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Quantitative assessment of the pivot shift test with smartphone accelerometer

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The pivot shift (PS) test is commonly used to diagnose and evaluate the dynamic instability of the knee joint in cases of anterior cruciate ligament (ACL) tear. There is a need of a reliable and inexpensive tool which is easily available to measure PS objectively in a clinical setting. The purpose of this study was to evaluate the use of a smartphone, which is readily available, to assess the PS phenomenon.

Methods

Seventeen patients with unilateral ACL-injured knees, undergoing ACL reconstruction, were enrolled in the study. PS was initially graded according to the International Knee Documentation Committee classification by two observers. The PS test was then performed by them in normal and injured knees under anaesthesia using a smartphone attached to Gerdy’s tubercle. Acceleration changes during the PS test were recorded using the smartphone accelerometer application. Intra-observer and inter-observer reliability of the test among the two observers were evaluated. Acceleration changes were compared between the injured and normal knees, and also between the clinical grades of PS. Diagnostic utility of the smartphone accelerometer was examined by a receiver operating characteristic curve analysis.

Results

Intra-observer and inter-observer reliability were high for the smartphone accelerometer. The acceleration change was higher in the ACL-injured knees than in normal knees. The mean acceleration change was 2.54 m/s2 (SD = 0.97) in ACL-injured knees and 0.73 m/s2 (SD = 0.19) in normal knees (p < 0.001). The mean acceleration change of Grade 1 knees was 1.89 m/s2 (SD = 0.57), and that of knees of Grade 2 and above were 2.99 m/s2 (SD = 0.95) (p < 0.05). Sensitivity was 94% and specificity was 100% for the acceleration change required to detect ACL injury, i.e., 1.24 m/s2.

Conclusions

The results show that a smartphone can be used to evaluate the PS quantitatively and reliably, in the diagnosis of ACL injury.

Level of evidence

II.

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Abbreviations

PS:

Pivot shift

ACL:

Anterior cruciate ligament

ROC:

Receiver operating characteristic

IKDC:

International Knee Documentation Committee

ICC:

Intraclass correlation coefficient

AUC:

Area under curve

EMS:

Electromagnetic measurement system

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Funding

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Author information

Author notes

  1. Rupesh Kumar Vaidya and Cheol Whan Yoo equally contributed to this work.

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea

    Rupesh Kumar Vaidya, Cheol Whan Yoo, Joonhee Lee, Hyuk-Soo Han, Myung Chul Lee & Du Hyun Ro

Authors
  1. Rupesh Kumar Vaidya
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  2. Cheol Whan Yoo
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  3. Joonhee Lee
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  4. Hyuk-Soo Han
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  5. Myung Chul Lee
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  6. Du Hyun Ro
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Contributions

RKV: data analysis, interpretation, and drafting manuscript; CWY: design, data acquisition, and analysis; JL: data acquisition, analysis, and data interpretation; H-SH: design and data acquisition; MCL: data interpretation and manuscript revision; DHR: design, drafting, and revision of manuscript.

Corresponding author

Correspondence to Du Hyun Ro.

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The authors certify that they have no commercial association that might pose a conflict of interest in connection with this article.

Ethical approval

This study was approved by the institutional review board of Seoul National University College of Medicine, Seoul National University Hospital (IRB No. H-1707-030-867).

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Vaidya, R.K., Yoo, C.W., Lee, J. et al. Quantitative assessment of the pivot shift test with smartphone accelerometer. Knee Surg Sports Traumatol Arthrosc 28, 2494–2501 (2020). https://doi.org/10.1007/s00167-019-05826-3

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  • DOI: https://doi.org/10.1007/s00167-019-05826-3

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