Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 22, Issue 9, pp 1966–1975 | Cite as

Individualized ACL reconstruction

  • Paulo H. AraujoEmail author
  • Mauricio Kfuri Junior
  • Bruno Ohashi
  • Yuichi Hoshino
  • Stephano Zaffagnini
  • Kristian Samuelsson
  • Jon Karlsson
  • Freddie Fu
  • Volker Musahl


The pivot shift test is the only physical examination test capable of predicting knee function and osteoarthritis development after an ACL injury. However, because interpretation and performance of the pivot shift are subjective in nature, the validity of the pivot shift is criticized for not providing objective information for a complete surgical planning for the treatment of rotatory knee laxity. The aim of ACL reconstruction was eliminating the pivot shift sign. Many structures and anatomical characteristics can influence the grading of the pivot shift test and are involved in the genesis and magnitude of rotatory instability after an ACL injury. The objective quantification of the pivot shift may be able to categorize knee laxity and provide adequate information on which structures are affected besides the ACL. A new algorithm for rotational instability treatment is presented, accounting for patients’ unique anatomical characteristics and objective measurement of the pivot shift sign allowing for an individualized surgical treatment.

Level of evidence V.


Pivot shift ACL reconstruction Individualized ACL reconstruction Anterior cruciate ligament Treatment Clinical examination Physical examination Rotatory laxity 


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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Paulo H. Araujo
    • 1
    Email author
  • Mauricio Kfuri Junior
    • 1
  • Bruno Ohashi
    • 2
  • Yuichi Hoshino
    • 3
  • Stephano Zaffagnini
    • 4
  • Kristian Samuelsson
    • 5
  • Jon Karlsson
    • 5
  • Freddie Fu
    • 2
  • Volker Musahl
    • 2
  1. 1.Department of Biomechanics, Medicine and Rehabilitation of Locomotor System - Ribeirao Preto Medical SchoolSão Paulo UniversityRibeirão PrêtoBrazil
  2. 2.Department of Orthopaedic SurgeryUniversity of PittsburghPittsburghUSA
  3. 3.Department of Orthopaedic SurgeryKobe Kaisei HospitalKobeJapan
  4. 4.Istituto Ortopedico RizzoliUniversity of BolognaBolognaItaly
  5. 5.Department of OrthopaedicsSahlgrenska UniversityGöteborgSweden

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