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Quantitative assessment of pivot-shift using inertial sensors

  • Nicola LopomoEmail author
  • Cecilia Signorelli
  • Tommaso Bonanzinga
  • Giulio Maria Marcheggiani Muccioli
  • Andrea Visani
  • Stefano Zaffagnini
Knee

Abstract

Purpose

The pivot-shift phenomenon has been identified to be one of the essential signs of functional anterior cruciate ligament (ACL) insufficiency. However, the pivot-shift test remains a surgeon-subjective examination, lacking a general recognized quantitative measurement. The goal of the present study was to validate the use of an inertial sensor for quantifying the pivot-shift test, using a commercial navigation system.

Methods

An expert surgeon intra-operatively performed the pivot-shift test on 15 consecutive patients before ACL reconstruction. A single accelerometer and a commercial navigation system simultaneously acquired limb kinematics. An additional optical tracker mounted on the accelerometer allowed following sensor movements. Anteroposterior (a-p) tibial acceleration obtained with the navigation system was compared with three-dimensional (3D) acceleration acquired by the accelerometer. The effect of skin artifacts and test–retest positioning were estimated. Repeatability of the acceleration parameter and waveform was analyzed. Correlation between the two measurements was also assessed.

Results

Average root mean square (RMS) error in test–retest positioning reported a good value of 5.5 ± 2.9 mm. Mean RMS displacement due to soft tissue artifacts was 4.9 ± 2.6 mm. The analysis of acceleration range repetitions reported a good intra-tester repeatability (Cronbach’s alpha = 0.86). Inter-patients similarity analysis showed a mean acceleration waveform correlation of 0.88 ± 0.14. The acceleration ranges demonstrated a good positive correlation between the two measurements (rs = 0.72, P < 0.05).

Conclusion

This study showed good reliability of the new device and good correlation with the navigation system results. Therefore, the accelerometer is a valid method to assess dynamic joint laxity.

Level of evidence

II.

Keywords

Pivot-shift Acceleration ACL Knee kinematics Navigation system 

Notes

Acknowledgments

We would like to acknowledge all the staff of Clinica Ortopedica e Traumatologica III at Istituto Ortopedico Rizzoli for their assistance during the study. NL would like to particularly thank Emil Ferretti for his great contribution in the management of technological stuff in the laboratory. No founding was directly received by any of the authors for the proposed study.

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Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Nicola Lopomo
    • 1
    • 2
    Email author
  • Cecilia Signorelli
    • 1
    • 3
  • Tommaso Bonanzinga
    • 1
  • Giulio Maria Marcheggiani Muccioli
    • 1
  • Andrea Visani
    • 1
  • Stefano Zaffagnini
    • 1
  1. 1.Laboratorio di Biomeccanica e Innovazione TecnologicaIstituto Ortopedico RizzoliBolognaItaly
  2. 2.Laboratorio di NanoBiotecnologie (NaBi)Istituto Ortopedico RizzoliBolognaItaly
  3. 3.Dipartimento di BioingegneriaPolitecnico di MilanoMilanoItaly

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