Grading the pivot shift. Objective tests with implications for treatment

Abstract

A logical, objective and reproducible grading system for the pivot shift test is proposed. The rationale is based on performing the examination in varying positions of rotation of the tibia, allowing the type and degree of the different laxities to be defined and quantified. The system has been assessed against a new "unblocked" test for anterior subluxation and against radiographic measurements, operative findings and results. This grading system can be valuable in pre-operative assessment and planning and its use in postoperative evaluation would enable results from different centres and different procedures to be compared more accurately.

Reconstructive versus non-reconstructive treatment of anterior cruciate ligament insufficiency. A retrospective matched-pair long-term follow-up

“…But as there is a variety of possible tools for measuring the rotational stability in the lab, the manual pivot shift test still remains the only validated parameter in the daily clinical routine. Even if there is an attempt of an objective quantitative measurement by several technical devices [17][18][19][20], objective quantitative assessment of the pivot shift phenomenon is currently lacking and the evaluation greatly depends on the examiner's subjective experience and impression [21,22]. Therefore, accurate assessment of the pivot shift is essential to obtain an exact clinical assessment of ACL-deficient or reconstructed knee.…”

Stressradiography of the knee

“…With the introduction of drawer testing at 15 degrees of flexion, examiners were able to demonstrate, with stressradiography, the advantages of assessing anterior knee motion (Jakob et al 1987) and posterior knee motion (Staubli and Jakob 1990b) in the near extended position.…”

“…The tests were performed at an anterior force level of 150 N without anesthesia. Jakob et al (1987) applied the technique of compartmental stressradiographic analysis of anterior knee motion to grade and document the pivot-shift-phenomena in anterior-cruciate-ligament-deficient knees. From these measurements, Jakob et al (1987) deduced treatment implications and treatment modalities.…”

“…Jakob et al (1987) applied the technique of compartmental stressradiographic analysis of anterior knee motion to grade and document the pivot-shift-phenomena in anterior-cruciate-ligament-deficient knees. From these measurements, Jakob et al (1987) deduced treatment implications and treatment modalities. In a subsequent prospective study on anterior knee motion, we compared arthrometry and simultaneous radiography in chronic anterior-cmciate-ligament-deficient knees (Staubli and Jakob 1991).…”

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

“…[1][2][3] This test is conducted by simultaneously applying valgus and axial tibial torques to the knee at near extension and evaluating subluxation of the tibia while gradually flexing the knee. 4 With an ACL deficient knee, the lateral tibial plateau subluxes anteriorly when the knee is extended but then reduces as the knee is flexed. 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.…”