Posterior Tibial Plateau Impaction Fractures Are Not Associated with Increased Knee Instability: a Quantitative Pivot Shift Analysis

Overview

Journal Knee Surg Sports Traumatol Arthrosc

Publisher Wiley

Specialties Emergency Medicine
General Surgery
Orthopedics

Date 2023 Jan 12

PMID 36633602

Authors

Brian M Godshaw

Jonathan D Hughes

Gian Andrea Lucidi

Joshua Setliff

Mikael Sansone

Jon Karlsson

Volker Musahl

Affiliations

Soon will be listed here.

Abstract

Purpose: This study aimed to evaluate posterolateral tibial plateau impaction fractures and how they contribute to rotatory knee laxity using quantitative pivot shift analysis. It was hypothesised that neither the presence of nor the degree of involvement of the plateau would affect rotatory knee laxity in the ACL-deficient knee.

Methods: A retrospective review of prospectively collected data on 284 patients with complete anterior cruciate ligament (ACL) injuries was conducted. Posterolateral tibial plateau impaction fractures were identified on preoperative MRI. The patients were divided into two cohorts: "fractures" or "no fractures". The cohort with fractures was further categorised based on fracture morphology: "extra-articular", "articular-impaction", or "displaced-articular fragment". All data were collected during examination under anaesthesia performed immediately prior to ACL reconstruction. This included a standard pivot shift test graded by the examiner and quantitative data including anterior tibial translation (mm) via Rolimeter, quantitative pivot shift (QPS) examination (mm) via PIVOT tablet technology, and acceleration (m/sec) during the pivot shift test via accelerometer. Quantitative examinations were compared with the contralateral knee.

Results: There were 112 patients with posterolateral tibial plateau impaction fractures (112/284, 39%). Of these, 71/112 (63%) were "extra-articular", 28/112 (25%) "articular-impaction", and 13/112 (12%) "displaced-articular". Regarding the two groups with or without fractures, there was no difference in subjective pivot shift (2 ± 0 vs 2 ± 0, respectively, n.s.), QPS (2.4 ± 1.6 mm vs 2.7 ± 2.2 mm, respectively, n.s.), anterior tibial translation measurements (6 ± 3 mm vs 5 ± 3 mm, respectively, n.s.), or acceleration of the knee during the pivot (1.7 ± 2.3 m/s vs 1.8 ± 3.1 m/s, respectively, n.s.). When the fractures were further subdivided, subgroup analysis revealed no significant differences noted in any of the measured examinations between the fracture subtypes.

Conclusion: This study showed that the posterolateral tibial plateau impaction fractures are commonly encountered in the setting of ACL tears; however, contrary to previous reports, they do not significantly increase rotatory knee laxity. This suggests that this type of concomitant injury may not need to be addressed at the time of ACL reconstruction.

Level Of Evidence: Level III.

Citing Articles

Intra- and interobserver reliability of two classification systems for posterolateral tibial plateau fractures in the setting of an ACL rupture.

Moreels R, Vervaecke A, Van Haver A, Heylen S J Orthop. 2024; 51:21-26.

PMID: 38299067 PMC: 10825913. DOI: 10.1016/j.jor.2024.01.003.

Letter to the editor of: "posterior tibial plateau impaction fractures are not associated with increased knee instability: a quantitative pivot shift analysis".

Krause M, Korthaus A, Frings J, Berninger M, Drenck T, Eggeling L Knee Surg Sports Traumatol Arthrosc. 2023; 31(8):3572-3575.

PMID: 36947235 PMC: 10356670. DOI: 10.1007/s00167-023-07361-8.

References

Arilla F, Rahnemai-Azar A, Yacuzzi C, Guenther D, Engel B, Fu F . Correlation between a 2D simple image analysis method and 3D bony motion during the pivot shift test. Knee. 2016; 23(6):1059-1063. DOI: 10.1016/j.knee.2016.06.003. View

Balasch H, Schiller M, FRIEBEL H, Hoffmann F . Evaluation of anterior knee joint instability with the Rolimeter. A test in comparison with manual assessment and measuring with the KT-1000 arthrometer. Knee Surg Sports Traumatol Arthrosc. 1999; 7(4):204-8. DOI: 10.1007/s001670050149. View

Bernholt D, DePhillipo N, Jeffrey Grantham W, Crawford M, Aman Z, Kennedy M . Morphologic Variants of Posterolateral Tibial Plateau Impaction Fractures in the Setting of Primary Anterior Cruciate Ligament Tear. Am J Sports Med. 2020; 48(2):318-325. DOI: 10.1177/0363546519893709. View

Bernholt D, Dornan G, DePhillipo N, Aman Z, Kennedy M, LaPrade R . High-Grade Posterolateral Tibial Plateau Impaction Fractures in the Setting of a Primary Anterior Cruciate Ligament Tear Are Correlated With an Increased Preoperative Pivot Shift and Inferior Postoperative Outcomes After Anterior Cruciate Ligament.... Am J Sports Med. 2020; 48(9):2185-2194. DOI: 10.1177/0363546520932912. View

Bojicic K, Beaulieu M, Imaizumi Krieger D, Ashton-Miller J, Wojtys E . Association Between Lateral Posterior Tibial Slope, Body Mass Index, and ACL Injury Risk. Orthop J Sports Med. 2017; 5(2):2325967116688664. PMC: 5315236. DOI: 10.1177/2325967116688664. View

Cui W, Nakagawa Y, Katagiri H, Otabe K, Ohara T, Shioda M . Knee laxity, lateral meniscus tear and distal femur morphology influence pivot shift test grade in ACL injury patients. Knee Surg Sports Traumatol Arthrosc. 2020; 29(2):633-640. DOI: 10.1007/s00167-020-05994-7. View

Getgood A, Bryant D, Litchfield R, Heard M, McCormack R, Rezansoff A . Lateral Extra-articular Tenodesis Reduces Failure of Hamstring Tendon Autograft Anterior Cruciate Ligament Reconstruction: 2-Year Outcomes From the STABILITY Study Randomized Clinical Trial. Am J Sports Med. 2020; 48(2):285-297. DOI: 10.1177/0363546519896333. View

Hoshino Y, Araujo P, Ahlden M, Moore C, Kuroda R, Zaffagnini S . Standardized pivot shift test improves measurement accuracy. Knee Surg Sports Traumatol Arthrosc. 2011; 20(4):732-6. DOI: 10.1007/s00167-011-1850-0. View

Hoshino Y, Araujo P, Ahlden M, Samuelsson K, Muller B, Hofbauer M . Quantitative evaluation of the pivot shift by image analysis using the iPad. Knee Surg Sports Traumatol Arthrosc. 2013; 21(4):975-80. DOI: 10.1007/s00167-013-2396-0. View

10.

Hoshino Y, Hiroshima Y, Miyaji N, Nagai K, Araki D, Kanzaki N . Unrepaired lateral meniscus tears lead to remaining pivot-shift in ACL-reconstructed knees. Knee Surg Sports Traumatol Arthrosc. 2020; 28(11):3504-3510. DOI: 10.1007/s00167-020-06007-3. View

11.

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

12.

Kanakamedala A, Burnham J, Pfeiffer T, Herbst E, Kowalczuk M, Popchak A . Lateral femoral notch depth is not associated with increased rotatory instability in ACL-injured knees: a quantitative pivot shift analysis. Knee Surg Sports Traumatol Arthrosc. 2017; 26(5):1399-1405. DOI: 10.1007/s00167-017-4770-9. View

13.

Kaplan N, Wickiewicz T, Warren R . Primary surgical treatment of anterior cruciate ligament ruptures. A long-term follow-up study. Am J Sports Med. 1990; 18(4):354-8. DOI: 10.1177/036354659001800404. View

14.

Kaplan P, Walker C, Kilcoyne R, Brown D, Tusek D, Dussault R . Occult fracture patterns of the knee associated with anterior cruciate ligament tears: assessment with MR imaging. Radiology. 1992; 183(3):835-8. DOI: 10.1148/radiology.183.3.1584943. View

15.

Katakura M, Nakamura K, Watanabe T, Horie M, Nakamura T, Katagiri H . Risk factors for residual anterolateral rotational instability after double bundle anterior cruciate ligament reconstruction: Evaluation by quantitative assessment of the pivot shift phenomenon using triaxial accelerometer. Knee. 2019; 27(1):95-101. DOI: 10.1016/j.knee.2019.09.016. View

16.

Leitze Z, Losee R, Jokl P, Johnson T, Feagin J . Implications of the pivot shift in the ACL-deficient knee. Clin Orthop Relat Res. 2005; (436):229-36. DOI: 10.1097/01.blo.0000160026.14363.22. View

17.

Li J, Hosseini A, Cancre L, Ryan N, Rubash H, Li G . Kinematic characteristics of the tibiofemoral joint during a step-up activity. Gait Posture. 2013; 38(4):712-6. PMC: 3722253. DOI: 10.1016/j.gaitpost.2013.03.004. View

18.

Lopomo N, Signorelli C, Bonanzinga T, Marcheggiani Muccioli G, Visani A, Zaffagnini S . Quantitative assessment of pivot-shift using inertial sensors. Knee Surg Sports Traumatol Arthrosc. 2012; 20(4):713-7. DOI: 10.1007/s00167-011-1865-6. View

19.

Lopomo N, Signorelli C, Rahnemai-Azar A, Raggi F, Hoshino Y, Samuelsson K . Analysis of the influence of anaesthesia on the clinical and quantitative assessment of the pivot shift: a multicenter international study. Knee Surg Sports Traumatol Arthrosc. 2016; 25(10):3004-3011. DOI: 10.1007/s00167-016-4130-1. View

20.

Lopomo N, Zaffagnini S, Signorelli C, Bignozzi S, Giordano G, Marcheggiani Muccioli G . An original clinical methodology for non-invasive assessment of pivot-shift test. Comput Methods Biomech Biomed Engin. 2011; 15(12):1323-8. DOI: 10.1080/10255842.2011.591788. View