Intraoperative pivot-shift accelerometry combined with anesthesia improves the measure of rotatory knee instability in anterior cruciate ligament injury

Caracciolo, Gaston; Yáñez, Roberto; Silvestre, Rony; Fuente, Carlos De la; Zamorano, Héctor; Ossio, Alejandra; Strömbäck, Lars; Abusleme, Sebastián; Carpes, Felipe Pivetta

doi:10.1186/s40634-021-00396-1

Cited by 9 publications

(14 citation statements)

References 36 publications

(63 reference statements)

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“…ɣ: Statistical significance for the non-preferred limb comparing before and after the match (p < 0.05). biomechanical behavior found for deficient ACL knees (Lam et al, 2011) and rotatory instabilities identified by the pivot shift maneuver (Caracciolo et al, 2021). In contrast, the lack of rotatory knee stability is an important risk factor for noncontact ACL rupture (Quatman et al, 2010).…”

Section: Discussionmentioning

confidence: 99%

“…The test was repeated three times, obtaining the mean of both the preferred and non-preferred limbs to kick a ball. The delta between the maximum and minimum from the modulus of the acceleration during the reduction phase of the pivot shift maneuver was used (Caracciolo et al, 2021). The modulus of the acceleration has been estimated from the Euclidean norm 2 as a 2 a 2 x + a 2 y + a 2 z 2 in m*s −2 .…”

Section: Instrumented Pivot Shift Maneuvermentioning

confidence: 99%

“…The modulus of the acceleration has been estimated from the Euclidean norm 2 as a 2 a 2 x + a 2 y + a 2 z 2 in m*s −2 . We chose the delta acceleration of the resultant acceleration to obtain a physical measure that can transduce equally the flexion, valgus, and internal rotation induced by the clinical test on the patient's knee, where more acceleration refers to a higher shifting of the axial rotatory axis of the knee (Caracciolo et al, 2021).…”

Section: Instrumented Pivot Shift Maneuvermentioning

confidence: 99%

“…On the other hand, the rotational knee stability allows an appropriate tibio-femoral displacements and knee axis shifting into physiological ranges (Bull and Amis, 1998). The pivoting knee movements are expected to be controlled by knee cocontraction (Caracciolo et al, 2021) and by an adequate knee laxity (Bull and Amis, 1998). In general, the rotational knee stability is measured by the pivot shift maneuver that elicits the coupled movement between the anterior displacement and medial rotation of the tibia while a knee flexion is developed.…”

Section: Introductionmentioning

confidence: 99%

“…In general, the rotational knee stability is measured by the pivot shift maneuver that elicits the coupled movement between the anterior displacement and medial rotation of the tibia while a knee flexion is developed. When the ACL is insufficient, the lateral tibial plateau displaces more anteriorly and medially (subluxation), and because the iliotibial band is stretched, a sudden higher posterior and lateral shift of the lateral tibial plateau (reduction) is caused (Caracciolo et al, 2021). In support, the pivoting landing task has been implemented to explore the excessive internal knee rotation in a closed kinetic chain (excessive knee rotation), increasing the rotational load on the knee joint (Pappas et al, 2013).…”

Section: Introductionmentioning

confidence: 99%

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Is the Rotatory Knee Stability Immediately Decreased Following a Competitive Soccer Match?

Neira

Silvestre

Debandi

et al. 2022

Front. Bioeng. Biotechnol.

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Fatigue induced by soccer playing increases physical efforts, which might alter the transverse knee stability, a known factor that promotes knee injuries, particularly anterior cruciate ligament injury. Thereby, primarily, we aimed to determine whether rotatory knee stability decreases immediately following a competitive soccer match in amateur players. Furthermore, we assessed the role of the preferred and non-preferred limbs to kick a ball in rotatory knee stability and the correlation between performance parameters and rotatory knee stability. We hypothesized that the knee stability decreases immediately after a competitive soccer match in amateur players. Eight healthy amateur soccer players (aged 27.2 ± 4.7 years and with body mass index of 23.8 ± 1.2 kg m−2) were included immediately before and after a competitive soccer match. The rotatory knee stability was assessed in the preferred and non-preferred limbs through the acceleration and jerk of the pivot shift maneuver and by the internal knee rotation of a pivoting landing task. Two-way repeated-measures ANOVA for factors time (before and after the soccer match) and limb (preferred and non-preferred) and multiple comparisons were performed using α = 5%. There was a statistical significance for the main factor time in the acceleration (5.04 vs. 6.90 ms−2, Δ = 1.86 ms−2, p = 0.020, η2 = 0.331) and jerk (18.46 vs. 32.10 ms−2, Δ = 13.64 ms−2, p = 0.004, η2 = 0.456) of the pivot shift maneuver. Rotatory stability decreases following a competitive soccer match in amateur soccer players under fatigue. Both the acceleration and jerk during the pivot shift maneuver is increased without significant internal knee rotation changes during the pivoting landing task.

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Section: Discussionmentioning

confidence: 99%

Section: Instrumented Pivot Shift Maneuvermentioning

confidence: 99%

Section: Instrumented Pivot Shift Maneuvermentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Is the Rotatory Knee Stability Immediately Decreased Following a Competitive Soccer Match?

Neira

Silvestre

Debandi

et al. 2022

Front. Bioeng. Biotechnol.

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Preoperative quantitative pivot shift does not correlate with in vivo kinematics following ACL reconstruction with or without lateral extraarticular tenodesis

Gibbs

Hughes

Popchak

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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PurposeQuantitative pivot shift (QPS) testing using PIVOT technology can detect high‐ and low‐grade rotatory knee instability following anterior cruciate ligament injury or reconstruction (ACLR). The aim of this project was to determine if preoperative QPS correlates with postoperative knee kinematics in the operative and contralateral, healthy extremity following ACLR with or without lateral extraarticular tenodesis (LET) using a highly precise in vivo analysis system. A positive correlation between preoperative QPS and postoperative tibial translation and rotation following ACLR with or without LET in the operative and healthy, contralateral extremity was hypothesized. MethodsTwenty patients with ACL injury and high‐grade rotatory knee instability were randomized to undergo anatomic ACLR with or without LET as part of a prospective randomized trial. At 6 and 12 months postoperatively, in vivo kinematic data were collected using dynamic biplanar radiography superimposed with high‐resolution computed tomography scans of patients’ knees during downhill running. Total anterior–posterior (AP) tibial translation and internal–external tibial rotation were measured during the gait cycle. Spearman’s rho was calculated for preoperative QPS and postoperative kinematics. ResultsIn the contralateral, healthy extremity, a significant positive correlation was seen between preoperative QPS and total AP tibial translation at 12 months postoperatively (rs = 0.6, p < 0.05). There were no additional significant correlations observed between preoperative QPS and postoperative knee kinematics at 6 and 12 months postoperatively in the operative and contralateral, healthy extremity for combined isolated ACLR and ACLR with LET patients as well as isolated ACLR patients or ACLR with LET patients analyzed separately. DiscussionThe main finding of this study was that there was a significant positive correlation between preoperative QPS and total AP tibial translation at 12 months postoperatively in the contralateral, healthy extremity. There were no significant correlations between preoperative QPS and postoperative in vivo kinematics at 6 and 12 months following ACLR with or without LET. This suggests that QPS as measured with PIVOT technology does correlate with healthy in vivo knee kinematics, but QPS does not correlate with in vivo kinematics following ACLR with or without LET.

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What it takes to have a high‐grade pivot shift—focus on bony morphology

Dadoo

Özbek

Nukuto

et al. 2023

Knee surg. sports traumatol. arthrosc.

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Purpose Variations in femoral and tibial bony morphology have been associated with higher clinical grading and increased quantitative tibial translation, but not tibial acceleration, during the pivot shift test following anterior cruciate ligament (ACL) injury. The purpose of this study was to determine the impact of femoral and tibial bony morphology, including a measurement inluenced by both parameters (the Lateral Tibiofemoral Articular Distance (LTAD)), on the degree of quantitative tibial acceleration during the pivot shift test and rates of future ACL injury. Methods All patients who underwent primary ACL reconstruction from 2014 to 2019 by a senior orthopedic surgeon with available quantitative tibial acceleration data were retrospectively reviewed. All patients underwent a pivot shift examination under anesthesia with a triaxial accelerometer. Measurements of femoral and tibial bony morphology were performed by two fellowship-trained orthopedic surgeons using preoperative magnetic resonance imaging and lateral radiographs. Results Fifty-one patients were included at a mean follow-up of 4.4 years. The mean quantitative tibial acceleration during the pivot shift was 13.8 m/s 2 (range: 4.9-52.0 m/s 2 ). A larger Posterior Condylar Ofset Ratio (r = 0.30, p = 0.045), smaller medial-to-lateral width of the medial tibial plateau (r = − 0.29, p = 0.041), lateral tibial plateau (r = − 0.28, p = 0.042), and lateral femoral condyle (r = − 0.29, p = 0.037), and a decreased LTAD (r = − 0.53, p < 0.001) signiicantly correlated with increased tibial acceleration during the pivot shift. Linear regression analysis demonstrated an increase in tibial acceleration of 1.24 m/s 2 for every 1 mm decrease in LTAD. Nine patients (17.6%) sustained ipsilateral graft rupture and 10 patients (19.6%) sustained contralateral ACL rupture. No morphologic measurements were associated with rates of future ACL injury. Conclusion Increased convexity and smaller bony morphology of the lateral femur and tibia were signiicantly associated with increased tibial acceleration during the pivot shift. Additionally, a measurement, termed the LTAD, was found to have the strongest association with increased tibial acceleration. Based on the results of this study, surgeons can utilize these measurements to preoperatively identify patients at risk of increased rotatory knee instability. Level of evidence Level IV.

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Intraoperative pivot-shift accelerometry combined with anesthesia improves the measure of rotatory knee instability in anterior cruciate ligament injury

Cited by 9 publications

References 36 publications

Is the Rotatory Knee Stability Immediately Decreased Following a Competitive Soccer Match?

Is the Rotatory Knee Stability Immediately Decreased Following a Competitive Soccer Match?

Preoperative quantitative pivot shift does not correlate with in vivo kinematics following ACL reconstruction with or without lateral extraarticular tenodesis

What it takes to have a high‐grade pivot shift—focus on bony morphology

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