What Does It Take to Have a High-grade Pivot Shift?

Overview

Journal Knee Surg Sports Traumatol Arthrosc

Publisher Wiley

Specialties Emergency Medicine
General Surgery
Orthopedics

Date 2012 Jan 7

PMID 22222616

Citations 51

Authors

M Tanaka

D Vyas

G Moloney

A Bedi

A D Pearle

V Musahl

Affiliations

Soon will be listed here.

Abstract

Unlabelled: The pivot shift is the most specific clinical test to assess pathological knee joint rotatory laxity following ACL injury. This article attempts to describe the anatomic structures responsible for creating a high-grade pivot shift and their potential role in customizing ACL reconstruction. A review of the literature demonstrates that disruption of the secondary stabilizers of anterior translation of the lateral compartment including the lateral meniscus, anterolateral capsule, and IT band contributes to a high-grade pivot shift in the ACL-deficient knee. The morphology of the lateral tibial plateau, including increased posteroinferior tibial slope and small size, can also contribute to high-grade pivot shift. Factors that may decrease the grade of the pivot shift include medial compartment injury, MCL injury, patient guarding, and osteoarthritis. In conclusion, a high-grade pivot shift in the ACL-deficient knee is often associated with incompetence of the lateral soft tissue envelope. Rotatory laxity as assessed by the pivot shift may also be falsely underestimated by concomitant injuries.

Level Of Evidence: IV.

Citing Articles

Effect of Graft Choice for ACL Reconstruction on Clinical Outcomes in Combined ACL and MCL Injuries: Comparison Between Bone-Patellar Tendon-Bone and Hamstring Autografts.

Chung K, Ham H, Kim S, Seo Y J Clin Med. 2024; 13(21).

PMID: 39518456 PMC: 11546250. DOI: 10.3390/jcm13216316.

Injuries to both anterolateral ligament and Kaplan fiber of the iliotibial band do not increase preoperative pivot-shift phenomenon in ACL injury.

Tokura T, Nagai K, Hoshino Y, Watanabe S, Kanzaki N, Nishida K Asia Pac J Sports Med Arthrosc Rehabil Technol. 2024; 36:40-44.

PMID: 38595931 PMC: 11001600. DOI: 10.1016/j.asmart.2024.03.004.

Greater Knee Rotatory Instability After Posterior Meniscocapsular Injury Versus Anterolateral Ligament Injury: A Proposed Mechanism of High-Grade Pivot Shift.

Kim Y, Koo S, Kim J, Tae J, Wang J, Ahn J Orthop J Sports Med. 2023; 11(9):23259671231188712.

PMID: 37693803 PMC: 10486219. DOI: 10.1177/23259671231188712.

ANTEROMEDIAL OR CENTRAL ANATOMIC ACL RECONSTRUCTION? A CADAVERIC HIP-TO-TOE STUDY.

Fernandes T, Souza M, Albuquerque C, Araujo P, Pedrinelli A, Hernandez A Acta Ortop Bras. 2023; 31(4):e268195.

PMID: 37547231 PMC: 10400003. DOI: 10.1590/1413-785220233104e268195.

Anatomical and Biomechanical Characteristics of the Anterolateral Ligament: A Descriptive Korean Cadaveric Study Using a Triaxial Accelerometer.

Suh D, Cho I, Noh S, Yoon D, Jang K Medicina (Kaunas). 2023; 59(2).

PMID: 36837620 PMC: 9964873. DOI: 10.3390/medicina59020419.

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