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Can the pivot-shift be eliminated by anatomic double-bundle anterior cruciate ligament reconstruction?

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

To assess the ability of anatomic double-bundle anterior cruciate ligament reconstruction in eliminating the pivot-shift phenomenon when identified by a quantitative measuring system (computer navigation or magnetic resonance imaging).

Methods

Literature review. Medline, Google Scholar and Cochrane Reviews computerized databases research using the keywords “pivot-shift,” “anterior cruciate ligament reconstruction” and “double bundle.” Twelve (7 in vitro and 5 in vivo) studies met the inclusion criteria.

Results

There was a wide variation in the absolute value of translation and rotation measured after anatomic double-bundle anterior cruciate ligament reconstruction. There were also differences in fixation methods, pivot-shift execution conditions, applied stresses during the pivot-shift, calculation methods and reference systems utilized by measurement systems.

Conclusions

The double-bundle reconstruction was shown to over-constrain the knee with respect to the intact value, especially closer to knee extension. This review demonstrated that anatomic double-bundle anterior cruciate ligament reconstruction is able to eliminate pathological translations and rotations during the pivot-shift phenomenon, as identified by quantitative measurement systems.

Level of evidence

Review of Level III studies, Level III.

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References

  1. Bach BR Jr, Warren RF, Wickiewicz TL (1988) The pivot shift phenomenon: results and description of a modified clinical test for anterior cruciate ligament insufficiency. Am J Sports Med 16(6):571–576

    Article  PubMed  Google Scholar 

  2. Bedi A, Musahl V, O’Loughlin P, Maak T, Citak M, Dixon P, Pearle AD (2010) A comparison of the effect of central anatomical single-bundle anterior cruciate ligament reconstruction and double-bundle anterior cruciate ligament reconstruction on pivot-shift kinematics. Am J Sports Med 38(9):1788–1794

    Article  PubMed  Google Scholar 

  3. Bull MJ, Amis AA (1998) The pivot-shift phenomenon: a clinical and biomechanical perspective. Knee 5(3):141–158

    Article  Google Scholar 

  4. Cha PS, Brucker PU, West RV, Zelle BA, Yagi M, Kurosaka M, Fu FH (2005) Arthroscopic double-bundle anterior cruciate ligament reconstruction: an anatomic approach. Arthroscopy 21(10):1275

    PubMed  Google Scholar 

  5. Colombet P, Robinson J, Christel P, Franceschi JP, Djian P (2007) Using navigation to measure rotation kinematics during ACL reconstruction. Clin Orthop Relat Res 454:59–65

    Article  PubMed  Google Scholar 

  6. Crawford C, Nyland J, Landes S, Jackson R, Chang HC, Nawab A, Caborn DN (2007) Anatomic double bundle ACL reconstruction: a literature review. Knee Surg Sports Traumatol Arthrosc 15(8):946–964

    Article  PubMed  Google Scholar 

  7. Ferretti A, Monaco E, Labianca L, Conteduca F, De Carli A (2008) Double-bundle anterior cruciate ligament reconstruction: a computer-assisted orthopaedic surgery study. Am J Sports Med 36(4):760–766

    Article  PubMed  Google Scholar 

  8. Fetto JF, Marshall JL (1979) Injury to the anterior cruciate ligament producing the pivot-shift sign. J Bone Joint Surg Am 61(5):710–714

    PubMed  CAS  Google Scholar 

  9. Galway HR, Beaupré A, MacIntosh DL (1972) Pivot shift: a clinical sign of symptomatic anterior cruciate insufficiency. In: Proceedings of British Orthopaedic Association spring meeting, Aviemore, Inverness-shire, UK. J Bone Joint Surg 54-B, pp 763–764

  10. Gobbi A, Mahajan V, Karnatzikos G, Nakamura N (2011) Single- versus double-bundle ACL reconstruction: is there any difference in stability and function at 3-year followup? Clin Orthop Relat Res. doi:10.1007/s11999-011-1940-9

    Google Scholar 

  11. Hughston JC, Andrews JR, Cross MJ, Moschi A (1976) Classification of knee ligament instabilities. Part I. The medial compartment and cruciate ligaments. J Bone Joint Surg Am 58(2):159–172

    PubMed  CAS  Google Scholar 

  12. Ishibashi Y, Tsuda E, Yamamoto Y, Tsukada H, Toh S (2009) Navigation evaluation of the pivot-shift phenomenon during double-bundle anterior cruciate ligament reconstruction: is the posterolateral bundle more important? Arthroscopy 25(5):488–495

    Article  PubMed  Google Scholar 

  13. Izawa T, Okazaki K, Tashiro Y, Matsubara H, Miura H, Matsuda S, Hashizume M, Iwamoto Y (2011) Comparison of rotatory stability after anterior cruciate ligament reconstruction between single-bundle and double-bundle techniques. Am J Sports Med 39(7):1470–1477

    Article  PubMed  Google Scholar 

  14. Jakob RP, Staubli HU, Deland JT (1987) Grading the pivot shift. Objective tests with implications for treatment. J Bone Joint Surg Br 69(2):294–299

    PubMed  CAS  Google Scholar 

  15. Jarvela T (2007) Double-bundle versus single-bundle anterior cruciate ligament reconstruction: a prospective, randomize clinical study. Knee Surg Sports Traumatol Arthrosc 15(5):500–507

    Article  PubMed  Google Scholar 

  16. Kanaya A, Ochi M, Deie M, Adachi N, Nishimori M, Nakamae A (2009) Intraoperative evaluation of anteroposterior and rotational stabilities in anterior cruciate ligament reconstruction: lower femoral tunnel placed single-bundle versus double-bundle reconstruction. Knee Surg Sports Traumatol Arthrosc 17(8):907–913

    Article  PubMed  Google Scholar 

  17. 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(7):1349–1358

    Article  PubMed  Google Scholar 

  18. Kondo E, Merican AM, Yasuda K, Amis AA (2011) Biomechanical comparison of anatomic double-bundle, anatomic single-bundle, and nonanatomic single-bundle anterior cruciate ligament reconstructions. Am J Sports Med 39(2):279–288

    Article  PubMed  Google Scholar 

  19. Lane CG, Warren R, Pearle AD (2008) The pivot shift. J Am Acad Orthop Surg 16(12):679–688

    PubMed  Google Scholar 

  20. Losee RE, Johnson TR, Southwick WO (1978) Anterior subluxation of the lateral tibial plateau. A diagnostic test and operative repair. J Bone Joint Surg Am 60(8):1015–1030

    PubMed  CAS  Google Scholar 

  21. Marcacci M, Molgora AP, Zaffagnini S, Vascellari A, Iacono F, Presti ML (2003) Anatomic double-bundle anterior cruciate ligament reconstruction with hamstrings. Arthroscopy 19(5):540–546

    Article  PubMed  Google Scholar 

  22. Matsumoto H (1990) Mechanism of the pivot shift. J Bone Joint Surg Br 72(5):816–821

    PubMed  CAS  Google Scholar 

  23. Musahl V, Bedi A, Citak M, O’Loughlin P, Choi D, Pearle AD (2011) Effect of single-bundle and double-bundle anterior cruciate ligament reconstructions on pivot-shift kinematics in anterior cruciate ligament- and meniscus-deficient knees. Am J Sports Med 39(2):289–295

    Article  PubMed  Google Scholar 

  24. Musahl V, Voos J, O’Loughlin PF, Stueber V, Kendoff D, Pearle AD (2010) Mechanized pivot shift test achieves greater accuracy than manual pivot shift test. Knee Surg Sports Traumatol Arthrosc 18(9):1208–1213

    Article  PubMed  Google Scholar 

  25. Musahl V, Voos JE, O’Loughlin PF, Choi D, Stueber V, Kendoff D, Pearle AD (2010) Comparing stability of different single- and double-bundle anterior cruciate ligament reconstruction techniques: a cadaveric study using navigation. Arthroscopy 26(9 Suppl):S41–S48

    PubMed  Google Scholar 

  26. Noyes FR, Grood ES, Cummings JF, Wroble RR (1991) An analysis of the pivot shift phenomenon. The knee motions and subluxations induced by different examiners. Am J Sports Med 19(2):148–155

    Article  PubMed  CAS  Google Scholar 

  27. Park SJ, Jung YB, Jung HJ, Shin HK, Kim E, Song KS, Kim GS, Cheon HY, Kim S (2010) Outcome of arthroscopic single-bundle versus double-bundle reconstruction of the anterior cruciate ligament: a preliminary 2-year prospective study. Arthroscopy 26(5):630–636

    Article  PubMed  Google Scholar 

  28. Petersen W, Tretow H, Weimann A, Herbort M, Fu FH, Raschke M, Zantop T (2007) Biomechanical evaluation of two techniques for double-bundle anterior cruciate ligament reconstruction: one tibial tunnel versus two tibial tunnels. Am J Sports Med 35(2):228–234

    Article  PubMed  Google Scholar 

  29. Plaweski S, Grimaldi M, Courvoisier A, Wimsey S (2011) Intraoperative comparisons of knee kinematics of double-bundle versus single-bundle anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 19(8):1277–1286

    Article  PubMed  Google Scholar 

  30. Robinson J, Carrat L, Granchi C, Colombet P (2007) Influence of anterior cruciate ligament bundles on knee kinematics: clinical assessment using computer-assisted navigation. Am J Sports Med 35(12):2006–2013

    Article  PubMed  Google Scholar 

  31. Shen W, Jordan S, Fu F (2007) Review article: anatomic double bundle anterior cruciate ligament reconstruction. J Orthop Surg (Hong Kong) 15(2):216–221

    CAS  Google Scholar 

  32. Siebold R, Branch TP, Freedberg HI, Jacobs CA (2011) A matched pairs comparison of single- versus double-bundle anterior cruciate ligament reconstructions, clinical results and manual laxity testing. Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-011-1475-3

    Google Scholar 

  33. Siebold R, Dehler C, Ellert T (2008) Prospective randomized comparison of double-bundle versus single-bundle anterior cruciate ligament reconstruction. Arthroscopy 24(2):137–145

    Article  PubMed  Google Scholar 

  34. Slocum DB, James SL, Larson RL, Singer KM (1976) Clinical test for anterolateral rotary instability of the knee. Clin Orthop Relat Res 118:63–69

    PubMed  Google Scholar 

  35. Takeda Y, Sato R, Ogawa T, Fujii K, Naruse A (2009) In vivo magnetic resonance imaging measurement of tibiofemoral relation with different knee flexion angles after single- and double-bundle anterior cruciate ligament reconstructions. Arthroscopy 25(7):733–741

    Article  PubMed  Google Scholar 

  36. Tamea CD Jr, Henning CE (1981) Pathomechanics of the pivot shift maneuver. An instant center analysis. Am J Sports Med 9(1):31–37

    Article  PubMed  Google Scholar 

  37. 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(2):263–272

    Article  PubMed  Google Scholar 

  38. Yoo YS, Jeong WS, Shetty NS, Ingham SJ, Smolinski P, Fu F (2010) Changes in ACL length at different knee flexion angles: an in vivo biomechanical study. Knee Surg Sports Traumatol Arthrosc 18(3):292–297

    Article  PubMed  Google Scholar 

  39. Zaffagnini S, Bruni D, Marcheggiani Muccioli GM, Bonanzinga T, Lopomo N, Bignozzi S, Marcacci M (2011) Single-bundle patellar tendon versus non-anatomical double-bundle hamstrings ACL reconstruction: a prospective randomized study at 8-year minimum follow-up. Knee Surg Sports Traumatol Arthrosc 19(3):390–397

    Article  PubMed  Google Scholar 

  40. Zaffagnini S, Signorelli C, Lopomo N, Bonanzinga T, Marcheggiani Muccioli GM, Bignozzi S, Visani A, Marcacci M (2011) Anatomic double-bundle and over-the-top single-bundle with additional extra-articular tenodesis: an in vivo quantitative assessment of knee laxity in two different ACL reconstructions. Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-011-1589-7

    Google Scholar 

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Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. 3rd Orthopaedic and Traumatology Clinic and Biomechanics Laboratory, Codivilla-Putti Research Center, Istituto Ortopedico Rizzoli—University of Bologna, via di Barbiano, 1/10, 40100, Bologna, Italy

    Stefano Zaffagnini, Giulio Maria Marcheggiani Muccioli, Nicola Lopomo, Cecilia Signorelli, Tommaso Bonanzinga, Costanza Musiani, Papakonstantinou Vassilis, Marco Nitri & Maurilio Marcacci

Authors
  1. Stefano Zaffagnini
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  2. Giulio Maria Marcheggiani Muccioli
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  3. Nicola Lopomo
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  4. Cecilia Signorelli
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  5. Tommaso Bonanzinga
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  6. Costanza Musiani
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  7. Papakonstantinou Vassilis
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  8. Marco Nitri
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  9. Maurilio Marcacci
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Correspondence to Stefano Zaffagnini.

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Zaffagnini, S., Marcheggiani Muccioli, G.M., Lopomo, N. et al. Can the pivot-shift be eliminated by anatomic double-bundle anterior cruciate ligament reconstruction?. Knee Surg Sports Traumatol Arthrosc 20, 743–751 (2012). https://doi.org/10.1007/s00167-012-1897-6

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  • DOI: https://doi.org/10.1007/s00167-012-1897-6

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