospective multicenter study of ACL ruptures

Sundemo

Blom²,

Hoshino

et al. 2017

Knee Surg Sports Traumatol Arthrosc

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PurposeTo investigate whether an increased magnitude of quantitative rotatory knee laxity is associated with a greater level of generalized joint laxity in ACL-injured and contralateral knees.MethodsA total of 103 patients were enrolled across four international centers to undergo anatomic ACL reconstruction. Rotatory knee laxity was evaluated preoperatively, both in the awake state and under anesthesia, using the standardized pivot shift test. Two devices were used to quantify rotatory knee laxity; an inertial sensor, measuring the joint acceleration, and an image analysis system, measuring the lateral compartment translation of the tibia. The presence of generalized joint laxity was determined using the Beighton Hypermobility Score. The correlation between the level of generalized joint laxity and the magnitude of rotatory knee laxity was calculated for both the involved knee and the non-involved knee. Further, patients were dichotomized into low (0–4) or high (5–9) Beighton Score groups. Alpha was set at < 0.05.ResultsNinety-six patients had complete datasets, 83 and 13 in the low and high Beighton Score groups respectively. In anesthetized patients, there was a significant correlation between the degree of Beighton Score and quantitative pivot shift when analyzing the non-involved knee using the image analysis system (r = 0.235, p < 0.05). When analyzing the same knee, multivariate analysis adjusted for meniscal injury, age and gender revealed an increased odds ratio for patients with increased lateral compartment translation to be part of the high Beighton Score group (OR 1.86, 95% CI 1.10–3.17, p < 0.05). No other correlation was significant. When analyzing the dichotomized subgroups, no significant correlations could be established.ConclusionThe findings in this study suggest that there is a weak correlation between generalized joint laxity and the contralateral healthy knee, indicating increased rotatory knee laxity in these patients. Generalized joint laxity does not appear to correlate with rotatory knee laxity in ACL-injured knees.Level of evidenceProspective cohort study; level of evidence, 2.

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Correlation between a 2D simple image analysis method and 3D bony motion during the pivot shift test

Cited by 23 publications

References 27 publications

Augmentation of Anatomic Anterior Cruciate Ligament Reconstruction With Lateral Extra-articular Tenodesis Does Not Significantly Affect Rotatory Knee Laxity: A Time Zero, In Vivo Kinematic Analysis

Augmentation of Anatomic Anterior Cruciate Ligament Reconstruction With Lateral Extra-articular Tenodesis Does Not Significantly Affect Rotatory Knee Laxity: A Time Zero, In Vivo Kinematic Analysis

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

Correlation between quantitative pivot shift and generalized joint laxity: a prospective multicenter study of ACL ruptures

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