TY - JOUR
T1 - Validation of quantitative measures of rotatory knee laxity
AU - Musahl, Volker
AU - Griffith, Chad
AU - Irrgang, James J.
AU - Hoshino, Yuichi
AU - Kuroda, Ryosuke
AU - Lopomo, Nicola
AU - Zaffagnini, Stefano
AU - Samuelsson, Kristian
AU - Karlsson, Jon
AU - Oostdyk, Alicia
AU - Rahnemai-Azar, Ata A.
AU - Arilla, Fabio V.
AU - Guenther, Daniel
AU - Zlotnicki, Jason
AU - Ohashi, Bruno
AU - Araujo, Paulo
AU - Kurosaka, Masahiro
AU - Nagamune, Kouki
AU - Marcheggiani Muccioli, Giulio Maria
AU - Signorelli, Cecilia
AU - Bjoernsson, Haukur
AU - Ahlden, Mattias
AU - Desai, Neel
AU - Fu, Freddie H.
N1 - Funding Information:
One or more of the authors has declared the following potential conflict of interest or source of funding: The study was funded through a grant from the International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine (ISAKOS) and the Orthopaedic Research and Education Foundation (OREF) (research grant No. 708661). V.M. is a consultant for Smith & Nephew, receives education funding from DePuy Synthes, and is co-developer of an iPad app (serial No. 61/566,761). R.K. is a paid presenter for Arthrex Inc, Biomet, and Smith & Nephew. K.N. is a paid consultant for Arthrex Inc. The PIVOT Shift Application developed in collaboration with James Irrgang was recently licensed by a group of investigators, negotiated through the Innovation Institute. We continue to conduct research to provide validity evidence from the application.
Publisher Copyright:
© American Orthopaedic Society for Sports Medicine.
PY - 2016/9/1
Y1 - 2016/9/1
N2 - Background: Prior attempts to quantify the pivot-shift examination have been too invasive or impractical for clinical use. A noninvasive method for quantifying rotatory knee laxity is needed. Hypothesis: Greater quantitative measurements of rotatory knee laxity (both of the involved knee as well as compared with the contralateral healthy knee) are associated with an increasing clinical pivot-shift grade. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A total of 103 patients undergoing anatomic single-bundle anterior cruciate ligament (ACL) reconstruction at 4 international centers underwent a standardized pivot-shift test preoperatively on both knees while anesthetized. Clinical grading of the pivot shift was performed according to the International Knee Documentation Committee (IKDC) knee ligament rating system. Two different quantitative technologies were used to measure rotatory knee laxity: an inertial sensor and an image analysis were independently used to measure tibial acceleration and lateral compartment translation, respectively, during the pivot-shift test. Patients were dichotomized to "high-grade" (abnormal and severely abnormal) or "low-grade" (normal and nearly normal) rotatory knee laxity groups based on the clinical pivot-shift test result of the involved side. Tibial acceleration and lateral compartment translation of the involved knee and the side-to-side difference between the involved and contralateral knees were separately compared between the high- and low-grade rotatory knee laxity groups utilizing t tests; significance was set at P <.05. Results: Forty-three patients were in the low-grade rotatory knee laxity group, and 60 patients were in the high-grade rotatory knee laxity group. Patients in the high-grade knee laxity group had significantly higher lateral compartment translation as measured with the image analysis (involved knee: 3.8 ± 2.3 mm; side-to-side difference: 2.5 ± 2.4 mm) compared with patients in the low-grade group (involved knee: 2.0 ± 1.4 mm; side-to-side difference: 1.4 ± 1.5 mm) (both P <.01). As measured with the inertial sensor, tibial acceleration for patients in the high-grade group was significantly higher (involved knee: 7.2 ± 5.3 m/s2; side-to-side difference: 4.2 ± 5.4 m/s2) compared with patients in the low-grade group (involved knee: 4.2 ± 1.6 m/s2; side-to-side difference: 1.2 ± 1.2 m/s2) (both P <.01). Conclusion: The inertial sensor and image analysis techniques were able to detect differences between low- and high-grade pivot-shift test results. A quantitative assessment of the pivot-shift test could augment the diagnosis of an ACL injury and improve the ability to detect changes in rotatory knee laxity over time.
AB - Background: Prior attempts to quantify the pivot-shift examination have been too invasive or impractical for clinical use. A noninvasive method for quantifying rotatory knee laxity is needed. Hypothesis: Greater quantitative measurements of rotatory knee laxity (both of the involved knee as well as compared with the contralateral healthy knee) are associated with an increasing clinical pivot-shift grade. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A total of 103 patients undergoing anatomic single-bundle anterior cruciate ligament (ACL) reconstruction at 4 international centers underwent a standardized pivot-shift test preoperatively on both knees while anesthetized. Clinical grading of the pivot shift was performed according to the International Knee Documentation Committee (IKDC) knee ligament rating system. Two different quantitative technologies were used to measure rotatory knee laxity: an inertial sensor and an image analysis were independently used to measure tibial acceleration and lateral compartment translation, respectively, during the pivot-shift test. Patients were dichotomized to "high-grade" (abnormal and severely abnormal) or "low-grade" (normal and nearly normal) rotatory knee laxity groups based on the clinical pivot-shift test result of the involved side. Tibial acceleration and lateral compartment translation of the involved knee and the side-to-side difference between the involved and contralateral knees were separately compared between the high- and low-grade rotatory knee laxity groups utilizing t tests; significance was set at P <.05. Results: Forty-three patients were in the low-grade rotatory knee laxity group, and 60 patients were in the high-grade rotatory knee laxity group. Patients in the high-grade knee laxity group had significantly higher lateral compartment translation as measured with the image analysis (involved knee: 3.8 ± 2.3 mm; side-to-side difference: 2.5 ± 2.4 mm) compared with patients in the low-grade group (involved knee: 2.0 ± 1.4 mm; side-to-side difference: 1.4 ± 1.5 mm) (both P <.01). As measured with the inertial sensor, tibial acceleration for patients in the high-grade group was significantly higher (involved knee: 7.2 ± 5.3 m/s2; side-to-side difference: 4.2 ± 5.4 m/s2) compared with patients in the low-grade group (involved knee: 4.2 ± 1.6 m/s2; side-to-side difference: 1.2 ± 1.2 m/s2) (both P <.01). Conclusion: The inertial sensor and image analysis techniques were able to detect differences between low- and high-grade pivot-shift test results. A quantitative assessment of the pivot-shift test could augment the diagnosis of an ACL injury and improve the ability to detect changes in rotatory knee laxity over time.
KW - ACL
KW - image analysis technique
KW - inertial sensor
KW - pivot shift
KW - quantitative measurement of rotatory knee laxity
UR - http://www.scopus.com/inward/record.url?scp=84984906817&partnerID=8YFLogxK
U2 - 10.1177/0363546516650667
DO - 10.1177/0363546516650667
M3 - Article
C2 - 27371547
AN - SCOPUS:84984906817
SN - 0363-5465
VL - 44
SP - 2393
EP - 2398
JO - American Journal of Sports Medicine
JF - American Journal of Sports Medicine
IS - 9
ER -