The diagnostic reliability of the quantitative pivot-shift evaluation using an electromagnetic measurement system for anterior cruciate ligament deficiency was superior to those of the accelerometer and iPad image analysis

  • Toshikazu Tanaka
  • Yuichi Hoshino
  • Nobuaki Miyaji
  • Kazuyuki Ibaragi
  • Kyohei Nishida
  • Yuichiro Nishizawa
  • Daisuke Araki
  • Noriyuki Kanzaki
  • Takehiko Matsushita
  • Ryosuke Kuroda



Several non-invasive devices have been developed to obtain quantitative assessment of the pivot-shift test in clinical setting using similar but diverse measurement parameters. However, the clinical usability of those measurements has yet to be closely investigated and compared. The purpose of this study was to compare the diagnostic accuracy of three non-invasive measurement devices for the pivot-shift test.


Thirty patients with unilateral anterior cruciate ligament (ACL) injury were enrolled. The pivot-shift test was performed under general anaesthesia. Three devices, an accelerometer system (KiRA), an image analysis iPad application (iPad), and electromagnetic measurement system (EMS), were used simultaneously to provide two parameters, namely tibial acceleration monitored using KiRA and EMS, and tibial translation recorded using iPad and EMS. Side-to-side differences in each parameter and correlation between the measurements were tested, and a receiver-operating characteristic (ROC) curve analysis was conducted to compare their measurement accuracy.


Significant side-to-side differences were successfully detected using any of the measurements (all p < 0.01). KiRA demonstrated moderate correlation with the EMS for tibial acceleration (r = 0.54; p < 0.01), while poor correlation was observed between iPad and the EMS for the translation (r = 0.28; p < 0.01). The ROC curve analysis demonstrated better accuracy for the detection of ACL insufficiency in the EMS than KiRA and iPad for tibial acceleration and translation, respectively.


Although all three measurements were similarly capable of detecting ACL deficiency, the EMS has the advantage of comprehensive evaluation of the pivot-shift test by evaluating both tibial acceleration and translation with higher accuracy than those of KiRA and iPad. It could be suggested that any of those measurement tools might improve the clinical diagnosis of ACL insufficiency.

Level of evidence

Diagnostic study of consecutive patients with a universally applied gold standard, Level Ib.


Anterior cruciate ligament Pivot-shift test Quantitative evaluation Acceleration Anterior tibial translation 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


The authors received no financial support for the research, authorship, and/or publication of this article.

Ethical approval

The study was approved by the Ethical committee of the institution.

Informed consent

Patients were informed, and they consented to conduct the study.


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Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2017

Authors and Affiliations

  • Toshikazu Tanaka
    • 1
  • Yuichi Hoshino
    • 1
  • Nobuaki Miyaji
    • 1
  • Kazuyuki Ibaragi
    • 1
  • Kyohei Nishida
    • 3
  • Yuichiro Nishizawa
    • 2
  • Daisuke Araki
    • 1
  • Noriyuki Kanzaki
    • 1
  • Takehiko Matsushita
    • 1
  • Ryosuke Kuroda
    • 1
  1. 1.Department of Orthopaedic Surgery, Graduate School of MedicineKobe UniversityKobeJapan
  2. 2.Department of Othopaedic SurgeryKobe Kaisei HospitalKobeJapan
  3. 3.Department of Orthopaedic SurgeryShinsuma HospitalKobeJapan

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