Nicola Lopomo1, Cecilia Signorelli2, Amir Ata Rahnemai-Azar3, Federico Raggi2, Yuichi Hoshino4, Kristian Samuelsson5, Volker Musahl3, Jon Karlsson5, Ryosuke Kuroda4, Stefano Zaffagnini2. 1. Dipartimento di Ingegneria dell'Informazione, Università degli Studi di Brescia, Brescia, Italy. nicola.lopomo@unibs.it. 2. Laboratorio di Biomeccanica e Innovazione Tecnologica, Istituto Ortopedico Rizzoli, Bologna, Italy. 3. Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA. 4. Department of Orthopaedic Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan. 5. Department of Orthopaedics, Sahlgrenska University Hospital, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.
Abstract
PURPOSE: The main goal of this work was to evaluate the pivot shift test in awake and anesthetized patients by using two different quantitative methodologies and comparing the results with the standard clinical grading, taking advantage of a multicenter international study. METHODS: Patients between 16 and 50 years of age undergoing primary unilateral single-bundle anterior cruciate ligament (ACL) reconstruction were considered eligible. The pivot shift test was performed pre-operatively, with the patient awake and again with the patient under general anaesthesia. The pivot shift test was clinically graded as defined by the International Knee Documentation Committee. The instrumented assessment was performed by using two non-invasive acquisition systems; specifically, a system exploiting an inertial sensor and a video-based application developed on a commercial tablet using skin markers. Lateral compartment translation and the tibial acceleration reached during joint reduction were used as quantitative parameters. RESULTS: A total of 103 patients were enrolled in the study. Statistically significant difference was found between the distributions of clinical grade evaluated in awake patients and those under general anaesthesia (P < 0.01). Comparing awake patients to those under general anaesthesia, lower values were found both for tibial acceleration (3.7 ± 1.5 vs 6.0 ± 4.6 m/s2, P < 0.01) and lateral compartment translation of the involved limb (2.2 ± 1.7 vs 3.0 ± 2.2 mm, P < 0.01). CONCLUSIONS: This study indicated that significant differences in the grading of the pivot shift test exist between awake and anesthetized patients, regardless of the use of quantitative instruments during the evaluation. Actual clinical assessment reported indeed its weakness, presenting subjective variability and dependence on tester's experience. However, several factors might influence the validity of awake examination such as experience level of examiner and cultural factors, as seen in this international multicenter study. LEVEL OF EVIDENCE: Prospective comparative study, Level II.
PURPOSE: The main goal of this work was to evaluate the pivot shift test in awake and anesthetized patients by using two different quantitative methodologies and comparing the results with the standard clinical grading, taking advantage of a multicenter international study. METHODS:Patients between 16 and 50 years of age undergoing primary unilateral single-bundle anterior cruciate ligament (ACL) reconstruction were considered eligible. The pivot shift test was performed pre-operatively, with the patient awake and again with the patient under general anaesthesia. The pivot shift test was clinically graded as defined by the International Knee Documentation Committee. The instrumented assessment was performed by using two non-invasive acquisition systems; specifically, a system exploiting an inertial sensor and a video-based application developed on a commercial tablet using skin markers. Lateral compartment translation and the tibial acceleration reached during joint reduction were used as quantitative parameters. RESULTS: A total of 103 patients were enrolled in the study. Statistically significant difference was found between the distributions of clinical grade evaluated in awake patients and those under general anaesthesia (P < 0.01). Comparing awake patients to those under general anaesthesia, lower values were found both for tibial acceleration (3.7 ± 1.5 vs 6.0 ± 4.6 m/s2, P < 0.01) and lateral compartment translation of the involved limb (2.2 ± 1.7 vs 3.0 ± 2.2 mm, P < 0.01). CONCLUSIONS: This study indicated that significant differences in the grading of the pivot shift test exist between awake and anesthetized patients, regardless of the use of quantitative instruments during the evaluation. Actual clinical assessment reported indeed its weakness, presenting subjective variability and dependence on tester's experience. However, several factors might influence the validity of awake examination such as experience level of examiner and cultural factors, as seen in this international multicenter study. LEVEL OF EVIDENCE: Prospective comparative study, Level II.
Authors: Rob J P M Scholten; Wim Opstelten; Cees G van der Plas; Dick Bijl; Walter L J M Deville; Lex M Bouter Journal: J Fam Pract Date: 2003-09 Impact factor: 0.493
Authors: Mininder S Kocher; J Richard Steadman; Karen K Briggs; William I Sterett; Richard J Hawkins Journal: Am J Sports Med Date: 2004 Apr-May Impact factor: 6.202
Authors: Theresa Diermeier; Sean J Meredith; James J Irrgang; Stefano Zaffagnini; Ryosuke Kuroda; Yuichi Hochino; Kristian Samuelsson; Clair Nicole Smith; Adam Popchak; Volker Musahl; Andrew Sheean; Jeremy M Burnham; Jayson Lian; Clair Smith; Adam Popchak; Elmar Herbst; Thomas Pfeiffer; Paulo Araujo; Alicia Oostdyk; Daniel Guenther; Bruno Ohashi; James J Irrgang; Freddie H Fu; Kouki Nagamune; Masahiro Kurosaka; Ryosuke Kuroda; Yuichi Hochino; Alberto Grassi; Giulio Maria Marcheggiani Muccioli; Nicola Lopomo; Cecilia Signorelli; Federico Raggi; Stefano Zaffagnini; Alexandra Horvath; Eleonor Svantesson; Eric Hamrin Senorski; David Sundemo; Haukur Bjoernsson; Mattias Ahlden; Neel Desai; Kristian Samuelsson; Jon Karlsson Journal: Orthop J Sports Med Date: 2020-07-07