Positive pivot shift after ACL reconstruction predicts later osteoarthrosis63 patients followed 5–9 years after surgery

Abstract

Background Rupture of the anterior cruciate ligament (ACL) may cause osteoarthrosis (OA) and functional impairment. We wanted to find out whether the degree of knee stability obtained after ACL reconstruction correlates with radiographic and clinical outcome.Patients and methods We examined 63 patients 2 and 5-9 years after anterior cruciate ligament (ACL) reconstruction. Knee stability was assessed 2 years after surgery by recording AP laxity using radiostereometric technique (RSA) and by performing the pivot shift test. Degeneration of the knee joint was evaluated with bone scintigraphy, and radiographically. Functional outcome was assessed with Lysholm score, Tegner activity scale and with the one-leg hop test.Results Radiographic signs of osteoarthrosis at the most recent follow-up (5-9 years) did not correlate with knee stability. Patients with positive pivot shift test 2 years after surgery showed increased scintigraphic activity of the subchondral bone at the most recent follow-up, and inferior subjective functional outcome 2 years after surgery. Knees having had meniscus resections had more often OA. Radiographical signs of OA were associated with higher scintigraphic uptake in the operated knee relative to the contralateral knee.Interpretation The ability to obliterate the pivoting by ACL reconstruction appears to be more important than normalizing the AP laxity in order to prevent later OA.

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

“…Patients having a negative pivot shift test showed significantly less signs of radiographic osteoarthritis and better functional assessment scores independent of reconstruction. This is in line with the results published by Jonsson et al [15] who suggested a positive pivot shift test as predictor of later osteoarthritis based on the results of a long-term radiographic evaluation. Also Kocher et al reported a significant relationship between the pivot shift test grades and patient satisfaction, whereas anterior posterior laxity did not have influence on patient subjective assessment two years postoperatively [16].…”

Kinematic outcomes following ACL reconstruction

“…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.…”

Electromagnetic tracking of the pivot-shift

“…This is due to the fact that the presence of a pivot-shift phenomenon after ACL reconstruction is associated with functional impairment and consequently poor patient satisfaction [5,6]. In addition, according to the report from Jonsson et al [7], patients with positive pivot-shift findings demonstrated increased scintigraphic activity in the subchondral bone of the knee joint [7]. Furthermore, negative pivot shift test demonstrated fewer signs of radiographic osteoarthritis [8].…”