PURPOSE Although several factors have been considered to be associated with pivot shift test grade in ACL injured patients, a conclusion regarding which factors contribute to the pivot shift test grade has not been reached. The purpose of this study was to identify factors associated with preoperative pivot shift test grade. METHODS Three hundred and sixty-six consecutive patients who underwent ACL reconstruction in our hospital were enrolled in the study. Patients were divided into two groups on the basis of preoperative pivot shift test grade (Mild: grade 0-3, Severe: grade 4-6). First, 13 independent variables (age, gender, period from injury to surgery, hyperextension, KT measurement, contralateral side pivot shift test grade, medial and lateral tibial slope, lateral condyle length, lateral condyle height, distal femoral condyle offset, medial and lateral meniscus tear) were analyzed by one-way ANOVA and Chi-squared test. Binary Logistic regression was then performed based on the results of univariate analyses (independent variables of p < 0.2 were included). RESULTS Hyperextension, lateral meniscus tear, contralateral side pivot shift test grade, distal femoral condyle offset and KT measurement were identified as risk factors for preoperative pivot shift grade via logistic regression analysis. CONCLUSION The current study revealed that hyperextension, lateral meniscus tear, contralateral side pivot shift test grade, distal femoral condyle offset and anterior instability were associated with preoperative pivot shift grade. Patients with above factors that cannot be modified during surgery may need special consideration when ACL reconstruction is performed, as greater preoperative pivot shift has been proven to be a risk factor for residual pivot shift after ACL reconstruction. LEVEL OF EVIDENCE III.

中文翻译：

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膝关节松弛，半月板外侧撕裂和股骨远端形态影响ACL损伤患者的枢轴位移测试等级。

目的尽管已考虑到ACL受伤患者的枢轴移位测试等级与几个因素有关，但尚未得出关于哪些因素会导致枢轴移位测试等级的结论。这项研究的目的是确定与术前枢轴位移测试等级相关的因素。方法对我院收治的366例连续ACL重建患者进行研究。根据术前枢轴移位测试等级（轻度：0-3级，严重：4-6级）将患者分为两组。首先，有13个独立变量（年龄，性别，从受伤到手术的时间段，过度伸展，KT测量，对侧侧枢轴移位测试等级，胫骨内侧和外侧倾斜度，外侧con长度，外侧con高度，股骨远端distal偏移，通过单向方差分析和卡方检验分析内侧和外侧半月板撕裂。然后根据单变量分析的结果进行二元Logistic回归（包括p <0.2的独立变量）。结果通过逻辑回归分析，过度伸展，半月板撕裂，对侧侧枢轴移位测试等级，远端股骨con偏移和KT测量被确定为术前枢轴移位等级的危险因素。结论当前的研究表明，过度伸展，半月板外侧撕裂，对侧侧枢轴移位试验等级，股骨远端con突偏移和前部不稳定性与术前枢轴移位等级有关。具有上述因素且在手术期间无法改变的患者在进行ACL重建时可能需要特别考虑，由于术前更大的枢轴移位已被证明是ACL重建后残余枢轴移位的危险因素。证据级别III。