Summary: Injury to the anterolateral structures was identified to be the most important risk factor for grade 3 pivot shift in acute ACL-injured knees when previously described osseous and soft-tissue parameters were comprehensively accounted for in an adequately powered study.

Introduction

Pre-operative high-grade pivot shift (PS) has been reported to be associated with higher rates of anterior cruciate ligament (ACL) failure, persistent instability and inferior patient reported outcomes. The aetiology of a high-grade PS is multifactorial and numerous factors have been suggested to be responsible. However, the literature is conflicting. In part, this is due to numerous underpowered studies that also fail to account for known risk factors. The aim of this study was to determine risk factors for high-grade pivot shift with a particular emphasis on addressing the limitations of previous studies, therefore including a comprehensive evaluation of both soft-tissue and osseous parameters in an adequately powered study.

Methods

A prospective evaluation of consecutive patients undergoing acute ACL reconstruction (within 10 days of injury) was undertaken. An a priori sample size calculation was performed in order to ensure recruitment of an adequate number of patients. At the time of surgery, the pivot shift test was performed in a standardized manner and graded (International Knee Documentation Criteria). Details regarding patient and injury characteristics were recorded, as were details of injuries to soft-tissues structures including the menisci, anterolateral structures (ALS), medial collateral ligament (other multi-ligament injuries excluded) and articular cartilage. Osseous parameters (tibial slope and condylar ratios) were evaluated using established magnetic resonance imaging (MRI) protocols.

A multivariate logistic regression with Penalized Maximum Likelihood was used to identified risk factors associated with grade 3 pivot shift. Factors initially considered were those selected as statistically significant at the 25% threshold, or of previously reported clinical interest. A stepwise descending strategy was applied from the initial full model to determine the most parsimonious one.

Results

200 consecutive patients with a mean age of 28.3 +/- 9.8 years were included in the study. 67.5% of patients were male. 35 (17.5%) of patients had a high grade (grade 3) pivot shift and 165 (82.5%) had a low-grade pivot shift (grades 1 and 2). Univariate analyses demonstrated that injury to the ALS was the only significant risk factor for high grade pivot shift. This finding remained true when factors reaching the 25% threshold or of previously reported clinical interest were included in multivariate analysis (OR 13.49; 95% CI, 1.80-1725.53). Although previous studies have suggested that there are other important risk factors for high grade pivot shift, this did not hold true in the current study.

Conclusions

This comprehensive evaluation of soft-tissue and osseous factors has identified that injury to the ALS is the most important risk factor for grade 3 pivot shift in acute ACL-injured knees.

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PSM: Pivot Shift Meter Cellphone Application for Classifying ACL Injuries Abstract Presentation 5 minutes Edmundo Berumen Nafarrate, PhD, Prof., MEXICO Carlos Alejandro Vega Najera, MD, MEXICO Joel Alejandro Cabral, MD, MEXICO Luis Sigala Gonzalez, Eng, MEXICO Ivan Ramos Moctezuma, Eng, MEXICO Carlos Leal, MD, Prof., COLOMBIA Jesus Javier Tonche, MD, MEXICO Avril Pérez Fontes, MD, MEXICO Fatima Quintana Trejo, Eng, MEXICO
Does In Vivo Kinematics Following Acl Reconstruction With Or Without Lateral Extraarticular Tenodesis Correlate With Preoperative Quantitative Pivot Shift? Abstract Presentation 5 minutes Christopher M. Gibbs, MD, UNITED STATES Philipp Wilhelm Winkler, MD, Assoc. Prof., AUSTRIA Jonathan D Hughes, MD, PhD, UNITED STATES Adam J. Popchak, DPT, PhD, UNITED STATES Daisuke Chiba, MD, PhD, JAPAN Bryson P. Lesniak, MD, UNITED STATES William Anderst, PhD, UNITED STATES Volker Musahl, MD, Prof., UNITED STATES
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
Acl - Pcl Fixation Sequence During Multi-Ligament Knee Reconstruction Does Not Affect Knee Laxity Abstract Presentation 6 minutes Carola F. van Eck, MD, PhD, FAAOS, UNITED STATES Aly Maher Fayed, MD, EGYPT Ryo Kanto, MD, JAPAN Taylor M. Price, MS, UNITED STATES Michael Dinenna, BS, UNITED STATES Monica A. Linde, MSIE, RN, UNITED STATES Patrick J. Smolinski, PhD, UNITED STATES
The Effect of Lateral Extra-Articular Tenodesis on Medial and Lateral Menisci Loading in Response To Simulated Tests of the Pivot Shift and Anterior Laxity Abstract Presentation 6 minutes Niv Marom, MD, ISRAEL Hamid Jahandar, BS, UNITED STATES Zaid Zayyad, MD, MS, UNITED STATES thomas fraychineaud, MD, UNITED STATES Herve Ouanezar, MD, UNITED ARAB EMIRATES Ronak M. Patel, MD, UNITED STATES Carl W Imhauser, PhD, UNITED STATES Thomas L. Wickiewicz, MD, UNITED STATES Andrew D. Pearle, MD, UNITED STATES Danyal H. Nawabi, MD, FRCS(Orth), UNITED STATES
Clinical Outcomes Of Primary Acl Reconstruction With Tibial Attachment Preserving Quadrupled Hamstring Graft: Does Graft Size Matter? - A Prospective Study With Review Of Literature Abstract Presentation 5 minutes Shaival Dalal, M.S.MRCS(Edinburgh), UNITED KINGDOM Ghislain N. Aminake, MBBS, MMed(Ortho),MRCPS(Glasg), CAMEROON Randy Guro, BSc, UNITED KINGDOM Amit Pramod Chandratreya, FRCS(Tr&Orth), MS(Orth), MCh(Orth), UNITED KINGDOM Rahul Kotwal, FRCS(Ortho), UNITED KINGDOM
Validation of a Risk Calculator to Personalize Graft Choice and Reduce Rupture Rates for Anterior Cruciate Ligament Reconstruction Abstract Presentation 6 minutes Hana Marmura, MPT, PhD, UNITED STATES Alan Getgood, MD, FRCS(Tr&Orth), DipSEM, QATAR Kurt Paul Spindler, MD, UNITED STATES Michael W Kattan, PhD, UNITED STATES Isaac Briskin, MA, UNITED STATES Dianne M. Bryant, PhD, CANADA
Effect Of Graft Choice On 6-Year Outcomes Of Revision Anterior Cruciate Ligament Reconstruction In The Multicenter ACL Revision Study (Mars) Cohort Abstract Presentation 6 minutes Rick W. Wright, MD, UNITED STATES
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

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Risk Factors for Grade 3 Pivot Shift in Acute ACL-Injured Knees

Risk Factors for Grade 3 Pivot Shift in Acute ACL-Injured Knees

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Risk Factors for Grade 3 Pivot Shift in Acute ACL-Injured Knees

Risk Factors for Grade 3 Pivot Shift in Acute ACL-Injured Knees

Introduction

Methods

Results

Conclusions

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