2025 ISAKOS Congress in Munich, Germany

2025 ISAKOS Biennial Congress In-Person Poster

 

Factors Associated With Residual Pivot Shift Two Years After Anterior Cruciate Ligament Reconstruction: A Multicenter Study

Atsuo Nakamae, MD, PhD, Hiroshima JAPAN
Eisaku Fujimoto, MD, PhD, Kure, Hiroshima JAPAN
Ayato Miyamoto, MD, matsuyama, Ehime JAPAN
Tsuyoshi Takada, MD, PhD, Kure, Hiroshima JAPAN
Tomohiro Kato, MD, Hiroshima JAPAN
Akinori Nekomoto, MD、PhD, Hiroshima, Hiroshima Prefecture JAPAN
Nobuo Adachi, MD, PhD, Hiroshima JAPAN

Hiroshima University Hospital, Hiroshima, Hiroshima, JAPAN

FDA Status Not Applicable

Summary

Female sex, preoperative high-grade of the pivot shift test, and severe lateral meniscal damage which required the meniscal repair were associated with residual pivot shift two year after ACL reconstruction.

Abstract

Purpose

The purpose of this multicenter prospective cohort study was to evaluate the factors influencing residual pivot shift two years after anterior cruciate ligament (ACL) reconstruction.

Methods

This study included patients who underwent primary ACL reconstruction using autologous hamstring tendon graft with or without ACL remnant preserving technique at five institutions. Patients who underwent ACL reconstruction using a quadriceps autograft or bone-patellar tendon-bone autograft were excluded, as were patients who underwent additional lateral extra-articular tenodesis (LET) or anterolateral ligament (ALL) reconstruction. Multivariable logistic regression analysis was conducted to identify factors that influence the residual pivot shift two years after ACL reconstruction. Age, sex, preoperative grade of the pivot shift test, preoperative side-to-side difference of anterior knee laxity, lateral meniscus treatment methods (normal, partial meniscectomy, and meniscal repair), and ACL reconstruction procedures (single-bundle reconstruction, double-bundle reconstruction, remnant-preserving single-bundle reconstruction, and others) were selected as the independent variables in the multivariable model. In this study, a postoperative positive pivot-shift test (IKDC grading) was defined as grade 1 or higher. Grade 0 on the pivot-shift test was defined as negative.

Results

In total, 359 patients (164 males and 195 females; average age at surgery, 29.2 years; age range) were enrolled in this study. Postoperative side-to-side difference of anterior knee laxity was 0.9 ± 2.3 mm, and the positive postoperative pivot shift test was found in 57 patients (15.9%) two year after ACL reconstruction. The factors that significantly influenced the postoperative positive pivot shift test were female sex (odds ratio [OR], 2.2; P=0.022), preoperative high-grade of the pivot shift test (OR, 2.0; P=0.001), and lateral meniscal repair (OR, 2.5; P=0.024). Interestingly, the postoperative positive pivot shift test was observed more frequently in the patients with lateral meniscal repair than those with normal lateral meniscus.

Conclusions

Female sex, preoperative high-grade of the pivot shift test, and severe lateral meniscal damage which required the meniscal repair were associated with residual pivot shift two year after ACL reconstruction.