Diagnosis of Chronic Injury to the Anterior Cruciate Ligament

Modified Iliotibial Band Tenodesis Is Indicated to Correct Intraoperative Residual Pivot Shift After Anterior Cruciate Ligament Reconstruction Using an Autologous Hamstring Tendon Graft: A Prospective Randomized Controlled Trial

“…20,21,38 The pivot-shift test remains the most practical tool available for the diagnosis of anterolateral instability. 30,35,41 The goal of most orthopaedic surgeons would be to correct ALRI, as evidenced by the pivot-shift test, and to restore the grades of the pivot shift to a value similar to that of the uninjured contralateral knee. Failure to do so may be a practical indication to add a lateral extra-articular tenodesis (LET)-type procedure.…”

“…After the administration of general anesthesia and before the application of the tourniquet, both knees underwent an examination under anesthesia. The pivot-shift test was performed in the standard manner as described previously, 15,22,30,35 and results were graded as 0 (none), 1 (glide), 2 (clunk), or 3 (gross). The tourniquet was applied and inflated before the pivot-shift test was repeated and results graded on the operative side.…”

“Anatomic” Single-Bundle Anterior Cruciate Ligament Reconstruction Reduces Both Anterior Translation and Internal Rotation During the Pivot Shift

“…In the conscious patient, protective muscle ''guarding'' will reduce its accuracy. 21 As a research tool, the disadvantage of this test has been the inability to quantify it reliably, accurately, and objectively. The relatively recent advent of computer navigation has enabled accurate analysis of this movement at the time of surgery.…”

“…19,33,34,38,39 The best accepted clinical measure of functional instability is the pivot-shift test, and its execution has been well described. 21,24,35 Correction of the pivot shift has also been shown to correlate with improved functional outcome. 17 As a research tool, the pivot shift lacked accurate objective measurement.…”

Femoral Aperture Fixation Improves Anterior Cruciate Ligament Graft Function When Added to Cortical Suspensory Fixation

“…The best accepted clinical measure of functional instability is the pivot-shift test, and its execution has been well described. 22,26,38 Unlike instrumented testing of knee laxity and the Lachman test, the severity of the pivot-shift test has been correlated with functional instability, patient dissatisfaction, activity limitation, poor knee function, limited sports participation, and lower functional knee scores. 16 Previously, the pivot shift lacked objective measurement.…”