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What it takes to have a high-grade pivot shift—focus on bony morphology

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Variations in femoral and tibial bony morphology have been associated with higher clinical grading and increased quantitative tibial translation, but not tibial acceleration, during the pivot shift test following anterior cruciate ligament (ACL) injury. The purpose of this study was to determine the impact of femoral and tibial bony morphology, including a measurement influenced by both parameters (the Lateral Tibiofemoral Articular Distance (LTAD)), on the degree of quantitative tibial acceleration during the pivot shift test and rates of future ACL injury.

Methods

All patients who underwent primary ACL reconstruction from 2014 to 2019 by a senior orthopedic surgeon with available quantitative tibial acceleration data were retrospectively reviewed. All patients underwent a pivot shift examination under anesthesia with a triaxial accelerometer. Measurements of femoral and tibial bony morphology were performed by two fellowship-trained orthopedic surgeons using preoperative magnetic resonance imaging and lateral radiographs.

Results

Fifty-one patients were included at a mean follow-up of 4.4 years. The mean quantitative tibial acceleration during the pivot shift was 13.8 m/s2 (range: 4.9–52.0 m/s2). A larger Posterior Condylar Offset Ratio (r = 0.30, p = 0.045), smaller medial-to-lateral width of the medial tibial plateau (r = − 0.29, p = 0.041), lateral tibial plateau (r = − 0.28, p = 0.042), and lateral femoral condyle (r = − 0.29, p = 0.037), and a decreased LTAD (r = − 0.53, p < 0.001) significantly correlated with increased tibial acceleration during the pivot shift. Linear regression analysis demonstrated an increase in tibial acceleration of 1.24 m/s2 for every 1 mm decrease in LTAD. Nine patients (17.6%) sustained ipsilateral graft rupture and 10 patients (19.6%) sustained contralateral ACL rupture. No morphologic measurements were associated with rates of future ACL injury.

Conclusion

Increased convexity and smaller bony morphology of the lateral femur and tibia were significantly associated with increased tibial acceleration during the pivot shift. Additionally, a measurement, termed the LTAD, was found to have the strongest association with increased tibial acceleration. Based on the results of this study, surgeons can utilize these measurements to preoperatively identify patients at risk of increased rotatory knee instability.

Level of evidence

Level IV.

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Funding

No funding was obtained for this study.

Author information

Authors and Affiliations

  1. Department of Orthopedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA

    Sahil Dadoo, Emre Anil Ozbek, Koji Nukuto, Armin Runer, Laura E. Keeling, Camila Grandberg, Jonathan D. Hughes, James J. Irrgang & Volker Musahl

  2. Department of Orthopedic Surgery and Traumatology, University of Ankara, Ankara, Turkey

    Emre Anil Ozbek

  3. Department of Orthopaedic Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan

    Koji Nukuto & Ryosuke Kuroda

  4. Department of Sports Orthopaedics, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany

    Armin Runer

  5. Clinica Ortopedica e Traumatologica, Istituto Orthopedico Rizzoli, Bologna, Italy

    Stefano Zaffagnini

  6. Department for Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden

    Jon Karlsson, Jonathan D. Hughes & Volker Musahl

Authors
  1. Sahil Dadoo
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  12. Volker Musahl
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Corresponding author

Correspondence to Sahil Dadoo.

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Conflict of interest

No Disclosure: Sahil Dadoo, B.S., Emre Anil Ozbek, M.D., Koji Nukuto, M.D., Ph.D., Armin Runer, M.D., Laura E. Keeling, M.D., Camila Grandberg, M.D., Ryosuke Kuroda, M.D., Ph.D., Stefano Zaffagnini, M.D., Jonathan D. Hughes, M.D. JK is editor-in-chief of Knee Surgery, Sports Traumatology, Arthroscopy (KSSTA). JJI will become President-Elect of the Board of Directors for the Journal of Orthopaedic and Sports Physical Therapy on 27 February 2023. VM reports educational grants, consulting fees and speaking fees from Smith & Nephew plc, educational grants from Arthrex and DePuy/Synthes, is a board member of the International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine (ISAKOS), and deputy editor-in-chief of Knee Surgery, Sports Traumatology, Arthroscopy (KSSTA).

Ethical approval

Ethical approval for this study was granted by the Institutional Review Board of the home institution (No: STUDY19030196).

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Dadoo, S., Ozbek, E.A., Nukuto, K. et al. What it takes to have a high-grade pivot shift—focus on bony morphology. Knee Surg Sports Traumatol Arthrosc 31, 4080–4089 (2023). https://doi.org/10.1007/s00167-023-07472-2

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  • DOI: https://doi.org/10.1007/s00167-023-07472-2

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