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Mechanizing the Pivot Shift Test

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Rotatory Knee Instability

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Abstract

The pivot shift test is a widely used test for anterior cruciate ligament (ACL) deficiency and has a high specificity. However, the test is subjective and has high interobserver variability. In order to overcome these disadvantages, we developed a mechanized pivot shift test. In this mechanized pivot shift, a modified continuous passive motion apparatus applies valgus force and internal rotation in human cadavers during the flexion–extension arc, while a navigation system tracks and quantifies the motion path. This standardized and mechanized setup was found to have an intraobserver test–retest reliability of 0.99. With this machine it was determined that ACL deficiency resulted in an 8.4 mm (mm) increase in lateral compartment anterior tibial translation (ATT) and that the difference between grade 0 pivot shift and grade ≥1 (positive) pivot shift has a threshold value of 6–7 mm. In addition, the roles of the lateral meniscus, iliotibial band, tibial slope, and tibial morphology were quantified as secondary stabilizers in knee stability. Using the mechanized pivot shift test, the different ACL reconstruction techniques and tibial tunnel placements were assessed and demonstrated that the double-bundle technique and anatomic single-bundle technique were better in restoring the lateral compartment ATT than the conventional technique. In knees that underwent radical meniscectomy, the double-bundle technique is favored over single-bundle techniques. In conclusion, using the mechanized pivot shift, the roles of several structures in the pivot shift were quantified. With the objectivity and high interobserver reliability, the mechanized pivot shift test assessed the role of several stabilizing structures in the knee.

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Authors and Affiliations

  1. Computer Assisted Surgery Center, Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA

    Jelle P. van der List & Andrew D. Pearle

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  1. Jelle P. van der List
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  2. Andrew D. Pearle
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Correspondence to Andrew D. Pearle .

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Editors and Affiliations

  1. UPMC Center for Sports Medicine, Pittsburgh, Pennsylvania, USA

    Volker Musahl

  2. Sahlgrenska Academy, University of Gothenburg, Mölndal, Sweden

    Jón Karlsson

  3. Orthopaedic Surgery, Kobe University School of Medicine, Kobe, Japan

    Ryosuke Kuroda

  4. Istituto Ortopedico Rizzoli, University of Bologna, Bologna, Italy

    Stefano Zaffagnini

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van der List, J.P., Pearle, A.D. (2017). Mechanizing the Pivot Shift Test. In: Musahl, V., Karlsson, J., Kuroda, R., Zaffagnini, S. (eds) Rotatory Knee Instability. Springer, Cham. https://doi.org/10.1007/978-3-319-32070-0_21

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