Fabio V Arilla1, Marco Yeung2, Kevin Bell3, Ata A Rahnemai-Azar4, Benjamin B Rothrauff4, Freddie H Fu5, Richard E Debski3, Olufemi R Ayeni2, Volker Musahl6. 1. Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A.; Orthopaedic Robotics Laboratory, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A.; Department of Orthopaedic Surgery, University Hospital of Canoas, Canoas, Rio Grande Do Sul, Brazil. 2. Division of Orthopaedic Surgery, McMaster University Medical Center, Hamilton, Ontario, Canada. 3. Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A.; Orthopaedic Robotics Laboratory, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A. 4. Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A.; Orthopaedic Robotics Laboratory, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A. 5. Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A. 6. Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A.; Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A.; Orthopaedic Robotics Laboratory, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A.. Electronic address: musahlv@upmc.edu.
Abstract
PURPOSE: To conduct a systematic review to identify and summarize the various techniques that have been used to simulate the pivot-shift test in vitro. METHODS: Medline, Embase, and the Cochrane Library were screened for studies involving the simulated pivot-shift test in human cadaveric knees published between 1946 and May 2014. Study parameters including sample size, study location, simulated pivot-shift technique, loads applied, knee flexion angles at which simulated pivot shift was tested, and kinematic evaluation tools were extracted and analyzed. RESULTS: Forty-eight studies reporting simulated pivot-shift testing on 627 cadaveric knees fulfilled the criteria. Reviewer inter-rater agreement for study selection showed a κ score of 0.960 (full-text review). Twenty-seven studies described the use of internal rotation torque, with a mean of 5.3 Nm (range, 1 to 18 Nm). Forty-seven studies described the use of valgus torque, with a mean of 8.8 Nm (range, 1 to 25 Nm). Four studies described the use of iliotibial tract tension, ranging from 10 to 88 N. Regarding static simulated pivot-shift test techniques, 100% of the studies performed testing at 30° of knee flexion, and the most tested range of motion in the continuous tests was 0° to 90°. Anterior tibial translation was the most analyzed parameter during the simulated pivot-shift test, being used in 45 studies. In 22% of the studies, a robotic system was used to simulate the pivot-shift test. Robotic systems were shown to have better control of the loading system and higher tracking system accuracy. CONCLUSIONS: This study provides a reference for investigators who desire to apply simulated pivot shift in their in vitro studies. It is recommended to simulate the pivot-shift test using a 10-Nm valgus torque and 5-Nm internal rotation torque. Knee flexion of 30° is mandatory for testing. LEVEL OF EVIDENCE: Level IV, systematic review of basic science studies.
PURPOSE: To conduct a systematic review to identify and summarize the various techniques that have been used to simulate the pivot-shift test in vitro. METHODS: Medline, Embase, and the Cochrane Library were screened for studies involving the simulated pivot-shift test in human cadaveric knees published between 1946 and May 2014. Study parameters including sample size, study location, simulated pivot-shift technique, loads applied, knee flexion angles at which simulated pivot shift was tested, and kinematic evaluation tools were extracted and analyzed. RESULTS: Forty-eight studies reporting simulated pivot-shift testing on 627 cadaveric knees fulfilled the criteria. Reviewer inter-rater agreement for study selection showed a κ score of 0.960 (full-text review). Twenty-seven studies described the use of internal rotation torque, with a mean of 5.3 Nm (range, 1 to 18 Nm). Forty-seven studies described the use of valgus torque, with a mean of 8.8 Nm (range, 1 to 25 Nm). Four studies described the use of iliotibial tract tension, ranging from 10 to 88 N. Regarding static simulated pivot-shift test techniques, 100% of the studies performed testing at 30° of knee flexion, and the most tested range of motion in the continuous tests was 0° to 90°. Anterior tibial translation was the most analyzed parameter during the simulated pivot-shift test, being used in 45 studies. In 22% of the studies, a robotic system was used to simulate the pivot-shift test. Robotic systems were shown to have better control of the loading system and higher tracking system accuracy. CONCLUSIONS: This study provides a reference for investigators who desire to apply simulated pivot shift in their in vitro studies. It is recommended to simulate the pivot-shift test using a 10-Nm valgus torque and 5-Nm internal rotation torque. Knee flexion of 30° is mandatory for testing. LEVEL OF EVIDENCE: Level IV, systematic review of basic science studies.
Authors: Ahmet Erdemir; Thor F Besier; Jason P Halloran; Carl W Imhauser; Peter J Laz; Tina M Morrison; Kevin B Shelburne Journal: J Biomech Eng Date: 2019-07-01 Impact factor: 2.097