Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 26, Issue 12, pp 3762–3769 | Cite as

High-grade rotatory knee laxity may be predictable in ACL injuries

  • Volker Musahl
  • Jeremy Burnham
  • Jayson Lian
  • Adam Popchak
  • Eleonor Svantesson
  • Ryosuke Kuroda
  • Stefano Zaffagnini
  • Kristian Samuelsson
  • PIVOT Study Group



Lateral compartment acceleration and translation have been used to quantify rotatory knee laxity in the setting of anterior cruciate ligament (ACL) injury; however, their relationship remains elusive. The purpose of this study was to examine the correlation between lateral compartment acceleration and translation during pivot shift testing. It was hypothesized that a correlation would exist in ACL-injured and uninjured knees, irrespective of sex, but would be greatest in knees with combined ACL and lateral meniscus tear.


Seventy-seven patients (34 females, 25.2 ± 9.0 years) undergoing primary single-bundle ACL reconstruction were prospectively enrolled in a 2-year study across four international centers. Patients underwent preoperative examination under anesthesia of the injured and uninjured knee using Image Analysis software and surface mounted accelerometer.


A moderate correlation between lateral compartment acceleration and translation was observed in ACL-injured knees [ρ = 0.36, p < 0.05), but not in uninjured knees (ρ = 0.17, not significant (n.s.)]. A moderate correlation between acceleration and translation was demonstrated in ACL-injured knees with lateral meniscus tears (ρ = 0.53, p < 0.05), but not in knees with isolated ACL-injury (ρ = 0.32, n.s.), ACL and medial meniscus tears (ρ = 0.14, n.s.), or ACL and combined medial and lateral meniscus tears (ρ = 0.40, n.s.). A moderate correlation between acceleration and translation was seen in males (ρ = 0.51, p < 0.05), but not in females (ρ = 0.21, n.s.). Largest correlations were observed in males with ACL and lateral meniscus tears (ρ = 0.75, p < 0.05).


Lateral compartment acceleration and translation were moderately correlated in ACL-injured knees, but largely correlated in males with combined ACL and lateral meniscus tears. ACL and lateral meniscus injury in males might, therefore, be suspected when both lateral compartment acceleration and translation are elevated. Surgeons should have a greater degree of suspicion for high-grade rotatory knee laxity in ACL-injured males with concomitant lateral meniscus tears. Future studies should investigate how these two distinct components of rotatory knee laxity—lateral compartment acceleration and translation—are correlated with patient outcomes and affected by ACL surgery.

Level of evidence

Prospective cohort study; Level of evidence II.


ACL Anterior cruciate ligament Pivot shift Image analysis Translation Inertial sensor Acceleration Rotatory knee laxity 



PIVOT study group authors: Andrew Sheean, Jeremy M Burnham, Jayson Lian, Clair Smith, Adam Popchak, Elmar Herbst, Thomas Pfeiffer, Paulo Araujo, Alicia Oostdyk, Daniel Guenther, Bruno Ohashi, James J Irrgang, Volker Musahl, Freddie H. Fu (Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA), Kouki Nagamune, Masahiro Kurosaka, Yuichi Hoshino, Ryosuke Kuroda (Department of Orthopaedic Surgery, Kobe University, Kobe, Japan), Alberto Grassi, Giulio Maria Marcheggiani Muccioli, Nicola Lopomo, Cecilia Signorelli, Federico Raggi, Stefano Zaffagnini (Instituto Ortopedico Rizzoli, Laboratorio di Biomeccanica eInnovazione Tecnologica, Bologna, Italy), Eleonor Svantesson, Eric Hamrin Senorski, David Sundemo, Haukur Bjoernsson, Mattias Ahlden, Neel Desai, Kristian Samuelsson, and Jon Karlsson (Department of Orthopaedics, Sahlgrenska University Hospital, Molndal, Sweden).


This study was funded by an ISAKOS/OREF research grant (research Grant no. 708661) and by Wallace Coulter Foundation contributions to the University of Pittsburgh Medical Center.

Compliance with ethical standards

Conflict of interest

Volker Musahl declares that he is co-developer of the image analysis system. At the moment, the application is not on the market and not producing revenue.

Ethical approval

Institutional review board approval was obtained from all four participating centers (University of Pittsburgh, Instituto Orthopedico Rizzoloi, Sahlgrenska University Hospital, and Kobe University) including coordinating center approval at the University of Pittsburgh.


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Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2018

Authors and Affiliations

  • Volker Musahl
    • 1
  • Jeremy Burnham
    • 1
  • Jayson Lian
    • 1
    • 2
  • Adam Popchak
    • 1
  • Eleonor Svantesson
    • 3
    • 4
  • Ryosuke Kuroda
    • 5
  • Stefano Zaffagnini
    • 6
  • Kristian Samuelsson
    • 3
    • 4
  • PIVOT Study Group
  1. 1.UPMC Center for Sports Medicine, Department of Orthopaedic SurgeryUniversity of PittsburghPittsburghUSA
  2. 2.Albert Einstein College of MedicineBronxUSA
  3. 3.Department of Orthopaedics, Institute of Clinical SciencesThe Sahlgrenska Academy, University of GothenburgGothenburgSweden
  4. 4.Department of OrthopedicsSahlgrenska University HospitalMölndalSweden
  5. 5.Department of Orthopaedic SurgeryKobe UniversityKobeJapan
  6. 6.Laboratorio di Biomeccanica e Innovazione TecnologicaIstituto Ortopedico RizzoliBolognaItaly

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