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Standardized pivot shift test improves measurement accuracy

  • Yuichi HoshinoEmail author
  • Paulo Araujo
  • Mattias Ahlden
  • Charity G. Moore
  • Ryosuke Kuroda
  • Stefano Zaffagnini
  • Jon Karlsson
  • Freddie H. Fu
  • Volker Musahl
Knee

Abstract

Purpose

The variability of the pivot shift test techniques greatly interferes with achieving a quantitative and generally comparable measurement. The purpose of this study was to compare the variation of the quantitative pivot shift measurements with different surgeons’ preferred techniques to a standardized technique. The hypothesis was that standardizing the pivot shift test would improve consistency in the quantitative evaluation when compared with surgeon-specific techniques.

Methods

A whole lower body cadaveric specimen was prepared to have a low-grade pivot shift on one side and high-grade pivot shift on the other side. Twelve expert surgeons performed the pivot shift test using (1) their preferred technique and (2) a standardized technique. Electromagnetic tracking was utilized to measure anterior tibial translation and acceleration of the reduction during the pivot shift test. The variation of the measurement was compared between the surgeons’ preferred technique and the standardized technique.

Results

The anterior tibial translation during pivot shift test was similar between using surgeons’ preferred technique (left 24.0 ± 4.3 mm; right 15.5 ± 3.8 mm) and using standardized technique (left 25.1 ± 3.2 mm; right 15.6 ± 4.0 mm; n.s.). However, the variation in acceleration was significantly smaller with the standardized technique (left 3.0 ± 1.3 mm/s2; right 2.5 ± 0.7 mm/s2) compared with the surgeons’ preferred technique (left 4.3 ± 3.3 mm/s2; right 3.4 ± 2.3 mm/s2; both P < 0.01).

Conclusion

Standardizing the pivot shift test maneuver provides a more consistent quantitative evaluation and may be helpful in designing future multicenter clinical outcome trials.

Level of evidence

Diagnostic study, Level I.

Keywords

Anterior cruciate ligament (ACL) Pivot shift test Electromagnetic measurement system Acceleration measurement Image analysis 

Notes

Acknowledgments

The authors would like to sincerely thank the expert surgeons for their participation and inspiring comments during the study (Drs. Roland Becker, Shiyi Chen, Moises Cohen, Andreas Imhoff, Timo Jarvela, Jon Karlsson, Masahiro Kurosaka, Benjamin Ma, Willem van der Merwe, Philippe Neyret and Robert Smigielski).

Supplementary material

Supplementary material 1 (WMV 5476 kb)

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Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Yuichi Hoshino
    • 1
    • 2
    Email author
  • Paulo Araujo
    • 1
  • Mattias Ahlden
    • 3
  • Charity G. Moore
    • 4
  • Ryosuke Kuroda
    • 2
  • Stefano Zaffagnini
    • 5
  • Jon Karlsson
    • 3
  • Freddie H. Fu
    • 1
  • Volker Musahl
    • 1
  1. 1.Department of Orthopaedic SurgeryUniversity of PittsburghPittsburghUSA
  2. 2.Department of Orthopaedic SurgeryKobe UniversityKobe, HyogoJapan
  3. 3.Department of OrthopaedicsSahlgrenska UniversityGöteborgSweden
  4. 4.The Center for Research on Health CareUniversity of PittsburghPittsburghUSA
  5. 5.Laboratorio di Biomeccanica e Innovazione TecnologicaIstituto Ortopedico RizzoliBolognaItaly

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