Pivot shift as an outcome measure for ACL reconstruction: a systematic review

Ayeni, Olufemi R.; Chahal, Manraj; Tran, Michael N.; Sprague, Sheila

doi:10.1007/s00167-011-1860-y

Cited by 206 publications

(199 citation statements)

References 72 publications

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“…However, the differences we found in terms of additional stability with the combined procedure were small, and although they were statistically significant, it is possible that they were not clinically important. Previous studies have determined a direct correlation between objective assessment of ligament stability and subjective outcomes of function [4,19]. As our results indicate that patient-reported functional outcomes were similar between both treatment groups, we may assume that the slight increase in stability offered by the addition of the extraarticular procedure did not reach a minimum threshold to be clinically perceptible to patients.…”

Section: Discussionsupporting

confidence: 53%

“…Improvement in patient satisfaction and knee function has been shown to maintain straight association with knee rotatory stability, therefore interest has grown in increasing reliability of diagnostic and treatment methods of rotatory stability after ACL reconstruction [19]. The pivot shift test remains the main tool to address rotational instability, as other knee rotation assessments are not standardized [4]. However, confounding factors such as differences in performance methods, strength torque applied, and excessive subjectivity in the examiner's interpretation of pivot shift evaluation may diminish its usefulness [48].…”

Section: Discussionmentioning

confidence: 99%

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Does Combined Intra- and Extraarticular ACL Reconstruction Improve Function and Stability? A Meta-analysis

Rezende

Moraes

Martimbianco

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background ACL reconstruction aims to restore knee function and stability; however, rotational stability may not be completely restored by use of standard intraarticular reconstruction alone. Although individual studies have not shown the superiority of combined ACL reconstruction compared with isolated intraarticular reconstruction in terms of function and stability, biomechanical principles suggest a combined approach may be helpful, therefore pooling (meta-analyzing) the available randomized clinical studies may be enlightening. Questions/purposes We performed a meta-analysis to determine whether combining extraarticular with intraarticular ACL reconstruction would lead to: (1) similar knee function measured by the IKDC evaluation, return-toactivity, and Tegner Lysholm scores, compared with isolated intraarticular reconstruction; (2) increased stability measured by pivot shift and instrumented Lachman examination; and (3) any differences in complications and adverse events? Methods To identify randomized controlled trials (RCTs) comparing combined intra-and extrarticular ACL reconstruction (combined reconstruction) with intraarticular ACL reconstruction only, we searched MEDLINE, EMBASE, SPORTDiscus, Latin American and Caribbean Health Sciences (LILACS), and the Cochrane Central Register of Controlled Trials, and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria. The main outcomes we sought were patient function and stability and complications after ACL reconstruction. Of 386 identified studies, eight RCTs were included (n = 682 participants; followup, 12-84 months; men to women ratio, 2.17:1) in our meta-analysis. Study quality (internal validity) was assessed using the Cochrane risk-of-bias tool; in general, we found a moderate quality of evidence of the included studies. Results When functional outcomes were compared, we found no difference between patients who underwent intraarticular ACL reconstruction only and those who underwent combined reconstruction (IKDC, return-to-activity, and Tegner Lysholm scores). However, patients who underwent combined reconstruction were more likely to show improved stability based on the pivot shift test (risk ratio [RR], 0.95; 95% CI, 0.91-0.99; p = 0.02) and Lachman test (RR, 0.93; 95% CI, 0.88-0.98; p = 0.01). In addition, our meta-analysis found no difference between the two treatments in terms of general complications or adverse events (RR, 1.31; 95% CI, 0.70-2.34; p = 0.40) and the proportion of patients whose reconstructions failed (RR, 2.88; 95% CI, 0.73-11.47; p = 0.13).

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Section: Discussionsupporting

confidence: 53%

Section: Discussionmentioning

confidence: 99%

Does Combined Intra- and Extraarticular ACL Reconstruction Improve Function and Stability? A Meta-analysis

Rezende

Moraes

Martimbianco

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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“…Correlations with clinical outcome, as well as with the development of OA [121][122][123], further emphasize the importance of this concept. Consequently, a variety of technical tools focus on objectifying the pivot shift.…”

Section: Assessment Of Rotatory Laxitymentioning

confidence: 88%

Kinematic outcomes following ACL reconstruction

Naendrup

Zlotnicki

Chao

et al. 2016

Curr Rev Musculoskelet Med

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Anterior cruciate ligament (ACL) reconstruction aims to restore the translational and rotational motion to the knee joint that is lost after injury. However, despite technical advancements, clinical outcomes are less than ideal, particularly in return to previous activity level. A major issue is the inability to standardize treatment protocols due to variations in materials and approaches used to accomplish ACL reconstruction. These include surgical techniques such as the transtibial and anteromedial portal methods that are currently under use and the wide availability of graft types that will be used to reconstruct the ACL. In addition, concomitant soft tissue injuries to the menisci and capsule are frequently present after ACL injury and, if left unaddressed, can lead to persistent instability even after the ACL has been reconstructed. Advances in the field of biomechanics that help to objectively measure motion of the knee joint may provide more precise data than current subjective clinical measurements. These technologies include extra-articular motion capture systems that measure the movement of the tibia in relation to the femur. With data gathered from these devices, a threshold for satisfactory knee stability may be established in order to correctly identify a successful reconstruction following ACL injury.

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“…In order to achieve standardized comparison of technique across patient populations, recent research has focused on the objective measurement of validated, subjective clinical exams such as the "pivot shift test." This specific clinical exam has been demonstrated as the most specific test for ACL deficiency, while also best correlating patient-reported outcome and the development of osteoarthritis [10][11][12]. Therefore, the objective reporting of this exam has significant value for both clinical and research outcomes.…”

Section: Basic Theory Of Clinical Knee Biomechanics and Objective Assmentioning

confidence: 99%

Basic biomechanic principles of knee instability

Zlotnicki

Naendrup

Ferrer

et al. 2016

Curr Rev Musculoskelet Med

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Motion at the knee joint is a complex mechanical phenomenon. Stability is provided by a combination of static and dynamic structures that work in concert to prevent excessive movement or instability that is inherent in various knee injuries. The anterior cruciate ligament (ACL) is a main stabilizer of the knee, providing both translational and rotatory constraint. Despite the high volume of research directed at native ACL function, pathogenesis and surgical reconstruction of this structure, a gold standard for objective quantification of injury and subsequent repair, has not been demonstrated. Furthermore, recent studies have suggested that novel anatomic structures may play a significant role in knee stability. The use of biomechanical principles and testing techniques provides essential objective/quantitative information on the function of bone, ligaments, joint capsule, and other contributing soft tissues in response to various loading conditions. This review discusses the principles of biomechanics in relation to knee stability, with a focus on the objective quantification of knee stability, the individual contributions of specific knee structures to stability, and the most recent technological advances in the biomechanical evaluation of the knee joint.

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Pivot shift as an outcome measure for ACL reconstruction: a systematic review

Abstract: The pivot shift test is an important test following ACL reconstruction, and it correlates with functional outcomes.

Cited by 206 publications

References 72 publications

Does Combined Intra- and Extraarticular ACL Reconstruction Improve Function and Stability? A Meta-analysis

Does Combined Intra- and Extraarticular ACL Reconstruction Improve Function and Stability? A Meta-analysis

Kinematic outcomes following ACL reconstruction

Basic biomechanic principles of knee instability

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