Risk factors for residual pivot shift after anterior cruciate ligament reconstruction: data from the MAKS group
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To investigate the risk factors for residual pivot shift test after anterior cruciate ligament (ACL) reconstruction based on a multicenter prospective cohort study.
This study included patients who were registered in the Multicenter Arthroscopic Knee Surgery Study, a prospective longitudinal multicenter cohort study, and who underwent primary ACL reconstruction using autologous hamstring tendon graft between 2013 and 2016. The exclusion criteria included prior injuries or surgeries in the contralateral knee, prior ligamentous injuries in the involved knee, grade 2 or 3 concomitant ligament injuries, and inflammatory or other forms of osteoarthritis. Data from the preoperative period and at 1-year follow-up were used for further analysis, and patients with incomplete data, re-injury and loss to follow-up were also excluded. Logistic regression analysis was conducted with age, gender, Lachman test, pivot shift test, KT measurement, hyperextension, single-bundle vs. double-bundle, meniscus injury sites, and meniscus treatments as the independent variables, and postoperative pivot shift test was used as the dependent variable.
Three hundred and sixty-eight patients were included in the study. Hyperextension knee (P = 0.025) and a preoperative pivot shift test under anesthesia (P = 0.040) were identified as risk factors for a postoperative pivot shift via logistic regression analysis. There were no statistically significant differences in the other variables.
The results from a multicenter cohort study indicated that knee hyperextension and greater preoperative pivot shift under anesthesia were risk factors for residual pivot shift at 1 year after ACL reconstruction. In cases with a preoperative high-grade pivot shift and knee hyperextension, additional anterolateral structure augmentation might be considered in order to eliminate pivot shift and eventually obtain better outcomes after ACL reconstruction.
Level of evidence
KeywordsAnterior cruciate ligament reconstruction Anterolateral rotatory instability Multicenter cohort study Pivot shift test Risk factor
We thank Atsushi Okawa, M.D., Ph.D., for continuous support; Aiko Yamada, Haruno Kroda, Kahaer abula, Yuki Omura and Miyoko Ojima for data registration.
Kawaguchikogyo General Hospital; Akiho Hoshino, M.D., Ph.D., Takashi Ogiuchi M.D., Ph.D., Hideya Yoshimura, M.D., Ph.D., Masaya Hayashi, M.D., Ph.D., Toru Takahashi, M.D., Ph.D., Katsuaki Yanagisawa, M.D., Ph.D., Mio Udo, M.D., Ph.D. Doai Memorial Hospital; Tsuyoshi Nagase, M.D., Ph.D., Tadanori Shimizu, M.D., Ph.D., Ryusuke Saito, M.D., Ph.D. Yokohama Minato Red Cross Hospital; Koji Asano, M.D., Ph.D., Shinpei Kondo, M.D., Ph.D. Tama-hokubu medical center; Jyu Neishin, M.D., Ph.D. Nitobe Memorial Nakano General Hospital; Jun Kitahama, M.D. Suwa Central Hospital; Shinichi Shirasawa, M.D., Ph.D. Nissan Tamagawa Hospital; Tomoyuki Mochizuki, M.D., Ph.D. National Hospital Organization Disaster Medical Center; Masayuki Shimaya, M.D., Ph.D. Mishima General Hospital; Mika Yamaga, M.D., Ph.D. Tsuchiura Kyodo General Hospital; Daisuke Hatsushika, M.D., Ph.D. Soka City Hospital; Arata Yuki, M.D., Ph.D. Tokyo Bay Urayasu Ichikawa Medical Center; Enichi Nakatsuru, M.D. Nerima General Hospital; Shingo Fukagawa, M.D., Ph.D.
HU analyzed the data and drafted the manuscript. YN and TO conducted the study. TW, MH, KO, HKa, IS and TM collected the data. KK, KH, MK, TH, KI and NA analyzed the data. HKo designed the initial plan, conducted the study and completed the final manuscript. All authors read and approved the final manuscript.
No funding was received for this study.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
Study was approved by the Institutional Review Board in Tokyo Medical and Dental University (research protocol identification number: 1547).
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