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Use of a gyroscope sensor to quantify tibial motions during a pivot shift test

Abstract

Purpose

The purpose of this preliminary study was to evaluate the use of a gyroscope sensor to record rotations of the tibia about its long axis during a clinical pivot shift examination.

Methods

Ten patients with a unilateral ACL injury were tested under anaesthesia prior to surgery. Each ankle was placed in neutral position, wrapped and stabilized with athletic tape, and a small aluminium plate was taped to the bottom of the foot. A data recovery module was attached to the bottom of each plate using a swivel bracket that allowed alignment of the gyro axis with the long axis of the tibia. The module contained a triaxial gyroscope, battery and circuitry for wireless data broadcast to a laptop computer. Ten pivot shift tests were performed on both knees, and the surgeon’s clinical grading of the pivot shift was noted for each limb. Mean values (10 trials) of peak tibial rotational velocity and integrated tibial rotation were compared between knees for each patient during the pivot shift reduction event (external tibial rotation during knee flexion).

Results

Five patients (50 %) had significantly greater tibial rotation in their injured knee, four showed no difference between knees, and one had significantly greater rotation in the normal knee (p < 0.05). Seven patients (70 %) showed greater peak rotational velocity in their injured knee, and three had no difference between the knees (p < 0.05). Correlations of rotation and rotational velocity with clinical pivot shift grade were weak (r 2 = 0.09 and 0.19, respectively).

Conclusions

Foot gyroscope measurements did not correctly identify the injured limb in all patients. Peak rotational velocity during the reduction event was a better indicator of ACL deficiency than the integrated rotation. If this technology is to be more useful clinically, gyroscope data may have to be combined with accelerometer data, perhaps with sensors mounted on both the tibia and femur.

Level of evidence

Diagnostic case–control study, Level III.

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References

  1. 1.

    Ahldén M, Araujo P, Hoshino Y, Samuelsson K, Middleton KK, Nagamune K, Karlsson J, Musahl V (2012) Clinical grading of the pivot shift test correlates best with tibial acceleration. Knee Surg Sports Traumatol Arthrosc 20:708–712

  2. 2.

    Ahldén M, Hoshino Y, Samuelsson K, Araujo P, Musahl V, Karlsson J (2012) Dynamic knee laxity measurement devices. Knee Surg Sports Traumatol Arthrosc 20:621–632

  3. 3.

    Araki D, Kuroda R, Kubo S, Fujita N, Tei K, Nishimoto K, Hoshino Y, Matsushita T, Matsumoto T, Nagamune K, Kurosaka M (2011) A prospective randomised study of anatomical single-bundle versus double-bundle anterior cruciate ligament reconstruction: quantitative evaluation using an electromagnetic measurement system. Int Orthop 20:439–446

  4. 4.

    Araujo PH, Ahlden M, Hoshino Y, Muller B, Moloney G, Fu FH, Musahl V (2012) Comparison of three non-invasive quantitative measurement systems for the pivot shift test. Knee Surg Sports Traumatol Arthrosc 4:692–697

  5. 5.

    Bignozzi S, Zaffagnini S, Lopomo N, Fu FH, Irrgang JJ, Marcacci M (2010) Clinical relevance of static and dynamic tests after anatomical double-bundle ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 18:37–42

  6. 6.

    Galway RD, Beaupre A, Macintosh DL (1972) Pivot shift: a clinical sign of symptomatic anterior cruciate insufficiency. J Bone Joint Surg Br 54:763–764

  7. 7.

    Hoshino Y, Araujo P, Ahlden M, Moore CG, Kuroda R, Zaffagnini S, Karlsson J, Fu FH, Musahl V (2012) Standardized pivot shift test improves measurement accuracy. Knee Surg Sports Traumatol Arthrosc 20:732–736

  8. 8.

    Hoshino Y, Araujo P, Irrgang JJ, Fu FH, Musahl V (2012) An image analysis method to quantify the lateral pivot shift test. Knee Surg Sports Traumatol Arthrosc 20:703–707

  9. 9.

    Hoshino Y, Kuroda R, Nagamune K, Araki D, Kubo S, Yamaguchi M, Kurosaka M (2012) Optimal measurement of clinical rotational test for evaluating anterior cruciate ligament insufficiency. Knee Surg Sports Traumatol Arthrosc 7:1323–1330

  10. 10.

    Hoshino Y, Kuroda R, Nagamune K, Yagi M, Mizuno K, Yamaguchi M, Muratsu H, Yoshiya S, Kurosaka M (2007) In vivo measurement of the pivot-shift test in the anterior cruciate ligament-deficient knee using an electromagnetic device. Am J Sports Med 35:1098–1104

  11. 11.

    Ishibashi Y, Tsuda E, Yamamoto Y, Tsukada H, Toh S (2009) Navigation evaluation of the pivot-shift phenomenon during double-bundle anterior cruciate ligament reconstruction: is the posterolateral bundle more important? Arthroscopy 25:488–495

  12. 12.

    Jonsson H, Riklund-Ahlström K, Lind J (2004) Positive pivot shift after ACL reconstruction predicts later osteoarthrosis: 63 patients followed 5–9 years after surgery. Acta Orthop Scand 75:594–599

  13. 13.

    Kocher MS, Steadman JR, Briggs KK, Sterett WI, Hawkins RJ (2004) Relationships between objective assessment of ligament stability and subjective assessment of symptoms and function after anterior cruciate ligament reconstruction. Am J Sports Med 32:629–634

  14. 14.

    Kopf S, Kauert R, Halfpaap J, Jung T, Becker R (2012) A new quantitative method for pivot shift grading. Knee Surg Sports Traumatol Arthrosc 20:718–723

  15. 15.

    Kubo S, Muratsu H, Yoshiya S, Mizuno K, Kurosaka M (2007) Reliability and usefulness of a new in vivo measurement system of the pivot shift. Clin Orthop Relat Res 454:54–58

  16. 16.

    Kuroda R, Hoshino Y, Kubo S, Araki D, Oka S, Nagamune K, Kurosaka M (2012) similarities and differences of diagnostic manual tests for anterior cruciate ligament insufficiency: a global survey and kinematics assessment. Am J Sports Med 40:91–99

  17. 17.

    Labbe DR, de Guise JA, Godbout V, Grimard G, Baillargeon D, Lavigne P, Fernandes J, Massé V, Ranger P, Hagemeister N (2011) Accounting for velocity of the pivot shift test manoeuvre decreases kinematic variability. Knee 18:88–93

  18. 18.

    Lane CG, Warren RF, Stanford FC, Kendoff D, Pearle AD (2008) In vivo analysis of the pivot shift phenomenon during computer navigated ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 16:487–492

  19. 19.

    Leitze Z, Losee RE, Jokl P, Johnson TR, Feagin JA (2005) Implications of the pivot shift in the ACL-deficient knee. Clin Orthop Relat Res 436:229–236

  20. 20.

    Lopomo N, Signorelli C, Bonanzinga T, Marcheggiani Muccioli GM, Visani A, Zaffagnini S (2012) Quantitative assessment of pivot-shift using inertial sensors. Knee Surg Sports Traumatol Arthrosc 20:713–717

  21. 21.

    Lopomo N, Zaffagnini S, Bignozzi S, Visani A, Marcacci M (2010) Pivot-shift test: analysis and quantification of knee laxity parameters using a navigation system. J Orthop Res 28:164–169

  22. 22.

    Lopomo N, Zaffagnini S, Signorelli C, Bignozzi S, Giordano G, Marcheggiani Muccioli GM, Visani A (2012) An original clinical methodology for non-invasive assessment of pivot-shift test. Comput Methods Biomech Biomed Eng 15:1323–1328

  23. 23.

    Lustig S, Magnussen RA, Cheze L, Neyret P (2012) The KneeKG system: a review of the literature. Knee Surg Sports Traumatol Arthrosc 20:633–638

  24. 24.

    Matsumoto H (1990) Mechanism of the pivot shift. J Bone Jt Surg Br 72:816–821

  25. 25.

    Matsumoto T, Nagamune K, Kurosaka M (2011) A prospective randomised study of anatomical single-bundle versus double-bundle anterior cruciate ligament reconstruction: quantitative evaluation using an electromagnetic measurement system. Int Orthop 35:439–446

  26. 26.

    Nakamura S, Kobayashi M, Asano T, Arai R, Nakagawa Y, Nakamura T (2011) Image-matching technique can detect rotational and AP instabilities in chronic ACL-deficient knees. Knee Surg Sports Traumatol Arthrosc 19(Suppl 1):S69–S76

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Correspondence to David R. McAllister.

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Borgstrom, P.H., Markolf, K.L., Foster, B. et al. Use of a gyroscope sensor to quantify tibial motions during a pivot shift test. Knee Surg Sports Traumatol Arthrosc 22, 2064–2069 (2014). https://doi.org/10.1007/s00167-013-2610-0

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Keywords

  • Pivot shift
  • Quantification
  • ACL
  • Gyroscope
  • Accelerometer