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A new quantitative method for pivot shift grading

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

Abstract

Purpose

The purposes of the study were to evaluate and to quantify the pivot shift phenomenon by using a small and easy to handle measuring device for pivot shift quantification.

Methods

Twenty patients (forty knees) with primary torn anterior cruciate ligaments (ACL) were tested under anesthesia, graded by the examiner and by the device according to the IKDC classification [normal (0), glide (1), clunk (2), and gross (3)]. For the grading by the device, a femoral and a tibial miniature inertial sensor measured the acceleration and the angular velocities. Three parameters were used for pivot shift identification and quantification: (1) difference between the positive and negative acceleration peak value (a diff), (2) the maximum jerk (j max), and (3) the standard deviation (SD a ) of the acceleration. The ratio between the ACL-deficient and the intact knees was calculated in order to normalize the data.

Results

The pivot shift phenomenon could be identified, and all three parameters showed significant higher values in the ACL-deficient knees compared to the intact knees (p < 0.05). The grading by examiner did not significantly correlate with a diff (p = 0.38; r = 0.21), j max (p = 0.36; r = −0.22), SD a (p = 0.65; r = 0.11), and grading by the device (p = 0.62; r = 0.12).

Conclusions

The present study has shown that the quantification of the pivot shift test is practicable when inertial sensors are used. The results have shown that the subjective grading of the pivot shift test does not correlate well with objective quantification.

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Authors and Affiliations

  1. Department of Orthopaedic and Traumatology, City Hospital, Hochstrasse 26, 14770, Brandenburg, Germany

    R. Becker

  2. Institute of Micro and Sensor Systems, Otto-von-Guericke-University, Magdeburg, Germany

    R. Kauert & J. Halfpaap

  3. Section Sports Traumatology and Arthroscopy, Center for Musculoskeletal Surgery, Charité, University Medicine, Berlin, Germany

    S. Kopf & T. Jung

Authors
  1. S. Kopf
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  2. R. Kauert
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  3. J. Halfpaap
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  4. T. Jung
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  5. R. Becker
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Corresponding author

Correspondence to R. Becker.

Appendix

Appendix

The raw signals underwent some pre-processing before the core analysis started. During pre-processing, the values for acceleration and angular velocity were multiplied with correction matrices to improve the accuracy of the measurements. The signals ran through a finite impulse response (FIR) low-pass filter with a 10 Hz cutoff frequency to clear the signal from noise and other artifacts.

The angle between the sensors on the femur and tibia (knee angle) was calculated with a complex sensor fusion algorithm using accelerometers and gyroscopes. The knee angle was required in order to identify and separate the subsequent test cycles and to specify the region where the pivot shift phenomenon occurred. The Euclidean norm of the acceleration (||a||) was calculated to separate linear acceleration from turnings without linear acceleration. The g-Bias was eliminated by subtracting ||g|| = 9.81 m/s2. The Euclidean norm in the region of the pivot shift had a typical progression as depicted in Figs. 3 and 4. The pivot shift phenomenon was identified due to the local maximum in the Euclidean norm of acceleration. For each of the ten cycles, the Pivot shift phenomenon was identified separately. The moment of the pivot shift phenomenon during testing was called T ps.

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Kopf, S., Kauert, R., Halfpaap, J. et al. A new quantitative method for pivot shift grading. Knee Surg Sports Traumatol Arthrosc 20, 718–723 (2012). https://doi.org/10.1007/s00167-012-1903-z

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  • DOI: https://doi.org/10.1007/s00167-012-1903-z

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