An original clinical methodology for non-invasive assessment of pivot-shift test

Even if pivot-shift (PS) test has been clinically used to specifically detect anterior cruciate ligament (ACL) injury, the main problem in using this combined test has been yet associated with the difficulty of clearly quantifying its outcome. The goal of this study was to describe an original non-invasive methodology used to quantify PS test, highlighting its possible clinical reliability. The method was validated on 66 consecutive unilateral ACL-injured patients. A commercial triaxial accelerometer was non-invasively mounted on patient's tibia, the corresponding 3D acceleration was acquired during PS test execution and a set of specific parameters were automatically identified on the signal to quantify the test. PS test was repeated three times on both injured and controlateral limbs. Reliability of the method was found to be good (mean intra-rater intraclass correlation coefficient was 0.79); moreover, we found that ACL-deficient knees presented statistically higher values for the identified parameters – than the controlateral healthy limbs, averagely reporting also large effect size.

[1]  J. A. Ostrowski.  Accuracy of 3 diagnostic tests for anterior cruciate ligament tears. , 2006, Journal of athletic training.

[2]  D. MacIntosh,et al.  The lateral pivot shift: a symptom and sign of anterior cruciate ligament insufficiency. , 1980, Clinical orthopaedics and related research.

[3]  W. Bugge,et al.  Inter- and intratester comparison of the Rolimeter knee tester: effect of tester's experience and the examination technique , 2001, Knee Surgery, Sports Traumatology, Arthroscopy.

[4]  Makoto Hashizume,et al.  Quantitative Assessment of Rotatory Instability after Anterior Cruciate Ligament Reconstruction , 2009, The American journal of sports medicine.

[5]  R. Wright.  Knee Injury Outcomes Measures , 2009, The Journal of the American Academy of Orthopaedic Surgeons.

[6]  S. Wiertsema,et al.  Reliability of the KT1000 arthrometer and the Lachman test in patients with an ACL rupture. , 2008, The Knee.

[7]  Freddie H. Fu,et al.  Development of a simple device for measurement of rotational knee laxity , 2007, Knee Surgery, Sports Traumatology, Arthroscopy.

[8]  Kouki Nagamune,et al.  Intraoperative Measurement of Pivot Shift by Electromagnetic Sensors , 2008 .

[9]  D. Daniel,et al.  The measurement of anterior knee laxity after ACL reconstructive surgery. , 1985, Clinical orthopaedics and related research.

[10]  Freddie H. Fu,et al.  Clinical relevance of static and dynamic tests after anatomical double-bundle ACL reconstruction , 2009, Knee Surgery, Sports Traumatology, Arthroscopy.

[11]  William I. Sterett,et al.  Relationships between Objective Assessment of Ligament Stability and Subjective Assessment of Symptoms and Function after Anterior Cruciate Ligament Reconstruction , 2004, The American journal of sports medicine.

[12]  C. Rangger,et al.  Comparison of Score Evaluations and Instrumented Measurement after Anterior Cruciate Ligament Reconstruction , 2000, The American journal of sports medicine.

[13]  D. Kohn,et al.  A non-invasive device to objectively measure tibial rotation: verification of the device , 2009, Knee Surgery, Sports Traumatology, Arthroscopy.

[14]  Stefano Zaffagnini,et al.  Does a lateral plasty control coupled translation during antero-posterior stress in single-bundle ACL reconstruction? An in vivo study , 2008, Knee Surgery, Sports Traumatology, Arthroscopy.

[15]  Jacob Cohen,et al.  A power primer. , 1992, Psychological bulletin.

[16]  Stefano Zaffagnini,et al.  Pivot‐shift test: Analysis and quantification of knee laxity parameters using a navigation system , 2009, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[17]  M. Prins.  The Lachman test is the most sensitive and the pivot shift the most specific test for the diagnosis of ACL rupture. , 2006, The Australian journal of physiotherapy.

[18]  W. D. Cannon,et al.  Use of Arthrometers to Assess Knee Laxity and Outcomes , 2002 .

[19]  Andrew A. Amis,et al.  Measurement of Knee Laxity and Pivot-Shift Kinematics With Magnetic Sensors , 2008 .

[20]  B. Beynnon,et al.  A new device to measure knee laxity during weightbearing and non‐weightbearing conditions , 2001, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[21]  C. Highgenboten,et al.  Genucom, KT-1000, and Stryker knee laxity measuring device comparisons , 1989, The American journal of sports medicine.

[22]  R P Jakob,et al.  Grading the pivot shift. Objective tests with implications for treatment. , 1987, The Journal of bone and joint surgery. British volume.

[23]  R. B. Smith,et al.  Outcome measurement in the ACL deficient knee--what's the score? , 2001, The Knee.

[24]  Thore Zantop,et al.  Rotational instability of the knee: internal tibial rotation under a simulated pivot shift test , 2009, Archives of Orthopaedic and Trauma Surgery.

[25]  A. Amis,et al.  Incidence and mechanism of the pivot shift. An in vitro study. , 1999, Clinical orthopaedics and related research.

[26]  R. P. Csintalan,et al.  Biomechanical and Anatomical Effects of an External Rotational Torque Applied to the Knee , 2006, The American journal of sports medicine.

[27]  R. Mascarenhas,et al.  Current Concepts in Instrumented Knee-Laxity Testing , 2009, The American journal of sports medicine.

[28]  G. Losse,et al.  Instrumented measurement of anterior laxity of the knee. , 1985, The Journal of bone and joint surgery. American volume.

[29]  K. McGraw,et al.  Forming inferences about some intraclass correlation coefficients. , 1996 .

[30]  Stefano Zaffagnini,et al.  Quantitative Correlation Between IKDC Score, Static Laxity, and Pivot-Shift Test: A Kinematic Analysis of Knee Stability in Anatomic Double-Bundle Anterior Cruciate Ligament Reconstruction , 2008 .

[31]  Andrew A. Amis,et al.  The pivot-shift phenomenon: a clinical and biomechanical perspective , 1998 .

[32]  J. Fairclough,et al.  Comparison of clinical tests and the KT1000 in the diagnosis of anterior cruciate ligament rupture. , 1991, British journal of sports medicine.

[33]  Andrew A. Amis,et al.  Biomechanics of rotational instability and anatomic anterior cruciate ligament reconstruction , 2005 .

[34]  V. Musahl,et al.  Lateral compartment translation predicts the grade of pivot shift: a cadaveric and clinical analysis , 2010, Knee Surgery, Sports Traumatology, Arthroscopy.

[35]  Stefano Zaffagnini,et al.  Automatic Screening of Acceleration Signal during Pivot-shift Test based on Pearson's Correlation Coefficient , 2010, BIOSIGNALS.

[36]  David R. Labbé,et al.  Accounting for velocity of the pivot shift test manoeuvre decreases kinematic variability. , 2011, The Knee.