Concepts of the Pivot Shift

Losee, Ronald E.

doi:10.1097/00003086-198301000-00010

Cited by 86 publications

(73 citation statements)

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“…5,17 The pivot shift test is best done in a controlled setting with the patient relaxed or under anesthesia because the amount of tibial subluxation can be significantly reduced due to pain, effusion, and hamstrings muscle contraction, yielding false-negative results. 27 Further, quadriceps contraction would increase tibial subluxation, causing patient discomfort and making the examination difficult to perform.…”

Section: Discussionmentioning

confidence: 99%

“…This reduction of the lateral tibial plateau characterizes a positive pivot shift test and has been described as a sudden decrease in anterior tibial translation and internal tibial rotation during knee flexion. [5][6][7] We have simulated the pivot shift test by applying a combination of valgus and internal tibial torques to human cadaveric knee specimens by means of a robotic/universal force-moment sensor (UFS) testing system. [8][9][10][11][12][13][14][15][16] With this testing methodology, significant increases in the coupled anterior tibial translation of ACL deficient knees over those for normal knees was illustrated at 158 and 308 of flexion.…”

Section: Introductionmentioning

confidence: 99%

“…The ITB reduces the anteriorly subluxed tibia of the ACL deficient knee as the knee is flexed; without the ITB, the lateral tibial plateau remains anteriorly subluxed and the ''pivot shift phenomenon,'' i.e., the reduction movement of the tibia, is absent. 5,6 In addition, Terry et al demonstrated that injury to the anatomic components of the ITB is highly correlated with levels of pivot shift for ACL deficient knees. 17 Thus, the ITB is necessary to provide reduction of ACL deficient knees during the pivot shift test at high flexion angles.…”

Section: Introductionmentioning

confidence: 99%

“…5,7,20 This rotatory load combination was applied to ACL intact and ACL deficient human cadaveric knees by means of the robotic/UFS testing system. To simulate the ITB force during the pivot shift test, magnitudes of 0, 22, 44, and 88 N were selected.…”

Section: Introductionmentioning

confidence: 99%

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Effect of the iliotibial band on knee biomechanics during a simulated pivot shift test

Yamamoto

Hsu

Fisk

et al. 2006

Journal Orthopaedic Research

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The purpose of this study was to evaluate the effect of the iliotibial band (ITB) on the kinematics of anterior cruciate ligament (ACL) intact and deficient knees and also on the in situ force in the ACL during a simulated pivot shift test. A combination of 10 N-m valgus and 5 N-m internal tibial torques was applied to 10 human cadaveric knees at 158, 308, 458, and 608 of flexion using a robotic/universal force-moment sensor testing system. ITB forces of 0, 22, 44, and 88 N were also applied. An 88 N ITB force significantly decreased coupled anterior tibial translation of ACL deficient knees by 32%-45% at high flexion angles, but did not have a significant effect at low flexion angles. Further, an 88 N ITB force significantly decreased in situ forces in the ACL at all flexion angles by 23%-40%. These results indicate that during the pivot shift test, the ITB can improve tibial reduction at high flexion angles while not affecting subluxation at low flexion angles. Additionally, the action of the ITB as an ACL agonist suggests that its use as an ACL graft might hinder knee stability in response to rotatory load. ß

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Effect of the iliotibial band on knee biomechanics during a simulated pivot shift test

Yamamoto

Hsu

Fisk

et al. 2006

Journal Orthopaedic Research

View full text Add to dashboard Cite

show abstract

“…Losee, in 1982, stated that for the pivot shift to occur, the ACL, lateral, and posterolateral portions of the capsule have to be deficient (Losee 1982).…”

Section: The Pivot-shift Test Historical Reviewmentioning

confidence: 99%