The pivot shift: a global user guide

Musahl, Volker; Hoshino, Yuichi; Ahldén, Mattias; Araújo, Paulo; Irrgang, James J.; Zaffagnini, Stefano; Karlsson, Jón; Fu, Freddie H.

doi:10.1007/s00167-011-1859-4

Cited by 108 publications

(106 citation statements)

References 22 publications

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“…Due to the intra-examiner variation in the technique being used for the assessment of knee stability, subjective tests need to be tough and applied in a standardized fashion. These differences make comparisons between the reported results in the literature difficult because of the inability to accurately and systematically compare two different techniques [79]. Hence, a better evaluation of each test needs to be conducted.…”

Section: Discussionmentioning

confidence: 99%

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An Extensive Evaluation of Different Knee Stability Assessment Measures: A Systematic Review

Abulhasan

Snow

Anley

et al. 2016

JFMK

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Abstract:Re-injury to a recently rehabilitated or operated knee is a common occurrence that can result in significant loss of function. Knee stability measures have been used to diagnose and assess knee stability before and after rehabilitation interventions. Here, we systematically review the literature and evaluate the different anterior-posterior and rotational knee stability measures currently in use. A computer-assisted literature search of the Medline, CINAHL, EMBASE, PubMed and Cochrane databases was conducted using keywords related to knee stability measures. In a second step, we conducted a manual search of the references cited in these articles to capture any studies that may have been missed in the searched databases. The literature search strategy identified a total of 574 potential studies. After revisiting the titles and abstracts, 34 full-text articles met the inclusion criteria and were included in this review. Most articles compared knee stability measures, whilst other studies assessed their sensitivity and specificity. Several techniques and devices used to measure knee stability are reported in the literature. However, there are only a limited number of quality studies where these techniques and/or devices have been evaluated. Further development and investigation with high quality study designs is necessary to robustly evaluate the existing devices/techniques.

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Section: Discussionmentioning

confidence: 99%

“…Firstly is the different pathomechanics between injured knees [79,80], as well as inter-individual variations in patient outcome during rehabilitation programs [80]. Secondly, the majority of the knee stability measures for anterior and rotational instability were highly sensitive, but had lower specificity (Table 3).…”

Section: Discussionmentioning

confidence: 99%

An Extensive Evaluation of Different Knee Stability Assessment Measures: A Systematic Review

Abulhasan

Snow

Anley

et al. 2016

JFMK

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“…Finally, the manual execution of the pivot-shift test has a wide variation among examiners [15,16,28]. The manually applied force, the testing speed, and the position of the hip joint are potential factors affecting the knee kinematics and the quantitative measurement of the pivot-shift.…”

Section: Limitationsmentioning

confidence: 99%

“…These factors are difficult to standardize between examiners. Valgus stress is always applied during the pivot-shift test, but axial rotational stress is not necessarily the same between surgeons [16]. Internal rotational stress is more important than external rotational stress, but some do not intentionally apply rotational torque [15].…”

Section: Limitationsmentioning

confidence: 99%

“…While a clinical exam for the pivot shift exists, there are some shortcomings in the clinically performed pivot-shift test. The pivot-shift test provides a rough four-grade evaluation, such as none (−), glide (+), clunk (++), and gross (+++), according to the magnitude of the pivot-shift phenomenon, and the clinical grading is determined in a highly subjective way based on the examiner's feeling [13][14][15][16]. In order to achieve more objective evaluation of the pivot-shift test, various measurement systems have been developed, such as an electromagnetic tracking system, a navigation system, an image analysis, and an accelerometer [17][18][19][20][21][22][23][24].…”

Section: Introductionmentioning

confidence: 99%

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Electromagnetic tracking of the pivot-shift

Kuroda

Hoshino

2016

Curr Rev Musculoskelet Med

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The pivot-shift test is an important examination to assess the rotational laxity in the anterior cruciate ligament (ACL) injured and reconstructed knees. Because this examination is related to subjective knee function, we may still see cases that have residual rotational laxity after ACL reconstruction. Quantitative evaluation of the pivot-shift test is preferable to the clinical pivot-shift test but is difficult to attain mainly due to complicated movements of the pivot-shift. The electromagnetic tracking system was developed to evaluate knee kinematics during the pivot-shift, providing information related to 6-degree-of-freedom knee kinematics with a high sampling rate. Through this device, the abnormal movement of the pivot-shift is characterized in two phases: an increased anterior tibial translation and a boosted acceleration of tibial posterior reduction. Since its invention, this system has been utilized to assess rotational laxity for clinical follow-up and research after the ACL reconstruction.

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Dynamic radiostereometry can objectively quantify the kinematic laxity patterns and rotation instability of the knee during a pivot‐shift test

Vind,

Petersen,

Sørensen

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeThe pivot‐shift test is used to clinically assess knee instability in patients with anterior cruciate ligament (ACL) lesions; however, it has low interobserver reliability. Dynamic radiostereometry (dRSA) is a highly precise and noninvasive method for the objective evaluation of joint kinematics. The purpose of this study was to quantify precise knee kinematics during a pivot‐shift test using dRSA imaging.MethodEight human donor legs, including hemipelvises, were evaluated. Arthroscopic intervention was performed inducing ligament lesions in the ACL, and anterolateral ligament (ALL) section was performed as a capsular incision. The pivot‐shift test was recorded with dRSA on knees with intact ligaments, ACL‐deficient and ACL + ALL‐deficient knees.ResultsA pivot‐shift pattern was identifiable after ligament lesion, as a change in tibial posterior drawer velocity from 7.8 mm/s (95% CI: 3.7; 11.9) in ligament intact knees to 30.4 mm/s (95% CI 23.0; 38.8) after ACL lesion to 35.1 mm/s (95% CI 23.4; 46.7) after combined ACL‐ALL lesion. The anterior‐posterior drawer excursion increased from 2.8 mm (95% CI 2.1; 3.4) in ligament intact knees to 7.2 mm (95% CI 5.5; 8.9) after ACL lesion to 7.6 mm (95% CI 5.5; 9.8) after combined lesion. A statistically significant increase in tibial external rotation towards the end of the pivot‐shift motion was observed when progressing from intact to ACL + ALL‐deficient knees (p < 0.023).ConclusionThis experimental study demonstrates the feasibility of dRSA to objectively quantify the kinematic laxity patterns of the knee during the pivot‐shift test. The dynamic parameters obtained through dRSA revealed the kinematic changes from ACL to combined ACL‐ALL ligament lesion.Level of EvidenceNot applicable.

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The pivot shift: a global user guide

Cited by 108 publications

References 22 publications

An Extensive Evaluation of Different Knee Stability Assessment Measures: A Systematic Review

An Extensive Evaluation of Different Knee Stability Assessment Measures: A Systematic Review

Electromagnetic tracking of the pivot-shift

Dynamic radiostereometry can objectively quantify the kinematic laxity patterns and rotation instability of the knee during a pivot‐shift test

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