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High-grade pivot-shift phenomenon after anterior cruciate ligament injury is associated with asymmetry of lateral and medial compartment anterior tibial translation and lateral meniscus posterior horn tears

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

To investigate whether the high-grade pivot-shift phenomenon is associated with asymmetry of the lateral and medial compartment anterior tibial translation (L-ATT and M-ATT) and lateral meniscus posterior horn (LMPH) tears in anterior cruciate ligament (ACL) injuries.

Methods

A retrospective analysis was performed on 192 consecutive patients who had complete ACL injuries between January 2019 and December 2020. Among these, 156 met the inclusion criteria. L-ATT and M-ATT were measured using preoperative weight-bearing magnetic resonance imaging (MRI), and the differences between L-ATT and M-ATT were calculated. Thirty-five patients who demonstrated excessive differences in L-ATT and M-ATT (> 6.0 mm) were regarded as asymmetric (study group), and 36 patients with minimal or no differences in L-ATT and M-ATT (< 3.0 mm) were allocated to the control group. Demographic data, grade of the pivot-shift test, integrality of LMPH, and medial meniscus posterior horn (MMPH) were compared between the groups. Moreover, predictors of high-grade pivot-shift phenomenon, including asymmetry of L-ATT and M-ATT, integrity of LMPH and MMPH, time from injury to surgery, sex, age, and body mass index (BMI) were assessed using multivariable logistic regression analysis.

Results

The difference between L-ATT and M-ATT in the study group was significantly higher than that in the control group (mean ± SD: 8.4 ± 2.1 mm vs. 1.5 ± 1.0 mm, P < 0.001). A higher proportion of patients with high-grade pivot-shift phenomenon (2 + and 3 +) and LMPH tears were identified in the study group (high-grade pivot-shift phenomenon: 25/35 vs. 13/36, P = 0.003; LMPH tears: 18/35 vs. 5/36, P = 0.001). Additionally, asymmetry of L-ATT, M-ATT (odds ratio 5.8; 95% CI 1.7–19.8; P = 0.005), and LMPH tears (odds ratio 3.8; 95% CI 1.3–11.6; P = 0.018) were found to be good predictors of the high-grade pivot-shift phenomenon after ACL injury, whereas MMPH tears, time from injury to surgery, sex, age, and BMI were not.

Conclusion

In patients with ACL injury, the high-grade pivot-shift phenomenon is associated with asymmetry between L-ATT and M-ATT, and LMPH tears.

Level of evidence

III.

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Availability of data and material

The datasets used or analyzed during the current study are available from the corresponding author on reasonable request.

Code availability

Yes.

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Funding

This study was funded by the National Natural Science Foundation of China (82172514), The Programs for Science and Technology Development of Henan Province (212102310173), and the Zhengzhou Key Laboratory of Sports Trauma(No Code).

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Authors and Affiliations

  1. Sports Medicine Department, Zhengzhou Orthopedics Hospital, No.58, Long Hai Middle Road, Er Qi District, Zhengzhou, Henan Province, China

    Qian-Kun Ni, Xu-Peng Wang, Qi Guo, Ming Li & Ning Liu

  2. Sports Medicine Department, Beijing Jishuitan Hospital, No. 31, Xin Jie Kou East Street, Xi Cheng District, Beijing, China

    Hui Zhang

Authors
  1. Qian-Kun Ni
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  2. Xu-Peng Wang
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  3. Qi Guo
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  4. Ming Li
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Contributions

QN participated in study design, data collection, radiological measurements and drafted the manuscript. XW carried out the radiological measurements. QG participated in the data collection and statistical analysis. ML participated in data collection. NL and HZ conceived of the study, and participated in its design and helped to draft and revise the manuscript. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Ning Liu or Hui Zhang.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethics approval

All procedures performed in this retrospective study were in accordance with the ethical standards of the Beijing Jishuitan hospital, and this study was performed after obtaining approval from our institutional review board (IRB, No. 20190103).

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All patients provided informed consent before participating in this study.

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All patients provided informed consent for publication.

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Ni, QK., Wang, XP., Guo, Q. et al. High-grade pivot-shift phenomenon after anterior cruciate ligament injury is associated with asymmetry of lateral and medial compartment anterior tibial translation and lateral meniscus posterior horn tears. Knee Surg Sports Traumatol Arthrosc 30, 3700–3707 (2022). https://doi.org/10.1007/s00167-022-06972-x

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  • DOI: https://doi.org/10.1007/s00167-022-06972-x

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