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Grade III Pivot Shift as an Early Sign of Knee Decompensation in Chronic ACL-Injured Knees with Bimeniscal Tears

2021 Congress Paper Abstracts

Grade III Pivot Shift as an Early Sign of Knee Decompensation in Chronic ACL-Injured Knees with Bimeniscal Tears

Amanda Magosch, Cand. med., LUXEMBOURG Christophe Jacquet , MD, LUXEMBOURG Christian Nührenbörger, MD, LUXEMBOURG Caroline Mouton, PhD, LUXEMBOURG Romain Seil, MD, Prof., LUXEMBOURG

Centre Hospitalier de Luxembourg, Clinique d'Eich, Luxembourg, LUXEMBOURG


2021 Congress   ePoster Presentation     Not yet rated

 

Anatomic Location

Anatomic Structure

Diagnosis / Condition

Diagnosis Method

Treatment / Technique

Ligaments

ACL

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Summary: A pre-operative high-grade pivot shift in anterior cruciate ligament deficient knees is associated with time from injury and the magnitude of injured soft-tissue structures, thereby suggesting a gradual decompensation of secondary restraints over time in chronic ACL-deficient knees.


Background

The pivot shift (PS) test is a clinical sign to assess the rotational instability occurring in Anterior Cruciate Ligament (ACL) injured patients. The exact origin and the evolution over time of a pre-operative high-grade PS is still controversial and incompletely understood. Recently, a multifactorial background involving different anatomical structures and more specifically the menisci has been discussed.

Purpose

The purpose of this study was to reveal associations between pre-operative PS test and patient and injury characteristics in a series of ACL injured knees. The hypothesis was that a pre-operative high-grade PS is associated with the magnitude of structural soft-tissue damage (type of ACL injury and number of injured menisci) and with the time between injury and surgery.

Methods

The study cohort involved 376 patients from a center-based registry receiving primary ACL reconstruction surgery (239 males/137 females; median age 26, IQR 19-34). All patients were clinically examined under anaesthesia before surgery by grading the PS test. During arthroscopy, the type of ACL tear (complete/partial) as well as the presence of associated meniscus lesions including ramp lesions were documented. Structural soft tissue damage in the injured knee was classified as follows: (1) partial ACL tear, (2) complete isolated ACL tear, (3) complete ACL tear with injury of one meniscus and (4) complete ACL tear with lesions of the 2 menisci. Cartilage damage and associated ligament injuries were not considered. Chi-square and Mann-Whitney-U tests were used to evaluate whether gender, age, body mass index, sport at injury, mechanism of injury, time between injury and surgery and structural damage were associated with a high-grade PS (grade III) when compared with low-grade PS (grade 0-II). Significance was set at p<0.05.

Results

A high-grade PS test was observed in 26% (n=98) of cases. A significant association with PS grading was shown for age (p<0.05) and time between injury and surgery (p<0.05). The degree of PS was also associated with the magnitude of structural soft-tissue damage (p=0.01). A high PS was observed in 9% of partial ACL tears, 25% of complete isolated ACL tears, 26% of complete ACL tears with injury of one meniscus and 36% of complete ACL tears with damage of the 2 menisci.

Conclusion

Younger age, time from injury to surgery and the magnitude of structural soft-tissue damage are associated with grade III pre-operative PS. A high-grade PS in chronic ACL-deficient knees may thus suggest a gradual decompensation of secondary soft tissue restraints over time.


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