Measurements of Tibial Rotation During a Simulated Pivot Shift Manoeuvre Using a Gyroscopic Sensor

Overview

Journal Knee Surg Sports Traumatol Arthrosc

Publisher Wiley

Specialties Emergency Medicine
General Surgery
Orthopedics

Date 2014 May 13

PMID 24817161

Citations 4

Authors

Frank A Petrigliano

Per Henrik Borgstrom

William J Kaiser

David R McAllister

Keith L Markolf

Affiliations

Soon will be listed here.

Abstract

Purpose: The pivot shift has been correlated with patient-reported outcomes and knee function following ACL injury and reconstruction. Tibial rotation has been recognized as an important component to the pivot shift motion path. However, few methodologies exist to quantify tibial rotation in the clinical setting. The purpose of this study was to validate the use of a wireless gyroscopic sensor to measure axial rotation of the tibia during a manually simulated pivot shift manoeuvre in cadaveric specimens. We hypothesized that integrated gyroscopic measurements of tibial rotation velocity (tibial rotation) would be highly correlated with tibial rotations simultaneously recorded with a rotary potentiometer during a simulated pivot shift motion under intact and ACL-deficient conditions.

Methods: Gyroscopic measurements of rotational velocity were integrated and calibrated to a known arc of rotation. The gyroscope was mounted on the distal tibia with its axis aligned to the tibial shaft. Ten simulations of a pivot shift motion pathway were performed on nine cadaveric knees under intact and ACL-deficient conditions. Logistic regression was used to compare gyroscopic and potentiometer measurements of tibial rotation for both test conditions.

Results: Gyroscopic measurements of maximum external tibial rotation during the simulated pivot shift motion pathway were strongly correlated with potentiometer measurements of external tibial rotation in both the intact and ACL-deficient states (R (2) = 0.984).

Conclusion: The gyroscope evaluated in this cadaveric study was capable of accurately recording tibial rotation during a simulated pivot shift motion pathway.

Citing Articles

Measures of knee internal and external rotation made with a digital inclinometer are consistent with the measures made with an electromagnetic tracking system.

Timmons M, Copley H, Darnell D, Jude S, McIlvain G J Exp Orthop. 2025; 12(1):e70209.

PMID: 40070595 PMC: 11894440. DOI: 10.1002/jeo2.70209.

Factors Associated With Residual Pivot Shift After ACL Reconstruction: A Quantitative Evaluation of the Pivot-Shift Test Preoperatively and at Minimum 12-Month Follow-up.

Kawanishi Y, Kobayashi M, Yasuma S, Fukushima H, Kato J, Murase A Orthop J Sports Med. 2024; 12(2):23259671241230967.

PMID: 38414663 PMC: 10898316. DOI: 10.1177/23259671241230967.

Anterolateral ligament reconstruction in addition to primary double-bundle anterior cruciate ligament reconstruction for grade 3 pivot shift improves residual knee instability during surgery.

Kawanishi Y, Kobayashi M, Yasuma S, Fukushima H, Kato J, Murase A J Exp Orthop. 2021; 8(1):51.

PMID: 34278532 PMC: 8286908. DOI: 10.1186/s40634-021-00369-4.

The influence of applied internal and external rotation on the pivot shift phenomenon.

Kopf S, Musahl V, Perka C, Kauert R, Hoburg A, Becker R Knee Surg Sports Traumatol Arthrosc. 2017; 25(4):1106-1110.

PMID: 28194500 DOI: 10.1007/s00167-017-4429-6.

Assessment of the pivot shift using inertial sensors.

Zaffagnini S, Signorelli C, Grassi A, Yue H, Raggi F, Urrizola F Curr Rev Musculoskelet Med. 2016; 9(2):160-3.

PMID: 26970757 PMC: 4896876. DOI: 10.1007/s12178-016-9333-z.

References

Colombet P, Robinson J, Christel P, Franceschi J, Djian P . Using navigation to measure rotation kinematics during ACL reconstruction. Clin Orthop Relat Res. 2006; 454:59-65. DOI: 10.1097/BLO.0b013e31802baf56. View

Jonsson H, Riklund-Ahlstrom K, Lind J . Positive pivot shift after ACL reconstruction predicts later osteoarthrosis: 63 patients followed 5-9 years after surgery. Acta Orthop Scand. 2004; 75(5):594-9. DOI: 10.1080/00016470410001484. View

Lane C, Warren R, Stanford F, Kendoff D, Pearle A . In vivo analysis of the pivot shift phenomenon during computer navigated ACL reconstruction. Knee Surg Sports Traumatol Arthrosc. 2008; 16(5):487-92. DOI: 10.1007/s00167-008-0504-3. View

Lopomo N, Zaffagnini S, Bignozzi S, Visani A, Marcacci M . Pivot-shift test: analysis and quantification of knee laxity parameters using a navigation system. J Orthop Res. 2009; 28(2):164-9. DOI: 10.1002/jor.20966. View

Colombet P, Jenny J, Menetrey J, Plaweski S, Zaffagnini S . Current concept in rotational laxity control and evaluation in ACL reconstruction. Orthop Traumatol Surg Res. 2012; 98(8 Suppl):S201-10. DOI: 10.1016/j.otsr.2012.10.005. View

Citak M, OLoughlin P, Citak M, Suero E, Bosscher M, Musahl V . Influence of the valgus force during knee flexion in neutral rotation. Knee Surg Sports Traumatol Arthrosc. 2011; 20(8):1571-4. DOI: 10.1007/s00167-011-1767-7. View

Araujo P, Ahlden M, Hoshino Y, Muller B, Moloney G, Fu F . Comparison of three non-invasive quantitative measurement systems for the pivot shift test. Knee Surg Sports Traumatol Arthrosc. 2012; 20(4):692-7. DOI: 10.1007/s00167-011-1862-9. View

Ahlden M, Hoshino Y, Samuelsson K, Araujo P, Musahl V, Karlsson J . Dynamic knee laxity measurement devices. Knee Surg Sports Traumatol Arthrosc. 2012; 20(4):621-32. DOI: 10.1007/s00167-011-1848-7. View

Markolf K, Gorek J, Kabo J, Shapiro M . Direct measurement of resultant forces in the anterior cruciate ligament. An in vitro study performed with a new experimental technique. J Bone Joint Surg Am. 1990; 72(4):557-67. View

10.

Musahl V, Hoshino Y, Becker R, Karlsson J . Rotatory knee laxity and the pivot shift. Knee Surg Sports Traumatol Arthrosc. 2011; 20(4):601-2. DOI: 10.1007/s00167-011-1844-y. View

11.

Lorbach O, Wilmes P, Theisen D, Brockmeyer M, Maas S, Kohn D . Reliability testing of a new device to measure tibial rotation. Knee Surg Sports Traumatol Arthrosc. 2009; 17(8):920-6. DOI: 10.1007/s00167-009-0772-6. View

12.

Musahl V, Hoshino Y, Ahlden M, Araujo P, Irrgang J, Zaffagnini S . The pivot shift: a global user guide. Knee Surg Sports Traumatol Arthrosc. 2012; 20(4):724-31. DOI: 10.1007/s00167-011-1859-4. View

13.

Musahl V, Kopf S, Rabuck S, Becker R, van der Merwe W, Zaffagnini S . Rotatory knee laxity tests and the pivot shift as tools for ACL treatment algorithm. Knee Surg Sports Traumatol Arthrosc. 2011; 20(4):793-800. DOI: 10.1007/s00167-011-1857-6. View

14.

Kocher M, Steadman J, Briggs K, Sterett W, Hawkins R . Relationships between objective assessment of ligament stability and subjective assessment of symptoms and function after anterior cruciate ligament reconstruction. Am J Sports Med. 2004; 32(3):629-34. DOI: 10.1177/0363546503261722. View

15.

Markolf K, Jackson S, McAllister D . Force measurements in the medial meniscus posterior horn attachment: effects of anterior cruciate ligament removal. Am J Sports Med. 2011; 40(2):332-8. DOI: 10.1177/0363546511426100. View

16.

Pearle A, Solomon D, Wanich T, Moreau-Gaudry A, Granchi C, Wickiewicz T . Reliability of navigated knee stability examination: a cadaveric evaluation. Am J Sports Med. 2007; 35(8):1315-20. DOI: 10.1177/0363546507300821. View

17.

Lorbach O, Brockmeyer M, Kieb M, Zerbe T, Pape D, Seil R . Objective measurement devices to assess static rotational knee laxity: focus on the Rotameter. Knee Surg Sports Traumatol Arthrosc. 2012; 20(4):639-44. DOI: 10.1007/s00167-011-1876-3. View

18.

Petrigliano F, Lane C, Suero E, Allen A, Pearle A . Posterior cruciate ligament and posterolateral corner deficiency results in a reverse pivot shift. Clin Orthop Relat Res. 2011; 470(3):815-23. PMC: 3270184. DOI: 10.1007/s11999-011-2045-1. View

19.

Markolf K, Jackson S, McAllister D . Relationship between the pivot shift and Lachman tests: a cadaver study. J Bone Joint Surg Am. 2010; 92(11):2067-75. DOI: 10.2106/JBJS.I.00862. View

20.

Kopf S, Kauert R, Halfpaap J, Jung T, Becker R . A new quantitative method for pivot shift grading. Knee Surg Sports Traumatol Arthrosc. 2012; 20(4):718-23. DOI: 10.1007/s00167-012-1903-z. View