Quantitative assessment of pivot-shift using inertial sensors



The pivot-shift phenomenon has been identified to be one of the essential signs of functional anterior cruciate ligament (ACL) insufficiency. However, the pivot-shift test remains a surgeon-subjective examination, lacking a general recognized quantitative measurement. The goal of the present study was to validate the use of an inertial sensor for quantifying the pivot-shift test, using a commercial navigation system.


An expert surgeon intra-operatively performed the pivot-shift test on 15 consecutive patients before ACL reconstruction. A single accelerometer and a commercial navigation system simultaneously acquired limb kinematics. An additional optical tracker mounted on the accelerometer allowed following sensor movements. Anteroposterior (a-p) tibial acceleration obtained with the navigation system was compared with three-dimensional (3D) acceleration acquired by the accelerometer. The effect of skin artifacts and test–retest positioning were estimated. Repeatability of the acceleration parameter and waveform was analyzed. Correlation between the two measurements was also assessed.


Average root mean square (RMS) error in test–retest positioning reported a good value of 5.5 ± 2.9 mm. Mean RMS displacement due to soft tissue artifacts was 4.9 ± 2.6 mm. The analysis of acceleration range repetitions reported a good intra-tester repeatability (Cronbach’s alpha = 0.86). Inter-patients similarity analysis showed a mean acceleration waveform correlation of 0.88 ± 0.14. The acceleration ranges demonstrated a good positive correlation between the two measurements (rs = 0.72, P < 0.05).


This study showed good reliability of the new device and good correlation with the navigation system results. Therefore, the accelerometer is a valid method to assess dynamic joint laxity.

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We would like to acknowledge all the staff of Clinica Ortopedica e Traumatologica III at Istituto Ortopedico Rizzoli for their assistance during the study. NL would like to particularly thank Emil Ferretti for his great contribution in the management of technological stuff in the laboratory. No founding was directly received by any of the authors for the proposed study.

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Correspondence to Nicola Lopomo.

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Lopomo, N., Signorelli, C., Bonanzinga, T. et al. Quantitative assessment of pivot-shift using inertial sensors. Knee Surg Sports Traumatol Arthrosc 20, 713–717 (2012).

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  • Pivot-shift
  • Acceleration
  • ACL
  • Knee kinematics
  • Navigation system