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Knee laxity, lateral meniscus tear and distal femur morphology influence pivot shift test grade in ACL injury patients

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

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.

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Acknowledgements

WC thanks the supporting from Takeda Science Foundation for oversea study. The authors thank Hiroko Ueki MD, Kei Inomata MD, and Masayo Tsukamoto for their assistance in collecting data.

Funding

This study received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Department of Joint Surgery and Sports Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan

    Weiding Cui, Yusuke Nakagawa, Hiroki Katagiri, Takashi Hoshino, Aritoshi Yoshihara & Hideyuki Koga

  2. Department Orthopaedic Surgery, Tokyo Medical and Dental University Hospital of Medicine, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan

    Weiding Cui, Yusuke Nakagawa, Hiroki Katagiri, Koji Otabe, Toshiyuki Ohara, Mikio Shioda, Yuji Kohno, Takashi Hoshino, Ichiro Sekiya & Hideyuki Koga

  3. Department of Orthopaedics, The First Affiliated Hospital with Nanjing Medical University, No. 300, Guangzhou Road, Nanjing, 210029, China

    Weiding Cui

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  1. Weiding Cui
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Contributions

WC analyzed the data and drafted the manuscript. YN designed the initial plan, conducted the study and edited the manuscript. HKA, KO, TO, MS, YK, TH and IS collected the data. AY analyzed the data. HKO designed the initial plan, conducted the study and completed the final manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Hideyuki Koga.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This study was approved by the Institutional Review Board in Tokyo Medical and Dental University (research protocol identification number: 2000-1146).

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Cui, W., Nakagawa, Y., Katagiri, H. et al. Knee laxity, lateral meniscus tear and distal femur morphology influence pivot shift test grade in ACL injury patients. Knee Surg Sports Traumatol Arthrosc 29, 633–640 (2021). https://doi.org/10.1007/s00167-020-05994-7

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