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Posterior Cruciate Ligament and Posterolateral Corner Deficiency Results in a Reverse Pivot Shift

  • Symposium: Complex Knee Ligament Surgery
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

As measured via static stability tests, the PCL is the dominant restraint to posterior tibial translation while the posterolateral corner is the dominant restraint to external tibial rotation. However, these uniplanar static tests may not predict multiplanar instability. The reverse pivot shift is a dynamic examination maneuver that may identify complex knee instability.

Questions/purposes

In this cadaver study, we asked whether (1) isolated sectioning or (2) combined sectioning of the PCL and posterolateral corner increased the magnitude of the reverse pivot shift and (3) the magnitude of the reverse pivot shift correlated with static external rotation or posterior drawer testing.

Methods

In Group I, we sectioned the PCL followed by structures of the posterolateral corner. In Group II, we sectioned the posterolateral corner structures before sectioning the PCL. We performed posterior drawer, external rotation tests, and mechanized reverse pivot shift for each specimen under each condition and measured translations via navigation.

Results

Isolated sectioning of the PCL or posterolateral corner had no effect on the reverse pivot shift. Conversely, combined sectioning of the PCL and posterolateral corner structures increased the magnitude of the reverse pivot shift. The magnitude of the reverse pivot shift correlated with the posterior drawer and external rotation tests.

Conclusions

Combined sectioning of the PCL and posterolateral corner was required to cause an increase in the magnitude of the mechanized reverse pivot shift. The reverse pivot shift correlated with both static measures of stability.

Clinical Relevance

Combined injury to the PCL and posterolateral corner should be considered in the presence of a positive reverse pivot shift.

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Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, David Geffen School of Medicine, University of California Los Angeles, 10945 Le Conte Avenue, PVUB #33-55 H, Los Angeles, CA, 90095, USA

    Frank A. Petrigliano MD

  2. Alabama Orthopaedic Clinic, Mobile, AL, USA

    Clayton G. Lane MD

  3. Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA

    Eduardo M. Suero MD, Answorth A. Allen MD & Andrew D. Pearle MD

Authors
  1. Frank A. Petrigliano MD
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  2. Clayton G. Lane MD
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  3. Eduardo M. Suero MD
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  4. Answorth A. Allen MD
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  5. Andrew D. Pearle MD
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Corresponding author

Correspondence to Frank A. Petrigliano MD.

Additional information

Dr. Pearle received research funding from the Hospital for Special Surgery Institute for Sports Medicine Research. Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Each author certifies that his or her institution approved or waived approval for the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.

The investigation was performed in the Computer Assisted Surgery Laboratory at Hospital for Special Surgery.

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Petrigliano, F.A., Lane, C.G., Suero, E.M. et al. Posterior Cruciate Ligament and Posterolateral Corner Deficiency Results in a Reverse Pivot Shift. Clin Orthop Relat Res 470, 815–823 (2012). https://doi.org/10.1007/s11999-011-2045-1

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  • DOI: https://doi.org/10.1007/s11999-011-2045-1

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