The pivot shift test is quantified subjectively during assessment of patients presenting with suspected Anterior Cruciate Ligament (ACL) tears and has a low interobserver reproducibility. The Kinematic Rapid Assessment (KiRA) is a triaxial accelerometer that makes it possible to non-invasively quantify tibial acceleration during the pivot shift test. Abolishing pivot shift is considered to be a key element in surgical reconstruction but is incomplete in 25–38% of patients.
Patients were included prospectively. Inclusion criteria were patients requiring ACL reconstruction associated with at least one of the following factors corresponding to the patient who have a high risk of rupture either by their sports activity, a failure case, or the notion of important rotational laxity: the patient practiced a competitive pivot-contact sport, revision ACL reconstruction (besides STG (semitendinosus-gracilis graft) repair), subjective explosive rotational laxity, Segond fracture, and TELOS value of >10 mm. Standardized pre- and postoperative pivot shift tests were immediately performed under anesthesia in both knees.
Forty-three patients were included. Mean preoperative variations in tibial acceleration in the healthy and injured knees were 1.2 ± 0.1 and 2.7 ± 0.3 m/s2, respectively, p < 0.01. A statistically significant decrease in immediate postoperative mean variations in acceleration in the injured knee occurred: 1.5 ± 0.3 m/s2, p < 0.01. There was no longer any statistical difference between postoperative contralateral healthy knees and operated knees (n.s).
Combined ACL reconstruction associated with anterolateral tenodesis suppress acute pathologic tibial acceleration in the pivot shift.
Level of evidence
This is a preview of subscription content, log in to check access.
Buy single article
Instant unlimited access to the full article PDF.
Price includes VAT for USA
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
This is the net price. Taxes to be calculated in checkout.
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
Anderson AF, Snyder RB, Lipscomb AB (2001) Anterior cruciate ligament reconstruction. A prospective randomized study of three surgical methods. Am J Sports Med 29:272–279
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 20:692–697
Ayeni OR, Chahal M, Tran MN, Sprague S (2012) Pivot shift as an outcome measure for ACL reconstruction: a systematic review. Knee Surg Sports Traumatol Arthrosc 20:767–777
Bedi A, Musahl V, Lane C, Citak M, Warren RF, Pearle AD (2010) Lateral compartment translation predicts the grade of pivot shift: a cadaveric and clinical analysis. Knee Surg Sports Traumatol Arthrosc 18:1269–1276
Benjaminse A, Gokeler A, van der Schans CP (2006) Clinical diagnosis of an anterior cruciate ligament rupture: a meta-analysis. J Orthop Sports Phys Ther 36:267–288
Berruto M, Uboldi F, Gala L, Marelli B, Albisetti W (2013) Is triaxial accelerometer reliable in the evaluation and grading of knee pivot-shift phenomenon? Knee Surg Sports Traumatol Arthrosc 21:981–985
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
Branch T, Lavoie F, Guier C, Branch E, Lording T, Stinton S, Neyret P (2015) Single-bundle ACL reconstruction with and without extra-articular reconstruction: evaluation with robotic lower leg rotation testing and patient satisfaction scores. Knee Surg Sports Traumatol Arthrosc 23:2882–2891
Colombet P (2011) Knee laxity control in revision anterior cruciate ligament reconstruction versus anterior cruciate ligament reconstruction and lateral tenodesis: clinical assessment using computer-assisted navigation. Am J Sports Med 39:1248–1254
Colombet P, Robinson J, Jambou S, Allard M, Bousquet V, de Lavigne C (2006) Two-bundle, four-tunnel anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 14:629–636
Dejour D, Ntagiopoulos PG, Saggin PR, Panisset J-C (2013) The diagnostic value of clinical tests, magnetic resonance imaging, and instrumented laxity in the differentiation of complete versus partial anterior cruciate ligament tears. Arthroscopy 29:491–499
Dodds AL, Halewood C, Gupte CM, Williams A, Amis AA (2014) The anterolateral ligament: anatomy, length changes and association with the Segond fracture. Bone Joint J 96-B:325–331
Engebretsen L, Lew WD, Lewis JL, Hunter RE (1990) The effect of an iliotibial tenodesis on intraarticular graft forces and knee joint motion. Am J Sports Med 18:169–176
Ferretti A, Monaco E, Labianca L, De Carli A, Conteduca F (2008) Double bundle or single bundle plus extra-articular tenodesis in ACL reconstruction? A CAOS study. Knee Surg Sports Traumatol Arthrosc 16:98
Frank CB, Jackson DW (1997) The science of reconstruction of the anterior cruciate ligament. J Bone Joint Surg Am 79:1556–1576
Galway HR, MacIntosh DL (1980) The lateral pivot shift: a symptom and sign of anterior cruciate ligament insufficiency. Clin Orthop Relat Res. 45–50
Georgoulis AD, Papadonikolakis A, Papageorgiou CD, Mitsou A, Stergiou N (2003) Three-dimensional tibiofemoral kinematics of the anterior cruciate ligament-deficient and reconstructed knee during walking. Am J Sports Med 31:75–79
Hefti F, Müller W, Jakob RP, Stäubli HU (1993) Evaluation of knee ligament injuries with the IKDC form. Knee Surg Sports Traumatol Arthrosc 1:226–234
Hewison CE, Tran MN, Kaniki N, Remtulla A, Bryant D, Getgood AM (2015) Lateral extra-articular tenodesis reduces rotational laxity when combined with anterior cruciate ligament reconstruction: a systematic review of the literature. Arthroscopy 31:2022–2034
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
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
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
Kaplan N, Wickiewicz TL, Warren RF (1990) Primary surgical treatment of anterior cruciate ligament ruptures. A long-term follow-up study. Am J Sports Med 18:354–358
Karlson JA, Steiner ME, Brown CH, Johnston J (1994) Anterior cruciate ligament reconstruction using gracilis and semitendinosus tendons. Comparison of through-the-condyle and over-the-top graft placements. Am J Sports Med 22:659–666
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
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
Kuroda R, Hoshino Y, Araki D, Nishizawa Y, Nagamune K, Matsumoto T, Kubo S, Matsushita T, Kurosaka M (2012) Quantitative measurement of the pivot shift, reliability, and clinical applications. Knee Surg Sports Traumatol Arthrosc 20:686–691
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
Labbe DR, de Guise JA, Mezghani N, Godbout V, Grimard G, Baillargeon D, Lavigne P, Fernandes J, Ranger P, Hagemeister N (2010) Feature selection using a principal component analysis of the kinematics of the pivot shift phenomenon. J Biomech 43:3080–3084
Logan M, Dunstan E, Robinson J, Williams A, Gedroyc W, Freeman M (2004) Tibiofemoral kinematics of the anterior cruciate ligament (ACL)-deficient weightbearing, living knee employing vertical access open “interventional” multiple resonance imaging. Am J Sports Med 32:720–726
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
Lopomo N, Signorelli C, Rahnemai-Azar AA, Raggi F, Hoshino Y, Samuelsson K, Musahl V, Karlsson J, Kuroda R, Zaffagnini S, PIVOT Study Group (2016) Analysis of the influence of anaesthesia on the clinical and quantitative assessment of the pivot shift: a multicenter international study. Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-016-4130-1
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 Engin 15:1323–1328
Monaco E, Ferretti A, Labianca L, Maestri B, Speranza A, Kelly MJ, D’Arrigo C (2012) Navigated knee kinematics after cutting of the ACL and its secondary restraint. Knee Surg Sports Traumatol Arthrosc 20:870–877
Monaco E, Labianca L, Conteduca F, De Carli A, Ferretti A (2007) Double bundle or single bundle plus extraarticular tenodesis in ACL reconstruction? A CAOS study. Knee Surg Sports Traumatol Arthrosc 15:1168–1174
Musahl V, Ayeni OR, Citak M, Irrgang JJ, Pearle AD, Wickiewicz TL (2010) The influence of bony morphology on the magnitude of the pivot shift. Knee Surg Sports Traumatol Arthrosc 18:1232–1238
Musahl V, Hoshino Y, Ahlden M, Araujo P, Irrgang JJ, Zaffagnini S, Karlsson J, Fu FH (2012) The pivot shift: a global user guide. Knee Surg Sports Traumatol Arthrosc 20:724–731
Nakamura K, Koga H, Sekiya I, Watanabe T, Mochizuki T, Horie M, Nakamura T, Otabe K, Muneta T (2015) Evaluation of pivot shift phenomenon while awake and under anaesthesia by different manoeuvres using triaxial accelerometer. Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-015-3740-3
Nitri M, Rasmussen MT, Williams BT, Moulton SG, Cruz RS, Dornan GJ, Goldsmith MT, LaPrade RF (2016) An In Vitro Robotic Assessment of the Anterolateral Ligament, Part 2: Anterolateral Ligament Reconstruction Combined With Anterior Cruciate Ligament Reconstruction. Am J Sports Med 44:593–601
Noyes FR, Barber SD (1991) The effect of an extra-articular procedure on allograft reconstructions for chronic ruptures of the anterior cruciate ligament. J Bone Joint Surg Am 73:882–892
Parsons EM, Gee AO, Spiekerman C, Cavanagh PR (2015) The biomechanical function of the anterolateral ligament of the knee. Am J Sports Med 43:669–674
Rezende FC, de Moraes VY, Martimbianco ALC, Luzo MV, da Silveira Franciozi CE, Belloti JC (2015) Does combined intra- and extraarticular ACL reconstruction improve function and stability? A meta-analysis. Clin Orthop Relat Res 473:2609–2618
Roth JH, Kennedy JC, Lockstadt H, McCallum CL, Cunning LA (1987) Intra-articular reconstruction of the anterior cruciate ligament with and without extra-articular supplementation by transfer of the biceps femoris tendon. J Bone Joint Surg Am 69:275–278
Song G, Zhang H, Wang Q, Zhang J, Li Y, Feng H (2016) Risk factors associated with grade 3 pivot shift after acute anterior cruciate ligament injuries. Am J Sports Med 44:362–369
Song G-Y, Hong L, Zhang H, Zhang J, Li Y, Feng H (2016) Clinical outcomes of combined lateral extra-articular tenodesis and intra-articular anterior cruciate ligament reconstruction in addressing high-grade pivot-shift phenomenon. Arthroscopy 32:898–905
Song G-Y, Hong L, Zhang H, Zhang J, Li Y, Feng H (2015) Clinical outcomes of combined lateral extra-articular tenodesis and intra-articular anterior cruciate ligament reconstruction in addressing high-grade pivot-shift phenomenon. Arthroscopy 32(5):898–905
Sonnery-Cottet B, Freychet B, Murphy CG, Pupim BHB, Thaunat M (2014) Anterior cruciate ligament reconstruction and preservation: the single-anteromedial bundle biological augmentation (SAMBBA) technique. Arthrosc Tech 3:e689–693
Sonnery-Cottet B, Thaunat M, Freychet B, Pupim BHB, Murphy CG, Claes S (2015) Outcome of a combined anterior cruciate ligament and anterolateral ligament reconstruction technique with a minimum 2-year follow-up. Am J Sports Med 43:1598–1605
Stergiou N, Ristanis S, Moraiti C, Georgoulis AD (2007) Tibial rotation in anterior cruciate ligament (ACL)-deficient and ACL-reconstructed knees: a theoretical proposition for the development of osteoarthritis. Sports Med Auckl NZ 37:601–613
Tashiro Y, Okazaki K, Miura H, Matsuda S, Yasunaga T, Hashizume M, Nakanishi Y, Iwamoto Y (2009) Quantitative assessment of rotatory instability after anterior cruciate ligament reconstruction. Am J Sports Med 37:909–916
Trojani C, Beaufils P, Burdin G, Bussière C, Chassaing V, Djian P, Dubrana F, Ehkirch F-P, Franceschi J-P, Hulet C, Jouve F, Potel J-F, Sbihi A, Neyret P, Colombet P (2012) Revision ACL reconstruction: influence of a lateral tenodesis. Knee Surg Sports Traumatol Arthrosc 20:1565–1570
Trojani C, Sbihi A, Djian P, Potel J-F, Hulet C, Jouve F, Bussière C, Ehkirch F-P, Burdin G, Dubrana F, Beaufils P, Franceschi J-P, Chassaing V, Colombet P, Neyret P (2011) Causes for failure of ACL reconstruction and influence of meniscectomies after revision. Knee Surg Sports Traumatol Arthrosc 19:196–201
Vadalà AP, Iorio R, De Carli A, Bonifazi A, Iorio C, Gatti A, Rossi C, Ferretti A (2013) An extra-articular procedure improves the clinical outcome in anterior cruciate ligament reconstruction with hamstrings in female athletes. Int Orthop 37:187–192
Zaffagnini S, Signorelli C, Lopomo N, Bonanzinga T, Marcheggiani Muccioli GM, Bignozzi S, Visani A, Marcacci M (2012) Anatomic double-bundle and over-the-top single-bundle with additional extra-articular tenodesis: an in vivo quantitative assessment of knee laxity in two different ACL reconstructions. Knee Surg Sports Traumatol Arthrosc 20:153–159
Conflict of interest
No funding was received for this study.
Study was approved by the local patient protection comitee and the study was registered.
All patients were included after signed consent.
Electronic supplementary material
Below is the link to the electronic supplementary material.
About this article
Cite this article
Hardy, A., Casabianca, L., Hardy, E. et al. Combined reconstruction of the anterior cruciate ligament associated with anterolateral tenodesis effectively controls the acceleration of the tibia during the pivot shift. Knee Surg Sports Traumatol Arthrosc 25, 1117–1124 (2017). https://doi.org/10.1007/s00167-017-4515-9
- Pivot shift
- Tibial acceleration
- Quantitative assessment