Sebastian Kopf1, Volker Musahl2, Carsten Perka3, Ralf Kauert4, Arnd Hoburg3, Roland Becker5. 1. Center for Musculoskeletal Surgery, Charité-University Medicine Berlin, Charitéplatz 1, 10117, Berlin, Germany. Sebastian.kopf@charite.de. 2. Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA. 3. Center for Musculoskeletal Surgery, Charité-University Medicine Berlin, Charitéplatz 1, 10117, Berlin, Germany. 4. Institute of Micro and Sensor Systems, Otto-von-Guericke-University, Magdeburg, Germany. 5. Department of Orthopaedic and Traumatology, Medical School Theodor Fontane, Brandenburg, Germany.
Abstract
PURPOSE: The pivot shift test is performed in different techniques and the rotation of the tibia seems to have a significant impact on the amount of the pivot shift phenomenon. It has been hypothesised that external rotation will increase the phenomenon due to less tension at the iliotibial band in knee extension. METHODS: Twenty-four patients with unilateral anterior cruciate ligament insufficiency were included prospectively. The pivot shift test was performed bilaterally in internal and external tibial rotation under general anaesthesia. Knee motion was captured using a femoral and a tibial inertial sensor. The difference between positive and negative peak values in Euclidean norm of acceleration was calculated to evaluate the amount of the pivot shift phenomenon. RESULTS: The pivot shift phenomenon was significantly increased in patients with ACL insufficiency when the test was performed in external [mean 5.2 ms- 2 (95% CI 4.3-6.0)] compared to internal tibial rotation [mean 4.4 ms- 2 (95% CI 3.5-5.4)] (p = 0.002). In healthy, contralateral knees did not show any difference between external [mean 4.0 ms- 2 (95% CI 3.3-4.7)] and internal tibial rotation [mean 4.0 ms- 2 (95% CI 3.4-4.6)] (ns). CONCLUSIONS: The pivot shift phenomenon was increased with external rotation in ACL-insufficient knees, and therefore, one should perform the pivot shift test, rather, in external rotation to easily evoke the, sometimes difficult to detect, pivot shift phenomenon. LEVEL OF EVIDENCE: I (diagnostic study).
PURPOSE: The pivot shift test is performed in different techniques and the rotation of the tibia seems to have a significant impact on the amount of the pivot shift phenomenon. It has been hypothesised that external rotation will increase the phenomenon due to less tension at the iliotibial band in knee extension. METHODS: Twenty-four patients with unilateral anterior cruciate ligament insufficiency were included prospectively. The pivot shift test was performed bilaterally in internal and external tibial rotation under general anaesthesia. Knee motion was captured using a femoral and a tibial inertial sensor. The difference between positive and negative peak values in Euclidean norm of acceleration was calculated to evaluate the amount of the pivot shift phenomenon. RESULTS: The pivot shift phenomenon was significantly increased in patients with ACL insufficiency when the test was performed in external [mean 5.2 ms- 2 (95% CI 4.3-6.0)] compared to internal tibial rotation [mean 4.4 ms- 2 (95% CI 3.5-5.4)] (p = 0.002). In healthy, contralateral knees did not show any difference between external [mean 4.0 ms- 2 (95% CI 3.3-4.7)] and internal tibial rotation [mean 4.0 ms- 2 (95% CI 3.4-4.6)] (ns). CONCLUSIONS: The pivot shift phenomenon was increased with external rotation in ACL-insufficient knees, and therefore, one should perform the pivot shift test, rather, in external rotation to easily evoke the, sometimes difficult to detect, pivot shift phenomenon. LEVEL OF EVIDENCE: I (diagnostic study).
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: Mark P Sena; Ryan DellaMaggioria; Jeffrey C Lotz; Brian T Feeley Journal: Knee Surg Sports Traumatol Arthrosc Date: 2015-09-10 Impact factor: 4.342
Authors: Volker Musahl; Olufemi R Ayeni; Musa Citak; James J Irrgang; Andrew D Pearle; Thomas L Wickiewicz Journal: Knee Surg Sports Traumatol Arthrosc Date: 2010-04-08 Impact factor: 4.342