Affordable Access

Access to the full text

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

Authors
  • Kopf, Sebastian1
  • Musahl, Volker2
  • Perka, Carsten1
  • Kauert, Ralf3
  • Hoburg, Arnd1
  • Becker, Roland4
  • 1 Charité-University Medicine Berlin, Center for Musculoskeletal Surgery, Charitéplatz 1, Berlin, 10117, Germany , Berlin (Germany)
  • 2 University of Pittsburgh, Department of Orthopaedic Surgery, Pittsburgh, PA, USA , Pittsburgh (United States)
  • 3 Otto-von-Guericke-University, Institute of Micro and Sensor Systems, Magdeburg, Germany , Magdeburg (Germany)
  • 4 Medical School Theodor Fontane, Department of Orthopaedic and Traumatology, Brandenburg, Germany , Brandenburg (Germany)
Type
Published Article
Journal
Knee Surgery Sports Traumatology Arthroscopy
Publisher
Springer-Verlag
Publication Date
Feb 14, 2017
Volume
25
Issue
4
Pages
1106–1110
Identifiers
DOI: 10.1007/s00167-017-4429-6
Source
Springer Nature
Keywords
License
Yellow

Abstract

PurposeThe pivot shift test is performed in different techniques and the rotation of the tibia seems to have a significant impact on the amount of the pivot shift phenomenon. It has been hypothesised that external rotation will increase the phenomenon due to less tension at the iliotibial band in knee extension.MethodsTwenty-four patients with unilateral anterior cruciate ligament insufficiency were included prospectively. The pivot shift test was performed bilaterally in internal and external tibial rotation under general anaesthesia. Knee motion was captured using a femoral and a tibial inertial sensor. The difference between positive and negative peak values in Euclidean norm of acceleration was calculated to evaluate the amount of the pivot shift phenomenon.ResultsThe pivot shift phenomenon was significantly increased in patients with ACL insufficiency when the test was performed in external [mean 5.2 ms− 2 (95% CI 4.3–6.0)] compared to internal tibial rotation [mean 4.4 ms− 2 (95% CI 3.5–5.4)] (p = 0.002). In healthy, contralateral knees did not show any difference between external [mean 4.0 ms− 2 (95% CI 3.3–4.7)] and internal tibial rotation [mean 4.0 ms− 2 (95% CI 3.4–4.6)] (ns).ConclusionsThe pivot shift phenomenon was increased with external rotation in ACL-insufficient knees, and therefore, one should perform the pivot shift test, rather, in external rotation to easily evoke the, sometimes difficult to detect, pivot shift phenomenon.Level of evidenceI (diagnostic study).

Report this publication

Statistics

Seen <100 times