Alexandre Hardy1,2, Laurent Casabianca3,4, Edouard Hardy5, Olivier Grimaud6, Alain Meyer6. 1. Service de chirurgie Orthopédique et traumatologie, Hôpital Cochin APHP, Paris, France. Alexandre.hardy@me.com. 2. Université Paris Descartes, Paris, France. Alexandre.hardy@me.com. 3. Service de chirurgie Orthopédique et traumatologie, Hôpital Cochin APHP, Paris, France. 4. Université Paris Descartes, Paris, France. 5. Université Paris dauphine, 75016, Paris, France. 6. Clinique du Sport Paris V, 75005, Paris, France.
Abstract
PURPOSE: The pivot shift test is quantified subjectively during assessment of patients presenting with suspected Anterior Cruciate Ligament (ACL) tears and has a low interobserver reproducibility. The Kinematic Rapid Assessment (KiRA) is a triaxial accelerometer that makes it possible to non-invasively quantify tibial acceleration during the pivot shift test. Abolishing pivot shift is considered to be a key element in surgical reconstruction but is incomplete in 25-38% of patients. METHODS: Patients were included prospectively. Inclusion criteria were patients requiring ACL reconstruction associated with at least one of the following factors corresponding to the patient who have a high risk of rupture either by their sports activity, a failure case, or the notion of important rotational laxity: the patient practiced a competitive pivot-contact sport, revision ACL reconstruction (besides STG (semitendinosus-gracilis graft) repair), subjective explosive rotational laxity, Segond fracture, and TELOS value of >10 mm. Standardized pre- and postoperative pivot shift tests were immediately performed under anesthesia in both knees. RESULTS: Forty-three patients were included. Mean preoperative variations in tibial acceleration in the healthy and injured knees were 1.2 ± 0.1 and 2.7 ± 0.3 m/s2, respectively, p < 0.01. A statistically significant decrease in immediate postoperative mean variations in acceleration in the injured knee occurred: 1.5 ± 0.3 m/s2, p < 0.01. There was no longer any statistical difference between postoperative contralateral healthy knees and operated knees (n.s). CONCLUSIONS: Combined ACL reconstruction associated with anterolateral tenodesis suppress acute pathologic tibial acceleration in the pivot shift. LEVEL OF EVIDENCE: III.
PURPOSE: The pivot shift test is quantified subjectively during assessment of patients presenting with suspected Anterior Cruciate Ligament (ACL) tears and has a low interobserver reproducibility. The Kinematic Rapid Assessment (KiRA) is a triaxial accelerometer that makes it possible to non-invasively quantify tibial acceleration during the pivot shift test. Abolishing pivot shift is considered to be a key element in surgical reconstruction but is incomplete in 25-38% of patients. METHODS:Patients were included prospectively. Inclusion criteria were patients requiring ACL reconstruction associated with at least one of the following factors corresponding to the patient who have a high risk of rupture either by their sports activity, a failure case, or the notion of important rotational laxity: the patient practiced a competitive pivot-contact sport, revision ACL reconstruction (besides STG (semitendinosus-gracilis graft) repair), subjective explosive rotational laxity, Segond fracture, and TELOS value of >10 mm. Standardized pre- and postoperative pivot shift tests were immediately performed under anesthesia in both knees. RESULTS: Forty-three patients were included. Mean preoperative variations in tibial acceleration in the healthy and injured knees were 1.2 ± 0.1 and 2.7 ± 0.3 m/s2, respectively, p < 0.01. A statistically significant decrease in immediate postoperative mean variations in acceleration in the injured knee occurred: 1.5 ± 0.3 m/s2, p < 0.01. There was no longer any statistical difference between postoperative contralateral healthy knees and operated knees (n.s). CONCLUSIONS: Combined ACL reconstruction associated with anterolateral tenodesis suppress acute pathologic tibial acceleration in the pivot shift. LEVEL OF EVIDENCE: III.
Authors: Martin Logan; Edward Dunstan; James Robinson; Andrew Williams; Wady Gedroyc; Michael Freeman Journal: Am J Sports Med Date: 2004 Apr-May Impact factor: 6.202
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: Stefano Zaffagnini; Cecilia Signorelli; Alberto Grassi; Yuichi Hoshino; Ryosuke Kuroda; Darren de Sa; David Sundemo; Kristian Samuelsson; Volker Musahl; Jon Karlsson; 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; Giulio Maria Marcheggiani Muccioli; Nicola Lopomo; Federico Raggi; Eleonor Svantesson; Eric Hamrin Senorski; Haukur Bjoernsson; Mattias Ahlden; Neel Desai Journal: Orthop J Sports Med Date: 2018-12-18