Weiding Cui1,2,3, Yusuke Nakagawa1,2, Hiroki Katagiri1,2, Koji Otabe2, Toshiyuki Ohara2, Mikio Shioda2, Yuji Kohno2, Takashi Hoshino1,2, Aritoshi Yoshihara1, Ichiro Sekiya2, Hideyuki Koga4,5. 1. Department of Joint Surgery and Sports Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan. 2. Department Orthopaedic Surgery, Tokyo Medical and Dental University Hospital of Medicine, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan. 3. Department of Orthopaedics, The First Affiliated Hospital with Nanjing Medical University, No. 300, Guangzhou Road, Nanjing, 210029, China. 4. Department of Joint Surgery and Sports Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan. koga.orj@tmd.ac.jp. 5. Department Orthopaedic Surgery, Tokyo Medical and Dental University Hospital of Medicine, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan. koga.orj@tmd.ac.jp.
Abstract
PURPOSE: Although several factors have been considered to be associated with pivot shift test grade in ACL injured patients, a conclusion regarding which factors contribute to the pivot shift test grade has not been reached. The purpose of this study was to identify factors associated with preoperative pivot shift test grade. METHODS: Three hundred and sixty-six consecutive patients who underwent ACL reconstruction in our hospital were enrolled in the study. Patients were divided into two groups on the basis of preoperative pivot shift test grade (Mild: grade 0-3, Severe: grade 4-6). First, 13 independent variables (age, gender, period from injury to surgery, hyperextension, KT measurement, contralateral side pivot shift test grade, medial and lateral tibial slope, lateral condyle length, lateral condyle height, distal femoral condyle offset, medial and lateral meniscus tear) were analyzed by one-way ANOVA and Chi-squared test. Binary Logistic regression was then performed based on the results of univariate analyses (independent variables of p < 0.2 were included). RESULTS: Hyperextension, lateral meniscus tear, contralateral side pivot shift test grade, distal femoral condyle offset and KT measurement were identified as risk factors for preoperative pivot shift grade via logistic regression analysis. CONCLUSION: The current study revealed that hyperextension, lateral meniscus tear, contralateral side pivot shift test grade, distal femoral condyle offset and anterior instability were associated with preoperative pivot shift grade. Patients with above factors that cannot be modified during surgery may need special consideration when ACL reconstruction is performed, as greater preoperative pivot shift has been proven to be a risk factor for residual pivot shift after ACL reconstruction. LEVEL OF EVIDENCE: III.
PURPOSE: Although several factors have been considered to be associated with pivot shift test grade in ACL injured patients, a conclusion regarding which factors contribute to the pivot shift test grade has not been reached. The purpose of this study was to identify factors associated with preoperative pivot shift test grade. METHODS: Three hundred and sixty-six consecutive patients who underwent ACL reconstruction in our hospital were enrolled in the study. Patients were divided into two groups on the basis of preoperative pivot shift test grade (Mild: grade 0-3, Severe: grade 4-6). First, 13 independent variables (age, gender, period from injury to surgery, hyperextension, KT measurement, contralateral side pivot shift test grade, medial and lateral tibial slope, lateral condyle length, lateral condyle height, distal femoral condyle offset, medial and lateral meniscus tear) were analyzed by one-way ANOVA and Chi-squared test. Binary Logistic regression was then performed based on the results of univariate analyses (independent variables of p < 0.2 were included). RESULTS: Hyperextension, lateral meniscus tear, contralateral side pivot shift test grade, distal femoral condyle offset and KT measurement were identified as risk factors for preoperative pivot shift grade via logistic regression analysis. CONCLUSION: The current study revealed that hyperextension, lateral meniscus tear, contralateral side pivot shift test grade, distal femoral condyle offset and anterior instability were associated with preoperative pivot shift grade. Patients with above factors that cannot be modified during surgery may need special consideration when ACL reconstruction is performed, as greater preoperative pivot shift has been proven to be a risk factor for residual pivot shift after ACL reconstruction. LEVEL OF EVIDENCE: III.
Authors: Lachlan M Batty; Andrew Firth; Gilbert Moatshe; Dianne M Bryant; Mark Heard; Robert G McCormack; Alex Rezansoff; Devin C Peterson; Davide Bardana; Peter B MacDonald; Peter C M Verdonk; Tim Spalding; Alan M J Getgood; Kevin Willits; Trevor Birmingham; Chris Hewison; Stacey Wanlin; Andrew Firth; Ryan Pinto; Ashley Martindale; Lindsey O'Neill; Morgan Jennings; Michal Daniluk; Dory Boyer; Mauri Zomar; Karyn Moon; Raely Pritchett; Krystan Payne; Brenda Fan; Bindu Mohan; Gregory M Buchko; Laurie A Hiemstra; Sarah Kerslake; Jeremy Tynedal; Greg Stranges; Sheila Mcrae; LeeAnne Gullett; Holly Brown; Alexandra Legary; Alison Longo; Mat Christian; Celeste Ferguson; Nick Mohtadi; Rhamona Barber; Denise Chan; Caitlin Campbell; Alexandra Garven; Karen Pulsifer; Michelle Mayer; Nicole Simunovic; Andrew Duong; David Robinson; David Levy; Matt Skelly; Ajaykumar Shanmugaraj; Fiona Howells; Murray Tough; Pete Thompson; Andrew Metcalfe; Laura Asplin; Alisen Dube; Louise Clarkson; Jaclyn Brown; Alison Bolsover; Carolyn Bradshaw; Larissa Belgrove; Francis Millan; Sylvia Turner; Sarah Verdugo; Janet Lowe; Debra Dunne; Kerri McGowan; Charlie-Marie Suddens; Geert Declercq; Kristien Vuylsteke; Mieke Van Haver Journal: Orthop J Sports Med Date: 2021-04-06