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Ligamentous Laxity, Male Sex, Chronicity, Meniscus Injury And Posterior Tibial Slope Are Associated With A High-Grade Pre-Operative Pivot Shift: A Post Hoc Analysis Of The Stability Study

Lachlan Batty, FRACS, AUSTRALIA Andrew Firth, PhD, CANADA Gilbert Moatshe, MD, PhD, NORWAY Dianne M. Bryant, PhD, CANADA S. Mark A. Heard, MD, FRCS, CANADA Robert G. McCormack, MD, CANADA Alex Rezansoff, MD, FRCSC, CANADA Devin Clarke Peterson, MD, FRCSC, Dip Sport Med, CANADA Davide Bardana, MD, CANADA Peter B. MacDonald, MD, FRCS, Dip Sport Med, CANADA Tim Spalding, FRCS(Orth), UNITED KINGDOM Alan Getgood, MD, FRCS(Tr&Orth), DipSEM, CANADA

Fowler Kennedy Sports Medicine Clinic, London, Ontario, CANADA

2021 Congress Abstract Presentation 6 minutes Not yet rated

Anatomic Location

Knee

Anatomic Structure

Ligaments

Diagnosis / Condition

Instability

Treatment / Technique

Repair / Reconstruction

Ligaments

ACL

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Summary: Ligamentous Laxity, Male Sex, Chronicity, Meniscus Injury and Posterior Tibial Slope are Associated with a High-Grade Pre-Operative Pivot Shift

Introduction

A spectrum of anterolateral rotatory laxity exists in anterior cruciate ligament (ACL) injured knees. Understanding of the factors contributing to a high-grade pivot shift continues to be refined. The effect of a high-grade pivot shift on baseline patient reported outcome measures (PROMs) is unclear.

Purpose

To investigate factors associated with a high-grade pre-operative pivot shift and to evaluate the relationship between a high-grade pivot shift and baseline PROMs.

Methods

A post hoc analysis of 618 ACL deficient patients deemed high risk for re-injury enrolled in a randomised trial was performed. A binary logistic regression model was developed with a high-grade pivot shift (International Knee Documentation Committee [IKDC] Grade 3) as the dependent variable. Age, sex, Beighton score, chronicity, posterior third medial or lateral meniscus injury and tibial slope were selected as independent variables. The importance of knee hyperextension as a component of the Beighton score was assessed using receiver operator characteristic curves. Baseline PROMs were compared between patients with and without a high-grade pivot.

Results

Six factors were associated with a high-grade pivot shift. These were Beighton score (each additional point, OR 1.17, 95%CI 1.06–1.30, p=0.002), male sex (OR 2.30, 95%CI 1.28–4.13, p=0.005), the presence of a posterior third medial (OR 2.55, 95%CI 1.11–5.84, p=0.03) or lateral meniscal injury (OR 1.76, 95%CI 1.01–3.08, p=0.05), tibial slope >9° (OR 2.35, 95%CI 1.09–5.07, p=0.03) and chronicity >6 months (OR 1.70, 95%CI 1.00–2.88, p=0.05). The presence of knee hyperextension improved the diagnostic utility of Beighton score as a predictor of a high-grade pivot shift. There was an interaction between tibial slope and posterior third medial meniscus pathology; tibial slope <9 degrees was only associated with a high-grade pivot in the presence of posterior third medial meniscus injury. Patients with a high-grade pivot shift had higher baseline 4-Item Pain Intensity Measure (P4) pain scores (11 ?13 vs. 8 ?14, p=0.04); however, there was no difference between baseline IKDC, ACL-Quality of life (ACL-QOL), Knee Injury and Osteoarthritis Outcome Score (KOOS) or KOOS sub-scales.

Conclusion

Ligamentous laxity, male sex, posterior third medial or lateral meniscal injury, increased posterior tibial slope and chronicity are associated with a high-grade pivot shift in this population deemed high risk for repeat ACL injury. Knee hyperextension improves the prognostic utility of the Beighton score. The effect of tibial slope may be accentuated by the presence of meniscal injury, supporting the need for meniscal preservation. Baseline PROMs are similar between patients with and without a high-grade pivot shift.

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Quadriceps Tendon Autograft Has Lower MRI Signal Than Hamstring Tendon Autograft In Anterior Cruciate Ligament Reconstructions Of Adolescent Athletes Abstract Presentation 5 minutes David Alcoloumbre, MD, UNITED STATES Alexandra Hunter Aitchison, UNITED STATES Douglas Mintz, MD, UNITED STATES Frank A. Cordasco, MD, MS, UNITED STATES Daniel W. Green, MD, MS, UNITED STATES
Combined ACL and Anterolateral Ligament Reconstruction Confers Significantly Improved Long Term Outcomes when Compared to Isolated ACL Reconstruction: A Matched-Pair Analysis Abstract Presentation 5 minutes Adnan Saithna, MD, FRCS, UNITED STATES Ibrahim Haidar, MD, FRANCE Johnny Rayes, MD, MSc, FEBOT, CANADA Thomas Fradin, MD, FRANCE Cédric Ngbilo, MD, SWITZERLAND Benjamin Freychet, MD, FRANCE Thais Dutra Vieira, MD, FRANCE Herve Ouanezar, MD, UNITED ARAB EMIRATES Bertrand Sonnery-Cottet, MD, PhD, FRANCE
Bone Marrow Aspiration Concentrate Augmentation in Anterior Cruciate Ligament Hamstring Autograft Reconstruction: Clinical and Functional Outcomes of a Cohort Study Abstract Presentation 5 minutes David H. Figueroa, MD, CHILE Rodrigo Guiloff, MD, Prof, CHILE Sergio Arellano, MD, CHILE Alex Vaisman, MD, Prof., CHILE Francisco Figueroa, MD, CHILE Nicolas Zilleruelo, MD, CHILE Rafael Calvo, MD, CHILE
Age, Time From Injury To Surgery And Quadriceps Strength Affect The Risk Of Revision Surgery After Primary Acl Reconstruction Abstract Presentation 6 minutes Riccardo Cristiani, MD, PhD, SWEDEN Magnus Forssblad, SWEDEN Gunnar Edman, MD, PhD, Prof., SWEDEN Karl Eriksson, MD, PhD, Prof., SWEDEN Anders Stalman, MD, PhD, associate professor, SWEDEN
THE OUTCOME OF BALANCE EXERCISES AND AGILITY TRAINING FOR POST ANTERIOR CRUCIATE LIGAMENT (ACL) RECONSTRUCTION: CLINICAL ASSESSMENT Abstract Presentation 7 minutes SITI MAIZATUL AKMAL ISMAIL, Medical Science (Orthopaedic Surgery Sports), MALAYSIA
Same Knee, Different Goals: Patients and Surgeons have Different Priorities Related to ACL Reconstructions and Surgeons are Resistant to Changing Clinical Practice Abstract Presentation 4 minutes Hana Marmura, BSc, CANADA Dianne M. Bryant, PhD, CANADA Trevor B. Birmingham, PT, PhD, CANADA Kurt Paul Spindler, MD, UNITED STATES Christopher C. Kaeding, MD, UNITED STATES Tim Spalding, FRCS(Orth), UNITED KINGDOM Alan Getgood, MD, FRCS(Tr&Orth), DipSEM, CANADA
Changes In Muscle Strength And Hop Performance After ACL Reconstruction. A Randomized Controlled Trial Comparing Patellar Tendon And Hamstring Tendon Autografts With Standard Or Accelerated Rehabilitation Abstract Presentation 6 minutes Riccardo Cristiani, MD, PhD, SWEDEN Christina Mikkelsen, PT, SWEDEN Peter Olov Wange, MD, SWEDEN Daniel Olsson, PhD, SWEDEN Anders Stalman, MD, PhD, associate professor, SWEDEN Bjorn Engstrom, MD, PhD, Assoc. Prof., SWEDEN
Analysis Of The Blood Supply To The Femoral Attachment Of The Anterior Cruciate Ligament After Acl Injury Abstract Presentation 4 minutes Jedrzej Jerzy Lesman, PhD MD, POLAND Marcin E. Domzalski, MD, Prof., POLAND Krzysztof Nowak, MD, PhD, POLAND Sebastian Zygmunt Żabierek, PhD, POLAND Radoslaw Grabowski, MD, POLAND Ilona Wagner-Olszewska, MD, POLAND
Risk Factor Analysis for Graft Failure after Anterior Cruciate Ligament Reconstruction with or without mLET Abstract Presentation 7 minutes Filip R Hendrikx, MD, BELGIUM Koen Lagae, MD, BELGIUM Annemieke Van Haver, PhD, MSc, BELGIUM Peter Verdonk, MD, PhD, BELGIUM
Outcomes Following Anterior Cruciate Ligament Reconstruction in Young Patients: An Observational Study. ePoster Presentation Kunal Mohan, MB MCh MRCSI, IRELAND David Cooper, MB MRCSI, IRELAND Niall McGoldrick, MB MCh FRCS (Tr & Orth), IRELAND Martin Davey, MB MCh MRCSI, IRELAND Megan Diack, MBCHB, MRCSI, MCh, IRELAND Paula McQuail, MB FRCSI, IRELAND Fintan J. Shannon, FRCS (Tr/Orth), IRELAND
MRI After ACL Reconstruction Demonstrates that Hamstring Grafts Heal and Integrate at Different Rates Abstract Presentation 6 minutes Sven Edward Putnis, MB ChB FRCS(Tr&Orth), UNITED KINGDOM Takeshi Oshima, MD, PhD, JAPAN Antonio Klasan, MD, AUSTRIA Samuel Grasso, PhD, B. Engineering (Mechanical), AUSTRALIA Thomas Neri, MD, PhD, Prof., FRANCE Myles R. J. Coolican, FRACS, AUSTRALIA Brett A. Fritsch, MBBS BSc(Med), FRACS, FAOrthA, AUSTRALIA David A. Parker, MBBS, BMedSc, FRACS, AUSTRALIA

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Ligamentous Laxity, Male Sex, Chronicity, Meniscus Injury And Posterior Tibial Slope Are Associated With A High-Grade Pre-Operative Pivot Shift: A Post Hoc Analysis Of The Stability Study

Ligamentous Laxity, Male Sex, Chronicity, Meniscus Injury And Posterior Tibial Slope Are Associated With A High-Grade Pre-Operative Pivot Shift: A Post Hoc Analysis Of The Stability Study

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Ligamentous Laxity, Male Sex, Chronicity, Meniscus Injury And Posterior Tibial Slope Are Associated With A High-Grade Pre-Operative Pivot Shift: A Post Hoc Analysis Of The Stability Study

Ligamentous Laxity, Male Sex, Chronicity, Meniscus Injury And Posterior Tibial Slope Are Associated With A High-Grade Pre-Operative Pivot Shift: A Post Hoc Analysis Of The Stability Study

Introduction

Purpose

Methods

Results

Conclusion

More ISAKOS 2021: Global Content