The Pivot Shift Test Is of Limited Clinical Relevance in the Arthritic Anterior Cruciate Ligament-Deficient Knee

Dodd, M; Trompeter, Alex; Harrison, T; Palmer, Sylvain

doi:10.1055/s-0030-1267473

Cited by 18 publications

(9 citation statements)

References 21 publications

(39 reference statements)

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“…Visual assessment in this study was used as the gold standard by which the various tests were assessed for sensitivity and specificity. Prior reports have suggested the ACL is intact in anywhere from 25% to 86% of patients undergoing TKA (Table 3) [10,12,17,21,24]. The current study is consistent with the previous reports of ACL integrity.…”

Section: Discussionsupporting

confidence: 92%

“…For these prostheses to be effective, however, there should be an intact ACL present at the time of arthroplasty. The current literature has variable reports of the presence of the ACL at the time of surgery [10,12,17,20,21,24]. Additionally, because of arthritic degeneration such as joint space narrowing and osteophytic changes at the joint, it may be difficult to assess the ACL preoperatively by physical examination.…”

Section: Discussionmentioning

confidence: 99%

“…The Lachman test is reportedly not useful for diagnosing ACL deficiency in arthritic knees [17]. In a study by Dodd et al [17], 50 knees that underwent TKA (seven of which were ACL-deficient) had pivot shift tests performed under anesthesia before surgery. None of the ACL-deficient knees had a positive pivot shift test, which the authors reported was consistent with the degenerative changes found in osteoarthritic knees.…”

Section: Discussionmentioning

confidence: 99%

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The ACL in the Arthritic Knee: How Often Is It Present and Can Preoperative Tests Predict Its Presence?

Johnson

Howell

Costa

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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Background TKA with retention of the anterior cruciate ligament (ACL) may improve kinematics and function. However, conflicting reports exist concerning the prevalence of intact ACLs at the time of TKA. Questions/purposes Therefore, we asked: (1) what was the ACL status at TKA; (2) what was the sensitivity and specificity of the Lachman test; (3) did MRI ACL integrity correlate with intraoperative observation; (4) did MRI tibial wear patterns correlate with ACL integrity; and (5) did ACL status depend on age or sex? Methods We evaluated 200 patients for ACL integrity at the time of TKA. All patients underwent a Lachman test under anesthesia. Intraoperatively, the ACL was characterized as intact, frayed, disrupted, or absent. In 100 patients, MRIs were performed, from which the ACL was graded as intact, indeterminate, or disrupted, and the AP location of tibial wear was categorized. Results The ACL was intact in 155 patients (78%). The Lachman test alone had poor diagnostic ability. The MRI predicted a tear, but we observed two ACLs with indeterminate status that were disrupted. All knees with anterior wear on the medial tibial condyle had an intact ACL (n = 45), and all knees with posterior wear on the medial tibial condyle had a disrupted ACL (n = 8).Conclusions Although the Lachman test alone had poor sensitivity, when combined with MRI they together provide a sensitivity of 93.3% and specificity of 99%, which we believe makes these reasonable tests for assessing ACL status in the arthritic knee.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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The ACL in the Arthritic Knee: How Often Is It Present and Can Preoperative Tests Predict Its Presence?

Johnson

Howell

Costa

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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“…The ACL can be evaluated using the anterior drawer, Lachman, and pivot shift tests. 41 The Lachman test is the most sensitive test in evaluating the ACL, whereas the pivot shift test, particularly when performed under anesthesia, is the most specific. 42 The posterior cruciate ligament can be evaluated with the posterior drawer and sag sign, and posteromedial and posterolateral corner pathology can be determined by varus/valgus and rotational stress testing in both supine and prone position.…”

Section: Physical Examinationmentioning

confidence: 99%

Two-Stage Revision Anterior Cruciate Ligament Reconstruction

Erickson¹,

Cvetanovich²,

Waliullah³

et al. 2016

Orthopedics

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The number of primary anterior cruciate ligament (ACL) tears is rapidly increasing. In patients who wish to return to their preoperative level of function, specifically as it pertains to participation in sports, the gold standard of treatment following an ACL tear remains an anterior cruciate ligament (ACL) reconstruction. Despite a majority of good/excellent results following primary ACL reconstruction, there is a growing subset of patients with persistent or recurrent functional instability who require revision ACL reconstruction. Preoperative planning for revision ACL reconstruction requires a careful understanding of the root cause of ACL failure, including possible technical causes of primary ACL failure and the presence of combined knee pathology that was not addressed at the index ACL reconstruction. The decision to perform 2-stage revision ACL reconstruction is multifactorial and is reached by technical considerations that may make a 1-stage revision less optimal, including tunnel widening, arthrofibrosis, active infection, and others. Concomitant knee pathology such as meniscal deficiency, malalignment (including an increase in posterior tibial slope), chondral lesions, and other ligamentous laxity may also require a staged approach to treatment. This evidence-based review covers the indications for 2-stage revision ACL reconstruction, surgical techniques, evidence for and technique of bone grafting prior ACL tunnels, and outcomes of 2-stage revision stratified by initial cause of ACL reconstruction failure. With proper preoperative planning and an understanding of the cause of failure following the primary ACL reconstruction, revision ACL reconstruction can offer excellent outcomes in the motivated patient. [Orthopedics. 2016; 39(3):e456-e464.].

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“…OA of the medial compartment is characterised by pain, crepitation, localised joint line tenderness and joint space collapse; collateral ligament pseudolaxity may also be noted 31. Because the manual pivot shift test62 is a subjective measure and the Lachman test has a low specificity (about 33%)63 for diagnosing ACL rupture, overall evaluation will include clinical findings and radiological imaging (box 4). …”

Section: Patient Selection and Preoperative Evaluationmentioning

confidence: 99%