Skip to main content

Advertisement

SpringerLink
Log in

Risk factors of residual pivot-shift after anatomic double-bundle anterior cruciate ligament reconstruction

  • Arthroscopy and Sports Medicine
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Although anterior cruciate ligament reconstruction (ACLR) is considered a successful procedure, residual pivot-shift after surgery remains to be solved. The purpose of this study was to comprehensively evaluate the risk factors of residual pivot-shift after anatomic double-bundle (DB) ACLR.

Materials and methods

A total of 164 patients who underwent primary anatomic DB-ACLR between January 2014 and December 2019 and screw removal after the index ACLR in our hospital were included in this retrospective case–control study. The manual pivot-shift test was performed under general anesthesia during screw removal surgery, and patients with grade 1 or higher pivot-shift were classified as the positive pivot-shift group, and those with grade 0 were defined as the negative pivot-shift group. Univariate and logistic regression analyses were performed to identify the factors associated with postoperative residual pivot-shift. Assessment included sex, age, time to surgery, preoperative Tegner activity scale, preoperative pivot-shift grade, preoperative anterior tibial translation by the KT-2000 arthrometer measurement, meniscus injury and its surgical procedure, knee hyperextension, cartilage damage, Segond fracture, medial and lateral posterior tibial slope, lateral—medial slope asymmetry, participation in pivoting sport/activity at the time of injury, and return to sports at postoperative one year line.

Results

Postoperative positive pivot-shift was observed in 14 (8.5%) of 164 patients. The KT-2000 measurement at 1-year postoperatively was significantly higher in the residual pivot-shift-positive group than in the negative group (P < 0.05). Logistic regression analysis revealed that age of patients < 20 years [P < 0.05, odds ratio (OR): 6.1)], preoperative pivot-shift grade (P < 0.05, OR: 4.4), and hyperextended knee (P < 0.05, OR: 11.8) were risk factors of postoperative pivot-shift. There were no statistically significant differences between other variables.

Conclusions

Patients < 20 years of age, with high-grade preoperative pivot-shift, or hyperextended knees had a higher risk of residual postoperative pivot-shift.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Leblanc MC, Kowalczuk M, Andruszkiewicz N, Simunovic N, Farrokhyar F, Turnbull TL, Debski RE, Ayeni OR (2015) Diagnostic accuracy of physical examination for anterior knee instability: a systematic review. Knee Surg Sports Traumatol Arthrosc 23:2805–2813. https://doi.org/10.1007/s00167-015-3563-2

    Article  PubMed  Google Scholar 

  2. Kocher MS, Steadman JR, Briggs KK, Sterett WI, Hawkins RJ (2004) Relationships between objective assessment of ligament stability and subjective assessment of symptoms and function after anterior cruciate ligament reconstruction. Am J Sports Med 32:629–634. https://doi.org/10.1177/0363546503261722

    Article  PubMed  Google Scholar 

  3. Jonsson H, Riklund-Åhlström K, Lind J (2004) Positive pivot shift after ACL reconstruction predicts later osteoarthrosis: 63 Patients followed 5–9 years after surgery. Acta Orthop Scand 75:594–599. https://doi.org/10.1080/00016470410001484

    Article  PubMed  Google Scholar 

  4. Janssen RPA, du Mée AWF, van Valkenburg J, Sala HAGM, Tseng CM (2013) Anterior cruciate ligament reconstruction with 4-strand hamstring autograft and accelerated rehabilitation: a 10-year prospective study on clinical results, knee osteoarthritis and its predictors. Knee Surg Sports Traumatol Arthrosc 21:1977–1988. https://doi.org/10.1007/s00167-012-2234-9

    Article  PubMed  Google Scholar 

  5. Mascarenhas R, Cvetanovich GL, Sayegh ET, Verma NN, Cole BJ, Bush-Joseph C, Bach BR (2015) Does double-bundle anterior cruciate ligament reconstruction improve postoperative knee stability compared with single-bundle techniques? A systematic review of overlapping meta-analyses. Arthroscopy 31:1185–1196. https://doi.org/10.1016/j.arthro.2014.11.014

    Article  PubMed  Google Scholar 

  6. Van Eck CF, Kopf S, Irrgang JJ, Blankevoort L, Bhandari M, Fu FH, Poolman RW (2012) Single-bundle versus double-bundle reconstruction for anterior cruciate ligament rupture: a meta-analysis-does anatomy matter? Arthroscopy 28:405–424. https://doi.org/10.1016/j.arthro.2011.11.021

    Article  PubMed  Google Scholar 

  7. Araki D, Kuroda R, Kubo S, Fujita N, Tei K, Nishimoto K, Hoshino Y, Matsushita T, Matsumoto T, Nagamune K, Kurosaka M (2011) A prospective randomised study of anatomical single-bundle versus double-bundle anterior cruciate ligament reconstruction: quantitative evaluation using an electromagnetic measurement system. Int Orthop 35:439–446. https://doi.org/10.1007/s00264-010-1110-9

    Article  PubMed  Google Scholar 

  8. Desai N, Björnsson H, Musahl V, Bhandari M, Petzold M, Fu FH, Samuelsson K (2014) Anatomic single- versus double-bundle ACL reconstruction: a meta-analysis. Knee Surg Sports Traumatol Arthrosc 22:1009–1023. https://doi.org/10.1007/s00167-013-2811-6

    Article  PubMed  Google Scholar 

  9. Yagi M, Kuroda R, Nagamune K, Yoshiya S, Kurosaka M (2007) Double-bundle ACL reconstruction can improve rotational stability. Clin Orthop Relat Res. https://doi.org/10.1097/BLO.0b013e31802ba45c

    Article  PubMed  Google Scholar 

  10. Kondo E, Merican AM, Yasuda K, Amis AA (2010) Biomechanical comparisons of knee stability after anterior cruciate ligament reconstruction between 2 clinically available transtibial procedures: anatomic double bundle versus single bundle. Am J Sports Med 38:1349–1358. https://doi.org/10.1177/0363546510361234

    Article  PubMed  Google Scholar 

  11. Tsai AG, Wijdicks CA, Walsh MP, LaPrade RF (2010) Comparative kinematic evaluation of all-inside single-bundle and double-bundle anterior cruciate ligament reconstruction: a biomechanical study. Am J Sports Med 38:263–272. https://doi.org/10.1177/0363546509348053

    Article  PubMed  Google Scholar 

  12. Suomalainen P, Moisala AS, Paakkala A, Kannus P, Järvelä T (2011) Double-bundle versus single-bundle anterior cruciate ligament reconstruction: randomized clinical and magnetic resonance imaging study with 2-year follow-up. Am J Sports Med 39:1615–1622. https://doi.org/10.1177/0363546511405024

    Article  PubMed  Google Scholar 

  13. Suomalainen P, Järvelä T, Paakkala A, Kannus P, Järvinen M (2012) Double-bundle versus single-bundle anterior cruciate ligament reconstruction: a prospective randomized study with 5-year results. Am J Sports Med 40:1511–1518. https://doi.org/10.1177/0363546512448177

    Article  PubMed  Google Scholar 

  14. Hussein M, Van Eck CF, Cretnik A, Dinevski D, Fu FH (2012) Prospective randomized clinical evaluation of conventional single-bundle, anatomic single-bundle, and anatomic double-bundle anterior cruciate ligament reconstruction: 281 Cases with 3- to 5-year follow-up. Am J Sports Med 40:512–520. https://doi.org/10.1177/0363546511426416

    Article  PubMed  Google Scholar 

  15. Cristiani R, Forssblad M, Engström B, Edman G, Stålman A (2018) Risk factors for abnormal anteroposterior knee laxity after primary anterior cruciate ligament reconstruction. Arthroscopy 34:2478–2484. https://doi.org/10.1016/j.arthro.2018.03.038

    Article  PubMed  Google Scholar 

  16. Nakanishi Y, Matsushita T, Nagai K, Araki D, Kanzaki N, Hoshino Y, Matsumoto T, Niikura T, Kuroda R (2020) Greater knee joint laxity remains in teenagers after anatomical double-bundle anterior cruciate ligament reconstruction compared to young adults. Knee Surg Sports Traumatol Arthrosc 28:2663–2667. https://doi.org/10.1007/s00167-020-05910-z

    Article  PubMed  Google Scholar 

  17. Hoshino Y, Hiroshima Y, Miyaji N, Nagai K, Araki D, Kanzaki N, Kakutani K, Matsushita T, Kuroda R (2020) Unrepaired lateral meniscus tears lead to remaining pivot-shift in ACL-reconstructed knees. Knee Surg Sports Traumatol Arthrosc 28:3504–3510. https://doi.org/10.1007/s00167-020-06007-3

    Article  PubMed  Google Scholar 

  18. Kim SH, Park YB, Kim DH, Pujol N, Lee HJ (2020) Predictive factors for failure of anterior cruciate ligament reconstruction via the trans-tibial technique. Arch Orthop Trauma Surg 140:1445–1457. https://doi.org/10.1007/s00402-020-03483-7

    Article  PubMed  Google Scholar 

  19. Ahn JH, Lee SH (2016) Risk factors for knee instability after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 24:2936–2942. https://doi.org/10.1007/s00167-015-3568-x

    Article  PubMed  Google Scholar 

  20. Ueki H, Nakagawa Y, Ohara T, Watanabe T, Horie M, Katagiri H, Otabe K, Katagiri K, Hiyama K, Katakura M, Hoshino T, Inomata K, Araya N, Sekiya I, Muneta T, Koga H (2018) Risk factors for residual pivot shift after anterior cruciate ligament reconstruction: Data from the MAKS group. Knee Surg Sports Traumatol Arthrosc 26:3724–3730. https://doi.org/10.1007/s00167-018-5005-4

    Article  PubMed  Google Scholar 

  21. Yamamoto Y, Tsuda E, Maeda S, Naraoka T, Kimura Y, Chiba D, Ishibashi Y (2018) Greater laxity in the anterior cruciate ligament–injured knee carries a higher risk of postreconstruction pivot shift: intraoperative measurements with a navigation system. Am J Sports Med 46:2859–2864. https://doi.org/10.1177/0363546518793854

    Article  PubMed  Google Scholar 

  22. Katakura M, Nakamura K, Watanabe T, Horie M, Nakamura T, Katagiri H, Otabe K, Nakagawa Y, Ohara T, Sekiya I, Muneta T, Koga H (2020) Risk factors for residual anterolateral rotational instability after double bundle anterior cruciate ligament reconstruction: evaluation by quantitative assessment of the pivot shift phenomenon using triaxial accelerometer. Knee 27:95–101. https://doi.org/10.1016/j.knee.2019.09.016

    Article  PubMed  Google Scholar 

  23. Yanagisawa S, Kimura M, Hagiwara K, Ogoshi A, Nakagawa T, Shiozawa H, Ohsawa T (2017) Factors affecting knee laxity following anterior cruciate ligament reconstruction using a hamstring tendon. Knee 24:1075–1082. https://doi.org/10.1016/j.knee.2017.07.009

    Article  PubMed  Google Scholar 

  24. Fetto JF, Marshall JL (1978) Medial collateral ligament injuries of the knee: a rationale for treatment. Clin Orthop Relat Res. https://doi.org/10.1097/00003086-197805000-00038

    Article  PubMed  Google Scholar 

  25. Hoshino Y, Araujo P, Ahlden M, Moore CG, Kuroda R, Zaffagnini S, Karlsson J, Fu FH, Musahl V (2012) Standardized pivot shift test improves measurement accuracy. Knee Surg Sports Traumatol Arthrosc 20:732–736. https://doi.org/10.1007/s00167-011-1850-0

    Article  PubMed  Google Scholar 

  26. Irrgang JJ, Ho H, Harner CD, Fu FH (1998) Use of the international knee documentation committee guidelines to assess outcome following anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 6:107–114. https://doi.org/10.1007/s001670050082

    Article  CAS  PubMed  Google Scholar 

  27. Hudek R, Schmutz S, Regenfelder F, Fuchs B, Koch PP (2009) Novel measurement technique of the tibial slope on conventional MRI. Clin Orthop Relat Res 467:2066–2072. https://doi.org/10.1007/s11999-009-0711-3

    Article  PubMed  PubMed Central  Google Scholar 

  28. Kawanishi Y, Nozaki M, Kobayashi M, Yasuma S, Fukushima H, Murase A, Takenaga T, Yoshida M, Kuroyanagi G, Kawaguchi Y, Nagaya Y, Murakami H (2020) Preoperative knee instability affects residual instability as evaluated by quantitative pivot-shift measurements during double-bundle ACL reconstruction. Orthop J Sports Med 8:2325967120959020. https://doi.org/10.1177/2325967120959020

    Article  PubMed  PubMed Central  Google Scholar 

  29. Yamasaki S, Hashimoto Y, Iida K, Nishino K, Nishida Y, Takigami J, Takahashi S, Nakamura H (2021) Risk factors for postoperative graft laxity without re-injury after double-bundle anterior cruciate ligament reconstruction in recreational athletes. Knee 28:338–345. https://doi.org/10.1016/j.knee.2020.12.009

    Article  PubMed  Google Scholar 

  30. Yasuma S, Nozaki M, Murase A, Kobayashi M, Kawanishi Y, Fukushima H, Takenaga T, Yoshida M, Kuroyanagi G, Kawaguchi Y, Nagaya Y, Murakami H (2020) Anterolateral ligament reconstruction as an augmented procedure for double-bundle anterior cruciate ligament reconstruction restores rotational stability: Quantitative evaluation of the pivot shift test using an inertial sensor. Knee 27:397–405. https://doi.org/10.1016/j.knee.2020.02.015

    Article  PubMed  Google Scholar 

  31. Dodds AL, Gupte CM, Neyret P, Williams AM, Amis AA (2011) Extra-articular techniques in anterior cruciate ligament reconstruction: a literature review. J Bone Joint Surg Br 93:1440–1448. https://doi.org/10.1302/0301-620X.93B11.27632

    Article  CAS  PubMed  Google Scholar 

  32. Vundelinckx B, Herman B, Getgood A, Litchfield R (2017) Surgical indications and technique for anterior cruciate ligament reconstruction combined with lateral extra-articular tenodesis or anterolateral ligament reconstruction. Clin Sports Med 36:135–153. https://doi.org/10.1016/j.csm.2016.08.009

    Article  PubMed  Google Scholar 

  33. Hewison CE, Tran MN, Kaniki N, Remtulla A, Bryant D, Getgood AM (2015) Lateral extra-articular tenodesis reduces rotational laxity when combined with anterior cruciate ligament reconstruction: a systematic review of the literature. Arthroscopy 31:2022–2034. https://doi.org/10.1016/j.arthro.2015.04.089

    Article  PubMed  Google Scholar 

  34. Inderhaug E, Stephen JM, Williams A, Amis AA (2017) Anterolateral tenodesis or anterolateral ligament complex reconstruction: effect of flexion angle at graft fixation when combined with ACL reconstruction. Am J Sports Med 45:3089–3097. https://doi.org/10.1177/0363546517724422

    Article  PubMed  Google Scholar 

  35. Rowan FE, Huq SS, Haddad FS (2019) Lateral extra-articular tenodesis with ACL reconstruction demonstrates better patient-reported outcomes compared to ACL reconstruction alone at 2 years minimum follow-up. Arch Orthop Trauma Surg 139:1425–1433. https://doi.org/10.1007/s00402-019-03218-3

    Article  CAS  PubMed  Google Scholar 

  36. Sonnery-Cottet B, Thaunat M, Freychet B, Pupim BHB, Murphy CG, Claes S (2015) Outcome of a combined anterior cruciate ligament and anterolateral ligament reconstruction technique with a minimum 2-year follow-up. Am J Sports Med 43:1598–1605. https://doi.org/10.1177/0363546515571571

    Article  PubMed  Google Scholar 

  37. Kraeutler MJ, Welton KL, Chahla J, LaPrade RF, McCarty EC (2018) Current concepts of the anterolateral ligament of the knee: anatomy, biomechanics, and reconstruction. Am J Sports Med 46:1235–1242. https://doi.org/10.1177/0363546517701920

    Article  PubMed  Google Scholar 

  38. Ra HJ, Kim JH, Lee DH (2020) Comparative clinical outcomes of anterolateral ligament reconstruction versus lateral extra-articular tenodesis in combination with anterior cruciate ligament reconstruction: systematic review and meta-analysis. Arch Orthop Trauma Surg 140:923–931. https://doi.org/10.1007/s00402-020-03393-8

    Article  PubMed  Google Scholar 

  39. Getgood AMJ, Bryant DM, Litchfield R, Heard M, McCormack RG, Rezansoff A, Peterson D, Van Haver M et al (2020) Lateral extra-articular tenodesis reduces failure of hamstring tendon autograft anterior cruciate ligament reconstruction: 2-year outcomes from the STABILITY study randomized clinical trial. Am J Sports Med 48:285–297. https://doi.org/10.1177/0363546519896333

    Article  PubMed  Google Scholar 

  40. Ariel de Lima D, de Lima LL, de Souza NGR, de Moraes Perez RA, Sobrado MF, Guimarães TM, Helito CP (2021) Clinical outcomes of combined anterior cruciate ligament and anterolateral ligament reconstruction: a systematic review and meta-analysis. Knee Surg Relat Res 33:33. https://doi.org/10.1186/s43019-021-00115-1

    Article  PubMed  PubMed Central  Google Scholar 

  41. Hiroshima Y, Hoshino Y, Miyaji N, Tanaka T, Araki D, Kanzaki N, Matsushita T, Kuroda R (2020) No difference in postoperative rotational laxity after ACL reconstruction in patients with and without anterolateral capsule injury: quantitative evaluation of the pivot-shift test at 1-year follow-up. Knee Surg Sports Traumatol Arthrosc 28:489–494. https://doi.org/10.1007/s00167-019-05664-3

    Article  PubMed  Google Scholar 

  42. Miyaji N, Hoshino Y, Tanaka T, Nishida K, Araki D, Kanzaki N, Matsushita T, Kuroda R (2019) MRI-determined anterolateral capsule injury did not affect the pivot-shift in anterior cruciate ligament-injured knees. Knee Surg Sports Traumatol Arthrosc 27:3426–3431. https://doi.org/10.1007/s00167-019-05376-8

    Article  PubMed  Google Scholar 

  43. Araki D, Matsushita T, Hoshino Y, Nagai K, Nishida K, Koga H, Nakamura T, Katakura M, Muneta T, Kuroda R (2019) The anterolateral structure of the knee does not affect anterior and dynamic rotatory stability in anterior cruciate ligament injury: Quantitative evaluation with the electromagnetic measurement system. Am J Sports Med 47:3381–3388. https://doi.org/10.1177/0363546519879692

    Article  PubMed  Google Scholar 

  44. Kuroda R, Hoshino Y, Araki D, Nishizawa Y, Nagamune K, Matsumoto T, Kubo S, Matsushita T, Kurosaka M (2012) Quantitative measurement of the pivot shift, reliability, and clinical applications. Knee Surg Sports Traumatol Arthrosc 20:686–691. https://doi.org/10.1007/s00167-011-1849-6

    Article  PubMed  Google Scholar 

  45. Berruto M, Uboldi F, Gala L, Marelli B, Albisetti W (2013) Is triaxial accelerometer reliable in the evaluation and grading of knee pivot-shift phenomenon? Knee Surg Sports Traumatol Arthrosc 21:981–985. https://doi.org/10.1007/s00167-013-2436-9

    Article  CAS  PubMed  Google Scholar 

  46. Hoshino Y, Araujo P, Ahldén M, Samuelsson K, Muller B, Hofbauer M, Wolf MR, Irrgang JJ, Fu FH, Musahl V (2013) Quantitative evaluation of the pivot shift by image analysis using the iPad. Knee Surg Sports Traumatol Arthrosc 21:975–980. https://doi.org/10.1007/s00167-013-2396-0

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We appreciate Editage (Cactus Communications) for the professional English proof.

Funding

There is no funding source.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan

    Kohei Kamada, Takehiko Matsushita, Kanto Nagai, Yuichi Hoshino, Daisuke Araki, Noriyuki Kanzaki, Tomoyuki Matsumoto, Takahiro Niikura & Ryosuke Kuroda

Authors
  1. Kohei Kamada
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Takehiko Matsushita
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kanto Nagai
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yuichi Hoshino
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Daisuke Araki
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Noriyuki Kanzaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Tomoyuki Matsumoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Takahiro Niikura
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Ryosuke Kuroda
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

KK designed the study and wrote the initial draft of the manuscript. TaM contributed to analysis and interpretation of data and assisted in the preparation of the manuscript. KN, DA, NK, YH, ToM, TN and RK contributed to data collection and interpretation and critically reviewed the manuscript. All authors approved the final version of the manuscript and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Takehiko Matsushita.

Ethics declarations

Ethical approval

The study was performed in line with the principles of the Declaration of Helsinki and in accordance with the ethical standards of the institutional review board of our hospital (ID No. B190055).

Informed consent

Informed consent was obtained from all the participants.

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kamada, K., Matsushita, T., Nagai, K. et al. Risk factors of residual pivot-shift after anatomic double-bundle anterior cruciate ligament reconstruction. Arch Orthop Trauma Surg 143, 977–985 (2023). https://doi.org/10.1007/s00402-022-04428-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00402-022-04428-y

Keywords

Search

Navigation