Skip to main content
SpringerLink
Log in

High-grade rotatory knee laxity may be predictable in ACL injuries

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

Abstract

Purpose

Lateral compartment acceleration and translation have been used to quantify rotatory knee laxity in the setting of anterior cruciate ligament (ACL) injury; however, their relationship remains elusive. The purpose of this study was to examine the correlation between lateral compartment acceleration and translation during pivot shift testing. It was hypothesized that a correlation would exist in ACL-injured and uninjured knees, irrespective of sex, but would be greatest in knees with combined ACL and lateral meniscus tear.

Methods

Seventy-seven patients (34 females, 25.2 ± 9.0 years) undergoing primary single-bundle ACL reconstruction were prospectively enrolled in a 2-year study across four international centers. Patients underwent preoperative examination under anesthesia of the injured and uninjured knee using Image Analysis software and surface mounted accelerometer.

Results

A moderate correlation between lateral compartment acceleration and translation was observed in ACL-injured knees [ρ = 0.36, p < 0.05), but not in uninjured knees (ρ = 0.17, not significant (n.s.)]. A moderate correlation between acceleration and translation was demonstrated in ACL-injured knees with lateral meniscus tears (ρ = 0.53, p < 0.05), but not in knees with isolated ACL-injury (ρ = 0.32, n.s.), ACL and medial meniscus tears (ρ = 0.14, n.s.), or ACL and combined medial and lateral meniscus tears (ρ = 0.40, n.s.). A moderate correlation between acceleration and translation was seen in males (ρ = 0.51, p < 0.05), but not in females (ρ = 0.21, n.s.). Largest correlations were observed in males with ACL and lateral meniscus tears (ρ = 0.75, p < 0.05).

Conclusion

Lateral compartment acceleration and translation were moderately correlated in ACL-injured knees, but largely correlated in males with combined ACL and lateral meniscus tears. ACL and lateral meniscus injury in males might, therefore, be suspected when both lateral compartment acceleration and translation are elevated. Surgeons should have a greater degree of suspicion for high-grade rotatory knee laxity in ACL-injured males with concomitant lateral meniscus tears. Future studies should investigate how these two distinct components of rotatory knee laxity—lateral compartment acceleration and translation—are correlated with patient outcomes and affected by ACL surgery.

Level of evidence

Prospective cohort study; Level of evidence II.

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
Fig. 3

Similar content being viewed by others

References

  1. Ahldén M, Araujo P, Hoshino Y, Samuelsson K, Middleton KK, Nagamune K, Karlsson J, Musahl V (2012) Clinical grading of the pivot shift test correlates best with tibial acceleration. Knee Surg Sports Traumatol Arthrosc 20(4):708–712

    Article  Google Scholar 

  2. 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  Google Scholar 

  3. Balasch H, Schiller M, Friebel H, Hoffmann F (1999) Evaluation of anterior knee joint instability with the Rolimeter. A test in comparison with manual assessment and measuring with the KT-1000 arthrometer. Knee Surg Sports Traumatol Arthrosc 7(4):204–208

    Article  CAS  Google Scholar 

  4. Bedi A, Musahl V, Lane C, Citak M, Warren RF, Pearle AD (2010) Lateral compartment translation predicts the grade of pivot shift: a cadaveric and clinical analysis. Knee Surg Sports Traumatol Arthrosc 18(9):1269–1276

    Article  Google Scholar 

  5. Collette M, Courville J, Forton M, Gagniere B (2012) Objective evaluation of anterior knee laxity; comparison of the KT-1000 and GNRB(R) arthrometers. Knee Surg Sports Traumatol Arthrosc 20(11):2233–2238

    Article  Google Scholar 

  6. Decker MJ, Torry MR, Wyland DJ, Sterett WI, Richard Steadman J (2003) Gender differences in lower extremity kinematics, kinetics and energy absorption during landing. Clin Biomech (Bristol Avon) 18(7):662–669

    Article  Google Scholar 

  7. Ford KR, Myer GD, Hewett TE (2003) Valgus knee motion during landing in high school female and male basketball players. Med Sci Sports Exerc 35(10):1745–1750

    Article  Google Scholar 

  8. Ganko A, Engebretsen L, Ozer H (2000) The rolimeter: a new arthrometer compared with the KT-1000. Knee Surg Sports Traumatol Arthrosc 8(1):36–39

    Article  CAS  Google Scholar 

  9. Gillquist J, Messner K (1995) Instrumented analysis of the pivot shift phenomenon after reconstruction of the anterior cruciate ligament. Int J Sports Med 16(7):484–488

    Article  CAS  Google Scholar 

  10. Hefti F, Muller W, Jakob RP, Staubli HU (1993) Evaluation of knee ligament injuries with the IKDC form. Knee Surg Sports Traumatol Arthrosc 1(3–4):226–234

    Article  CAS  Google Scholar 

  11. Highgenboten CL, Jackson A, Meske NB (1989) Genucom, KT-1000, and Stryker knee laxity measuring device comparisons. Device reproducibility and interdevice comparison in asymptomatic subjects. Am J Sports Med 17(6):743–746

    Article  CAS  Google Scholar 

  12. Highgenboten CL, Jackson AW, Jansson KA, Meske NB (1992) KT-1000 arthrometer: conscious and unconscious test results using 15, 20, and 30 pounds of force. Am J Sports Med 20(4):450–454

    Article  CAS  Google Scholar 

  13. Hoshino Y, Araujo P, Ahlden 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(4):975–980

    Article  Google Scholar 

  14. Hoshino Y, Araujo P, Irrgang JJ, Fu FH, Musahl V (2012) An image analysis method to quantify the lateral pivot shift test. Knee Surg Sports Traumatol Arthrosc 20(4):703–707

    Article  Google Scholar 

  15. Hoshino Y, Kuroda R, Nagamune K, Yagi M, Mizuno K, Yamaguchi M, Muratsu H, Yoshiya S, Kurosaka M (2007) In vivo measurement of the pivot-shift test in the anterior cruciate ligament-deficient knee using an electromagnetic device. Am J Sports Med 35(7):1098–1104

    Article  Google Scholar 

  16. Jakob RP, Hassler H, Staeubli H-U (1981) Observations on rotatory instability of the lateral compartment of the knee: experimental studies on the functional anatomy and the pathomechanism of the true and the reversed pivot shift sign. Acta Orthop Scand 52(sup191):1–34

    Article  Google Scholar 

  17. Lerat JL, Moyen B, Jenny JY, Perrier JP (1993) A comparison of pre-operative evaluation of anterior knee laxity by dynamic X-rays and by the arthrometer KT 1000. Knee Surg Sports Traumatol Arthrosc 1(1):54–59

    Article  CAS  Google Scholar 

  18. Lipps DB, Oh YK, Ashton-Miller JA, Wojtys EM (2012) Morphologic characteristics help explain the gender difference in peak anterior cruciate ligament strain during a simulated pivot landing. Am J Sports Med 40(1):32–40

    Article  Google Scholar 

  19. Lopomo N, Zaffagnini S, Signorelli C, Bignozzi S, Giordano G, Marcheggiani Muccioli GM, Visani A (2012) An original clinical methodology for non-invasive assessment of pivot-shift test. Comput Methods Biomech Biomed Engin 15(12):1323–1328

    Article  Google Scholar 

  20. Lucie RS, Wiedel JD, Messner DG (1984) The acute pivot shift: clinical correlation. Am J Sports Med 12(3):189–191

    Article  CAS  Google Scholar 

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

    Article  CAS  Google Scholar 

  22. McDonald LS, Boorman-Padgett J, Kent R, Stone K, Wickiewicz TL, Pearle AD, Imhauser CW (2016) ACL deficiency increases forces on the medial femoral condyle and the lateral meniscus with applied rotatory loads. J Bone Joint Surg Am 98(20):1713–1721

    Article  Google Scholar 

  23. McLean SG, Oh YK, Palmer ML, Lucey SM, Lucarelli DG, Ashton-Miller JA, Wojtys EM (2011) The relationship between anterior tibial acceleration, tibial slope, and ACL strain during a simulated jump landing task. J Bone Joint Surg Am 93(14):1310–1317

    Article  Google Scholar 

  24. Muellner T, Bugge W, Johansen S, Holtan C, Engebretsen L (2001) Inter- and intratester comparison of the Rolimeter knee tester: effect of tester’s experience and the examination technique. Knee Surg Sports Traumatol Arthrosc 9(5):302–306

    Article  CAS  Google Scholar 

  25. Muller B, Hofbauer M, Rahnemai-Azar AA, Wolf M, Araki D, Hoshino Y, Araujo P, Debski RE, Irrgang JJ, Fu FH, Musahl V (2016) Development of computer tablet software for clinical quantification of lateral knee compartment translation during the pivot shift test. Comput Methods Biomech Biomed Engin 19(2):217–228

    Article  Google Scholar 

  26. Musahl V, Griffith C, Irrgang JJ, Hoshino Y, Kuroda R, Lopomo N, Zaffagnini S, Samuelsson K, Karlsson J, Group PS (2016) Validation of quantitative measures of rotatory knee laxity. Am J Sports Med 44(9):2393–2398

    Article  Google Scholar 

  27. Musahl V, Rahnemai-Azar AA, Costello J, Arner JW, Fu FH, Hoshino Y, Lopomo N, Samuelsson K, Irrgang JJ (2016) The influence of meniscal and anterolateral capsular injury on knee laxity in patients with anterior cruciate ligament injuries. Am J Sports Med 44(12):3126–3131

    Article  Google Scholar 

  28. 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  CAS  Google Scholar 

  29. Paine R, Lowe W (2012) Comparison of Kneelax and KT-1000 knee ligament arthrometers. J Knee Surg 25(2):151–154

    Article  Google Scholar 

  30. Pfeiffer TR, Kanakamedala AC, Herbst E, Nagai K, Murphy C, Burnham JM, Popchak A, Debski RE, Musahl V (2017) Female sex is associated with greater rotatory knee laxity in collegiate athletes. Knee Surg Sports Traumatol Arthrosc 26(5):1319–1325

    Article  Google Scholar 

  31. Prodromos CC, Han Y, Rogowski J, Joyce B, Shi K (2007) A meta-analysis of the incidence of anterior cruciate ligament tears as a function of gender, sport, and a knee injury-reduction regimen. Arthroscopy 23(12):1320–1325 (e1326)

    Article  Google Scholar 

  32. Rahnemai-Azar AA, Abebe ES, Johnson P, Labrum J, Fu FH, Irrgang JJ, Samuelsson K, Musahl V (2016) Increased lateral tibial slope predicts high-grade rotatory knee laxity pre-operatively in ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 25(4):1170–1176

    Article  Google Scholar 

  33. Tanaka M, Vyas D, Moloney G, Bedi A, Pearle AD, Musahl V (2012) What does it take to have a high-grade pivot shift? Knee Surg Sports Traumatol Arthrosc 20(4):737–742

    Article  CAS  Google Scholar 

  34. Vrooijink SH, Wolters F, Van Eck CF, Fu FH (2011) Measurements of knee morphometrics using MRI and arthroscopy: a comparative study between ACL-injured and non-injured subjects. Knee Surg Sports Traumatol Arthrosc 19(Suppl 1):S12-16

    Google Scholar 

  35. Wroble RR, Van Ginkel LA, Grood ES, Noyes FR, Shaffer BL (1990) Repeatability of the KT-1000 arthrometer in a normal population. Am J Sports Med 18(4):396–399

    Article  CAS  Google Scholar 

Download references

Acknowledgements

PIVOT study group authors: Andrew Sheean, Jeremy M Burnham, Jayson Lian, Clair Smith, Adam Popchak, Elmar Herbst, Thomas Pfeiffer, Paulo Araujo, Alicia Oostdyk, Daniel Guenther, Bruno Ohashi, James J Irrgang, Volker Musahl, Freddie H. Fu (Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA), Kouki Nagamune, Masahiro Kurosaka, Yuichi Hoshino, Ryosuke Kuroda (Department of Orthopaedic Surgery, Kobe University, Kobe, Japan), Alberto Grassi, Giulio Maria Marcheggiani Muccioli, Nicola Lopomo, Cecilia Signorelli, Federico Raggi, Stefano Zaffagnini (Instituto Ortopedico Rizzoli, Laboratorio di Biomeccanica eInnovazione Tecnologica, Bologna, Italy), Eleonor Svantesson, Eric Hamrin Senorski, David Sundemo, Haukur Bjoernsson, Mattias Ahlden, Neel Desai, Kristian Samuelsson, and Jon Karlsson (Department of Orthopaedics, Sahlgrenska University Hospital, Molndal, Sweden).

Funding

This study was funded by an ISAKOS/OREF research grant (research Grant no. 708661) and by Wallace Coulter Foundation contributions to the University of Pittsburgh Medical Center.

Author information

Authors and Affiliations

  1. UPMC Center for Sports Medicine, Department of Orthopaedic Surgery, University of Pittsburgh, 3200 S Water Street, Pittsburgh, PA, 15203, USA

    Volker Musahl, Jeremy Burnham, Jayson Lian, Adam Popchak, Andrew Sheean, Jeremy M. Burnham, Jayson Lian, Clair Smith, Adam Popchak, Elmar Herbst, Thomas Pfeiffer, Paulo Araujo, Alicia Oostdyk, Daniel Guenther, Bruno Ohashi, James J. Irrgang, Volker Musahl, Freddie H. Fu, Kouki Nagamune, Masahiro Kurosaka, Yuichi Hoshino, Ryosuke Kuroda, Alberto Grassi, Giulio Maria Marcheggiani Muccioli, Nicola Lopomo, Cecilia Signorelli, Federico Raggi, Stefano Zaffagnini, Eleonor Svantesson, Eric Hamrin Senorski, David Sundemo, Haukur Bjoernsson, Mattias Ahlden, Neel Desai, Kristian Samuelsson & Jon Karlsson

  2. Albert Einstein College of Medicine, Bronx, NY, 10461, USA

    Jayson Lian

  3. Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden

    Eleonor Svantesson & Kristian Samuelsson

  4. Department of Orthopedics, Sahlgrenska University Hospital, Mölndal, Sweden

    Eleonor Svantesson & Kristian Samuelsson

  5. Department of Orthopaedic Surgery, Kobe University, Kobe, Japan

    Ryosuke Kuroda

  6. Laboratorio di Biomeccanica e Innovazione Tecnologica, Istituto Ortopedico Rizzoli, Bologna, Italy

    Stefano Zaffagnini

Authors
  1. Volker Musahl
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jeremy Burnham
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jayson Lian
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Adam Popchak
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Eleonor Svantesson
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ryosuke Kuroda
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Stefano Zaffagnini
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Kristian Samuelsson
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

PIVOT Study Group

  • Andrew Sheean
  • , Jeremy M. Burnham
  • , Jayson Lian
  • , Clair Smith
  • , Adam Popchak
  • , Elmar Herbst
  • , Thomas Pfeiffer
  • , Paulo Araujo
  • , Alicia Oostdyk
  • , Daniel Guenther
  • , Bruno Ohashi
  • , James J. Irrgang
  • , Volker Musahl
  • , Freddie H. Fu
  • , Kouki Nagamune
  • , Masahiro Kurosaka
  • , Yuichi Hoshino
  • , Ryosuke Kuroda
  • , Alberto Grassi
  • , Giulio Maria Marcheggiani Muccioli
  • , Nicola Lopomo
  • , Cecilia Signorelli
  • , Federico Raggi
  • , Stefano Zaffagnini
  • , Eleonor Svantesson
  • , Eric Hamrin Senorski
  • , David Sundemo
  • , Haukur Bjoernsson
  • , Mattias Ahlden
  • , Neel Desai
  • , Kristian Samuelsson
  •  & Jon Karlsson

Corresponding author

Correspondence to Volker Musahl.

Ethics declarations

Conflict of interest

Volker Musahl declares that he is co-developer of the image analysis system. At the moment, the application is not on the market and not producing revenue.

Ethical approval

Institutional review board approval was obtained from all four participating centers (University of Pittsburgh, Instituto Orthopedico Rizzoloi, Sahlgrenska University Hospital, and Kobe University) including coordinating center approval at the University of Pittsburgh.

Additional information

The members of PIVOT Study Group are listed in “Acknowledgements”.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Musahl, V., Burnham, J., Lian, J. et al. High-grade rotatory knee laxity may be predictable in ACL injuries. Knee Surg Sports Traumatol Arthrosc 26, 3762–3769 (2018). https://doi.org/10.1007/s00167-018-5019-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-018-5019-y

Keywords

Search

Navigation