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Grade III pivot shift as an early sign of knee decompensation in chronic ACL-injured knees with bimeniscal tears

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

To analyse possible associations between the preoperative pivot shift (PS) test and both patient and injury characteristics in anterior cruciate ligament (ACL)-injured knees, considering previously neglected meniscal injuries such as ramp and root tears. The hypothesis was that a preoperative grade III PS was associated with the amount of intra-articular soft-tissue damage and chronicity of the injury.

Methods

The cohort involved 376 patients who underwent primary ACL reconstruction (239 males/137 females; median age 26). Patients were examined under anesthesia before surgery, using the PS test. During arthroscopy, intra-articular soft-tissue damage of the injured knee was classified as: (1) partial ACL tear; (2) complete isolated ACL tear; (3) complete ACL tear with one meniscus tear; and (4) complete ACL and bimeniscal tears. Chi-square and Mann–Whitney U tests were used to evaluate whether sex, age, body mass index, sport at injury, mechanism of injury, time from injury and intra-articular damage (structural damage of ACL and menisci) were associated with a grade III PS. Intra-articular damage was further analyzed for two sub-cohorts: acute (time from injury ≤ 6 months) and chronic injuries (> 6 months).

Results

A grade III PS test was observed in 26% of patients. A significant association with PS grading was shown for age, time from injury and intra-articular soft-tissue damage (p < 0.05). Further analyses showed that grade III PS was associated with intra-articular damage in chronic injuries only (p < 0.01). In complete ACL and bimeniscal tears, grade III PS was more frequent in chronic (53%) than in acute knee injuries (26%; p < 0.01). Patients with chronic complete ACL and bimeniscal tears had a grade III PS 3.3 [1.3–8.2] times more often than patients in the acute sub-cohort.

Conclusion

In ACL-injured patients, a preoperative grade III PS was mainly associated with a higher amount of intra-articular soft-tissue damage and chronicity of the injury. Patients with complete chronic ACL injuries and bimeniscal tears were more likely to have a preoperative grade III PS than their acute counterparts. This suggests that grade III PS may be an early sign of knee decompensation of dynamic rotational knee laxity in chronic ACL-injured knees with bimeniscal lesions.

Level of evidence

Level III.

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Abbreviations

ACL:

Anterior cruciate ligament

BMI:

Body mass index

CI:

Confidence interval

IRB:

Institutional Review Board

IQR:

Inter quartile range

LM:

Lateral meniscus

MM:

Medial meniscus

MRI:

Magnetic Resonance Imaging

ns:

Not significant

PS:

Pivot shift

TFI:

Time from injury

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Authors and Affiliations

  1. Sports Clinic, Centre Hospitalier de Luxembourg–Clinique d’Eich, 78 Rue d’Eich, 1460, Luxembourg, Luxembourg

    Amanda Magosch, Christian Nührenbörger, Caroline Mouton & Romain Seil

  2. Institute for Movement and Locomotion (IML), Department of Orthopedic Surgery and Traumatology, St. Marguerite Hospital, Marseille, France

    Christophe Jacquet

  3. Luxembourg Institute of Research in Orthopaedics, Sports Medicine and Science, Luxembourg, Luxembourg

    Christian Nührenbörger, Caroline Mouton & Romain Seil

  4. Human Motion, Orthopaedics, Sports Medicine and Digital Methods, Luxembourg Institute of Health, Strassen, Luxembourg

    Romain Seil

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  1. Amanda Magosch
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  2. Christophe Jacquet
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  4. Caroline Mouton
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  5. Romain Seil
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Contributions

All authors contributed equally to the study.

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Correspondence to Romain Seil.

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National Ethics Committee for Research (No. 201101/05).

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All patients signed an informed consent to participate in the study.

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Investigation performed at Sports Clinic, Centre Hospitalier de Luxembourg–Clinique d’Eich, Luxembourg.

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Magosch, A., Jacquet, C., Nührenbörger, C. et al. Grade III pivot shift as an early sign of knee decompensation in chronic ACL-injured knees with bimeniscal tears. Knee Surg Sports Traumatol Arthrosc 30, 1611–1619 (2022). https://doi.org/10.1007/s00167-021-06673-x

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