1
|
Willinger L, Runer A, Vieider R, Muench LN, Siebenlist S, Winkler PW. Noninvasive and Reliable Quantification of Anteromedial Rotatory Knee Laxity: A Pilot Study on Healthy Individuals. Am J Sports Med 2024; 52:1229-1237. [PMID: 38506950 PMCID: PMC10986148 DOI: 10.1177/03635465241234263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 12/18/2023] [Indexed: 03/22/2024]
Abstract
BACKGROUND Anteromedial rotatory instability (AMRI) of the knee is a complex and severe condition caused by injury to the anterior cruciate ligament and/or the medial collateral ligament. Clinical studies dealing with AMRI are rare, and objective measurements are nonexistent. PURPOSE/HYPOTHESIS The objectives of this study were, first, to quantify anteromedial rotatory knee laxity in healthy individuals using a noninvasive image analysis software and, second, to assess intra- and interrater reliability and equivalence in measuring anteromedial knee translation (AMT). It was hypothesized that AMT could be reliably quantified using a noninvasive image analysis software. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS This prospective proof-of-concept study included healthy individuals aged 16 to 40 years with no history of knee injury or surgery. Three adhesive surface markers were placed on predefined landmarks on the medial side of the knee. Three independent investigators examined anteromedial rotatory knee laxity with an anterior drawer test in different tibial rotations (neutral tibial rotation, 15° of external tibial rotation, and 15° of internal tibial rotation). The entire examination of each knee was recorded, and AMT including the side-to-side difference (SSD) was assessed using a freely available and validated image analysis software (PIVOT iPad application). Group comparisons were performed using a 1-way analysis of variance with Bonferroni-adjusted post hoc analysis. Intraclass correlation coefficients (ICCs) were calculated to assess inter- and intrarater reliability of AMT measurements. Equivalence of measurements was evaluated using the 2 one-sided t-test procedure. RESULTS Anteromedial rotatory knee laxity was assessed in 30 knees of 15 participants (53% male) with a mean age of 26.2 ± 3.5 years. In all 3 raters, the highest AMT was observed in neutral tibial rotation (range of means, 2.2-3.0 mm), followed by external tibial rotation (range of means, 2.0-2.4 mm) and internal tibial rotation (range of means, 1.8-2.2 mm; P < .05). Intrarater reliability of AMT (ICC, 0.88-0.96) and SSD (ICC, 0.61-0.96) measurements was good to excellent and moderate to excellent, respectively. However, interrater reliability was poor to moderate for AMT (ICC, 0.44-0.73) and SSD (ICC, 0.12-0.69) measurements. Statistically significant equivalence of AMT and SSD measurements was observed between and within raters for almost all testing conditions. CONCLUSION Anteromedial rotatory knee laxity could be quantified using a noninvasive image analysis software, with the highest AMT observed during neutral tibial rotation in uninjured individuals. Reliability and equivalence of measurements were good to excellent within raters and moderate between raters.
Collapse
Affiliation(s)
- Lukas Willinger
- Department of Sports Orthopaedics, Technical University of Munich, Munich, Germany
| | - Armin Runer
- Department of Sports Orthopaedics, Technical University of Munich, Munich, Germany
| | - Romed Vieider
- Department of Sports Orthopaedics, Technical University of Munich, Munich, Germany
| | - Lukas N. Muench
- Department of Sports Orthopaedics, Technical University of Munich, Munich, Germany
- Department of Trauma and Reconstructive Surgery, Artemed Klinikum München Süd, Munich, Germany
| | - Sebastian Siebenlist
- Department of Sports Orthopaedics, Technical University of Munich, Munich, Germany
| | - Philipp W. Winkler
- Department of Sports Orthopaedics, Technical University of Munich, Munich, Germany
- Department of Orthopaedics and Traumatology, Kepler University Hospital Linz, Linz, Austria
| |
Collapse
|
2
|
Godshaw BM, Hughes JD, Lucidi GA, Setliff J, Sansone M, Karlsson J, Musahl V. Posterior tibial plateau impaction fractures are not associated with increased knee instability: a quantitative pivot shift analysis. Knee Surg Sports Traumatol Arthrosc 2023:10.1007/s00167-023-07312-3. [PMID: 36633602 DOI: 10.1007/s00167-023-07312-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 01/03/2023] [Indexed: 01/13/2023]
Abstract
PURPOSE This study aimed to evaluate posterolateral tibial plateau impaction fractures and how they contribute to rotatory knee laxity using quantitative pivot shift analysis. It was hypothesised that neither the presence of nor the degree of involvement of the plateau would affect rotatory knee laxity in the ACL-deficient knee. METHODS A retrospective review of prospectively collected data on 284 patients with complete anterior cruciate ligament (ACL) injuries was conducted. Posterolateral tibial plateau impaction fractures were identified on preoperative MRI. The patients were divided into two cohorts: "fractures" or "no fractures". The cohort with fractures was further categorised based on fracture morphology: "extra-articular", "articular-impaction", or "displaced-articular fragment". All data were collected during examination under anaesthesia performed immediately prior to ACL reconstruction. This included a standard pivot shift test graded by the examiner and quantitative data including anterior tibial translation (mm) via Rolimeter, quantitative pivot shift (QPS) examination (mm) via PIVOT tablet technology, and acceleration (m/sec2) during the pivot shift test via accelerometer. Quantitative examinations were compared with the contralateral knee. RESULTS There were 112 patients with posterolateral tibial plateau impaction fractures (112/284, 39%). Of these, 71/112 (63%) were "extra-articular", 28/112 (25%) "articular-impaction", and 13/112 (12%) "displaced-articular". Regarding the two groups with or without fractures, there was no difference in subjective pivot shift (2 ± 0 vs 2 ± 0, respectively, n.s.), QPS (2.4 ± 1.6 mm vs 2.7 ± 2.2 mm, respectively, n.s.), anterior tibial translation measurements (6 ± 3 mm vs 5 ± 3 mm, respectively, n.s.), or acceleration of the knee during the pivot (1.7 ± 2.3 m/s2 vs 1.8 ± 3.1 m/s2, respectively, n.s.). When the fractures were further subdivided, subgroup analysis revealed no significant differences noted in any of the measured examinations between the fracture subtypes. CONCLUSION This study showed that the posterolateral tibial plateau impaction fractures are commonly encountered in the setting of ACL tears; however, contrary to previous reports, they do not significantly increase rotatory knee laxity. This suggests that this type of concomitant injury may not need to be addressed at the time of ACL reconstruction. LEVEL OF EVIDENCE Level III.
Collapse
Affiliation(s)
- Brian M Godshaw
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, UPMC Rooney Sports Complex, 3200 South Water Street, Pittsburgh, PA, 15203, USA
| | - Jonathan D Hughes
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, UPMC Rooney Sports Complex, 3200 South Water Street, Pittsburgh, PA, 15203, USA
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Gian Andrea Lucidi
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, UPMC Rooney Sports Complex, 3200 South Water Street, Pittsburgh, PA, 15203, USA
| | - Joshua Setliff
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, UPMC Rooney Sports Complex, 3200 South Water Street, Pittsburgh, PA, 15203, USA
| | - Mikael Sansone
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jon Karlsson
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Volker Musahl
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, UPMC Rooney Sports Complex, 3200 South Water Street, Pittsburgh, PA, 15203, USA.
| |
Collapse
|
3
|
Lucidi GA, Grassi A, Di Paolo S, Agostinone P, Neri MP, Macchiarola L, Dal Fabbro G, Zaffagnini S. The Lateral Femoral Notch Sign Is Correlated With Increased Rotatory Laxity After Anterior Cruciate Ligament Injury: Pivot Shift Quantification With A Surgical Navigation System. Am J Sports Med 2021; 49:649-655. [PMID: 33449808 DOI: 10.1177/0363546520982002] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The lateral femoral notch sign (LNS) is a bony impression on the lateral femoral condyle correlated with anterior cruciate ligament (ACL) injury. Its presence is associated with lateral meniscal injury and higher cartilage degradation on the lateral femoral condyle. PURPOSE/HYPOTHESIS The purpose was to investigate the effect of the presence and magnitude of LNS on rotatory instability. The hypothesis was that a positive LNS is correlated with a high-grade pivot shift (PS). STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS A total of 90 consecutive patients with complete ACL tears between 2013 and 2017 underwent intraoperative kinematic evaluation with the surgical navigation system and were included in the present study. The same surgeon performed a standardized PS under anesthesia. The PS was quantified through the acceleration of the lateral compartment during tibial reduction (PS ACC) and the internal-external rotation (PS IE). Presence and depth of LNS were evaluated on sagittal magnetic resonance images (1.5-T). RESULTS In 47 patients, the LNS was absent; in 33, the LNS depth was between 1 mm and 2 mm; and in 10 patients, it was deeper than 2 mm. Patients with a notch deeper than 2 mm showed increased PS ACC and PS IE compared with the group without the LNS. However, no significant differences were present between the group with a notch between 1 and 2 mm and the patients without LNS. Receiver operating characteristic curve analysis showed that 2 mm was the most predictive cutoff value to identify the "high-grade rotatory instability" group, with an accuracy of 77.8% and 74.4% and a specificity of 95.5% and 93.9% referred to the PS ACC and PS IE, respectively. CONCLUSION The presence of a lateral LNS deeper than 2 mm could be used for the preoperative identification of patients with a high risk of increased rotatory instability.
Collapse
Affiliation(s)
- Gian Andrea Lucidi
- IIa Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Alberto Grassi
- IIa Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Stefano Di Paolo
- IIa Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Piero Agostinone
- IIa Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Maria Pia Neri
- IIa Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Luca Macchiarola
- IIa Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Giacomo Dal Fabbro
- IIa Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Stefano Zaffagnini
- IIa Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| |
Collapse
|
4
|
Totlis T, Kitridis D, Tsikopoulos K, Georgoulis A. A computer tablet software can quantify the deviation of scapula medial border from the thoracic wall during clinical assessment of scapula dyskinesis. Knee Surg Sports Traumatol Arthrosc 2021; 29:202-209. [PMID: 32152691 DOI: 10.1007/s00167-020-05916-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 02/24/2020] [Indexed: 12/13/2022]
Abstract
PURPOSE Aim of this study is to establish an objective and easily applicable method that will allow clinicians to quantitatively assess scapular dyskinesis during clinical examination using a computer tablet software. Hypothesis is that dyskinetic scapulae present greater motion-deviation from the thoracic wall-compared to the non-dyskinetic ones and that the software will be able to record those differences. METHODS Twenty-five patients and 19 healthy individuals were clinically evaluated for the presence of dyskinesis or not. According to the clinical diagnosis, the observations were divided into three groups; A. Dyskinetic scapulae with symptoms (n = 25), B. Contralateral non-dyskinetic scapulae without symptoms (n = 25), C. Healthy control scapulae (n = 38). Then, all individuals were tested using a tablet with the PIVOT™ image-based analysis software (PIVOT, Impellia, Pittsburgh, PA, USA). The motion produced by the scapula medial border and inferior angle deviation from the thoracic wall was recorded. RESULTS The deviation of the medial border and inferior angle of the scapula from the thoracic wall was 24.6 ± 7.3 mm in Group A, 14.7 ± 4.9 mm in Group B, and 12.4 ± 5.2 mm in Group C. The motion recorded in the dyskinetic scapulae group was significantly greater than both the contralateral non-dyskinetic scapulae group (p < 0.01) and the healthy control scapulae group (p < 0.01). CONCLUSION The PIVOT™ software was efficient to detect significant differences in the motion between dyskinetic and non-dyskinetic scapulae. This system can support the clinical diagnosis of dyskinesis with a numeric value, which not only contributes to scapula dyskinesis grading but also to the evaluation of the progress and efficacy of the applied treatment, thus providing a feedback to the clinician and the patient. LEVEL OF EVIDENCE IV, laboratory study.
Collapse
Affiliation(s)
- Trifon Totlis
- Thessaloniki Minimally Invasive Surgery (The-MIS) Orthopaedic Center, St. Luke's Hospital, 55236, Thessaloniki, Greece. .,Department of Anatomy and Surgical Anatomy, Faculty of Health Sciences, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | - Dimitrios Kitridis
- 1st Orthopaedic Department, George Papanikolaou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Anastasios Georgoulis
- Department of Orthopaedic Surgery, Orthopaedic Sports Medicine Center, University of Ioannina, Ioannina, Greece
| |
Collapse
|
5
|
Sheean AJ, Lian J, Tisherman R, Meredith SJ, de Sa D, Lynch A, Lesniak BP, Musahl V. Augmentation of Anatomic Anterior Cruciate Ligament Reconstruction With Lateral Extra-articular Tenodesis Does Not Significantly Affect Rotatory Knee Laxity: A Time Zero, In Vivo Kinematic Analysis. Am J Sports Med 2020; 48:3495-3502. [PMID: 33176107 DOI: 10.1177/0363546520966624] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The pivot-shift test is used to assess for rotatory knee laxity in the anterior cruciate ligament (ACL)-deficient knee and ACL-reconstructed knee; however, the pivot shift uses a subjective grading system that is limited by variability between examiners. Consequently, quantified pivot shift (QPS) test software (PIVOT iPad application) has been developed and validated to measure the magnitude of rotatory knee laxity during the positive pivot-shift test. PURPOSE To employ intraoperative QPS (iQPS) to assess for differences in residual rotatory knee laxity after ACL reconstruction (ACLR) versus ACLR augmented with lateral extra-articular tenodesis (ACLR + LET), and to employ iQPS to determine if ACLR and/or ACLR + LET result in overconstrained knee kinematics when compared with the contralateral knee. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS iQPS was performed in 20 patients by a single surgeon on both the operative and contralateral knees before ACLR. ACLR was augmented with a LET if the lateral compartment tibial translation measured during QPS was greater than or equal to double the amount of lateral tibial compartment translation measured for the contralateral knee. After each reconstruction (ACLR or ACLR + LET), iQPS measurements were performed. iQPS data were compared with the preoperative QPS measurements of the operative and contralateral knees. Postoperative iQPS data were compared with both the preoperative QPS measurements of the operative and contralateral knees with paired samples t tests. Categorical variables were compared using the Fisher exact test. RESULTS The mean age in the cohort was 17.3 years (range, 15-24 years). There were no significant differences between the groups in terms of the proportion of male patients (ACLR: 5 male, 5 female vs ACLR + LET: 4 male, 6 female) or age (ACLR: 17.7 ± 3.3 years; 95% CI, 15.4-24.0 vs ACLR + LET: 16.8 ± 2.8 years, 95% CI, 14.8-22.0; P = .999). There were no significant differences between the groups with respect to preoperative QPS performed during examination under anesthesia (ACLR: 4.7 ± 2.0 mm; 95% CI, 3.3-6.1 vs ACLR + LET: 3.6 ± 1.8 mm; 95% CI, 2.3-4.9; P = .2). Both ACLR and ACLR + LET resulted in significant decreases in rotatory knee laxity when compared with preoperative QPS measurements (ACLR: -3.4 ± 1.7 mm; 95% CI, -4.6 to -2.2; P < .001: ACLR + LET: -2.6 ± 1.9 mm; 95% CI, -3.9 to -1.3; P < .002). Moreover, when compared with isolated ACLR, ACLR + LET did not result in a significantly smaller magnitude of change in iQPS between the pre- and postoperative states (P = .3). CONCLUSION Both ACLR and ACLR + LET resulted in significant decreases in rotatory knee laxity. The augmentation of ACLR with LET did not change the constraint of the knee with respect to lateral compartment translation as measured during iQPS.
Collapse
Affiliation(s)
- Andrew J Sheean
- Department of Orthopaedic Surgery, San Antonio Military Medical Center, San Antonio, Texas, USA
| | - Jayson Lian
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Robert Tisherman
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Sean J Meredith
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Darren de Sa
- Division of Orthopaedic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Andrew Lynch
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Bryson P Lesniak
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Volker Musahl
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| |
Collapse
|
6
|
Tisherman RT, Patel NK, Murphy CI, Debski RE, Musahl V. Mobile application for quantification of the pivot shift examination: intraoperative usability and utility during real-world deployment. J ISAKOS 2020. [DOI: 10.1136/jisakos-2020-000483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
7
|
Abstract
The pivot shift test is utilized for assessment of rotatory instability in the anterior cruciate ligament (ACL) deficient knee. There are multiple reports of the pivot shift maneuver, and there is a lack of consensus among clinicians as to a standardized maneuver. Measurement devices are a feasible option to evaluate rotatory knee instability, objectively or quantitatively. Traditionally, measurement systems have been invasive systems. More recently, electromagnetic system, inertial sensor, or imaging analysis systems, specifically with the utilization of a tablet computer, have emerged as noninvasive, and more importantly, validated options. It is important to recognize that anatomic structures other than the ACL contribute to rotatory knee stability. Addressing the tibial slope, anterolateral structures of the knee, specifically the iliotibial band, and menisci during ACL surgery may decrease residual pivot shift in an attempt to improve clinical outcomes and prevent reinjury. This review article describes the pivot shift maneuver, objective measurement tools, and clinical applications of the pivot shift test.
Collapse
|
8
|
Svantesson E, Hamrin Senorski E, Webster KE, Karlsson J, Diermeier T, Rothrauff BB, Meredith SJ, Rauer T, Irrgang JJ, Spindler KP, Ma CB, Musahl V. Clinical outcomes after anterior cruciate ligament injury: Panther Symposium ACL Injury Clinical Outcomes Consensus Group. J ISAKOS 2020. [DOI: 10.1136/jisakos-2020-000494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
9
|
Svantesson E, Hamrin Senorski E, Webster KE, Karlsson J, Diermeier T, Rothrauff BB, Meredith SJ, Rauer T, Irrgang JJ, Spindler KP, Ma CB, Musahl V, The Panther Symposium Acl Injury Clinical Outcomes Consensus Group, Fu FH, Ayeni OR, Della Villa F, Della Villa S, Dye S, Ferretti M, Getgood A, Järvelä T, Kaeding CC, Kuroda R, Lesniak B, Marx RG, Maletis GB, Pinczewski L, Ranawat A, Reider B, Seil R, van Eck C, Wolf BR, Yung P, Zaffagnini S, Hao Zheng M. Clinical Outcomes After Anterior Cruciate Ligament Injury: Panther Symposium ACL Injury Clinical Outcomes Consensus Group. Orthop J Sports Med 2020; 8:2325967120934751. [PMID: 32754624 PMCID: PMC7378729 DOI: 10.1177/2325967120934751] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 05/12/2020] [Indexed: 01/16/2023] Open
Abstract
A stringent outcome assessment is a key aspect of establishing evidence-based
clinical guidelines for anterior cruciate ligament (ACL) injury treatment. To
establish a standardized assessment of clinical outcome after ACL treatment, a
consensus meeting including a multidisciplinary group of ACL experts was held at
the ACL Consensus Meeting Panther Symposium, Pittsburgh, Pennsylvania, USA, in
June 2019. The aim was to establish a consensus on what data should be reported
when conducting an ACL outcome study, what specific outcome measurements should
be used, and at what follow-up time those outcomes should be assessed. The group
reached consensus on 9 statements by using a modified Delphi method. In general,
outcomes after ACL treatment can be divided into 4 robust categories: early
adverse events, patient-reported outcomes (PROs), ACL graft failure/recurrent
ligament disruption, and clinical measures of knee function and structure. A
comprehensive assessment after ACL treatment should aim to provide a complete
overview of the treatment result, optimally including the various aspects of
outcome categories. For most research questions, a minimum follow-up of 2 years
with an optimal follow-up rate of 80% is necessary to achieve a comprehensive
assessment. This should include clinical examination, any sustained reinjuries,
validated knee-specific PROs, and health-related quality of life questionnaires.
In the midterm to long-term follow-up, the presence of osteoarthritis should be
evaluated. This consensus paper provides practical guidelines for how the
aforementioned entities of outcomes should be reported and suggests the
preferred tools for a reliable and valid assessment of outcome after ACL
treatment.
Collapse
Affiliation(s)
- Eleonor Svantesson
- Investigation performed at UPMC Freddie Fu Sports Medicine Center, Pittsburgh, Pennsylvania, USA
| | - Eric Hamrin Senorski
- Investigation performed at UPMC Freddie Fu Sports Medicine Center, Pittsburgh, Pennsylvania, USA
| | - Kate E Webster
- Investigation performed at UPMC Freddie Fu Sports Medicine Center, Pittsburgh, Pennsylvania, USA
| | - Jón Karlsson
- Investigation performed at UPMC Freddie Fu Sports Medicine Center, Pittsburgh, Pennsylvania, USA
| | - Theresa Diermeier
- Investigation performed at UPMC Freddie Fu Sports Medicine Center, Pittsburgh, Pennsylvania, USA
| | - Benjamin B Rothrauff
- Investigation performed at UPMC Freddie Fu Sports Medicine Center, Pittsburgh, Pennsylvania, USA
| | - Sean J Meredith
- Investigation performed at UPMC Freddie Fu Sports Medicine Center, Pittsburgh, Pennsylvania, USA
| | - Thomas Rauer
- Investigation performed at UPMC Freddie Fu Sports Medicine Center, Pittsburgh, Pennsylvania, USA
| | - James J Irrgang
- Investigation performed at UPMC Freddie Fu Sports Medicine Center, Pittsburgh, Pennsylvania, USA
| | - Kurt P Spindler
- Investigation performed at UPMC Freddie Fu Sports Medicine Center, Pittsburgh, Pennsylvania, USA
| | - C Benjamin Ma
- Investigation performed at UPMC Freddie Fu Sports Medicine Center, Pittsburgh, Pennsylvania, USA
| | - Volker Musahl
- Investigation performed at UPMC Freddie Fu Sports Medicine Center, Pittsburgh, Pennsylvania, USA
| | | | - Freddie H Fu
- Investigation performed at UPMC Freddie Fu Sports Medicine Center, Pittsburgh, Pennsylvania, USA
| | - Olufemi R Ayeni
- Investigation performed at UPMC Freddie Fu Sports Medicine Center, Pittsburgh, Pennsylvania, USA
| | - Francesco Della Villa
- Investigation performed at UPMC Freddie Fu Sports Medicine Center, Pittsburgh, Pennsylvania, USA
| | - Stefano Della Villa
- Investigation performed at UPMC Freddie Fu Sports Medicine Center, Pittsburgh, Pennsylvania, USA
| | - Scott Dye
- Investigation performed at UPMC Freddie Fu Sports Medicine Center, Pittsburgh, Pennsylvania, USA
| | - Mario Ferretti
- Investigation performed at UPMC Freddie Fu Sports Medicine Center, Pittsburgh, Pennsylvania, USA
| | - Alan Getgood
- Investigation performed at UPMC Freddie Fu Sports Medicine Center, Pittsburgh, Pennsylvania, USA
| | - Timo Järvelä
- Investigation performed at UPMC Freddie Fu Sports Medicine Center, Pittsburgh, Pennsylvania, USA
| | - Christopher C Kaeding
- Investigation performed at UPMC Freddie Fu Sports Medicine Center, Pittsburgh, Pennsylvania, USA
| | - Ryosuke Kuroda
- Investigation performed at UPMC Freddie Fu Sports Medicine Center, Pittsburgh, Pennsylvania, USA
| | - Bryson Lesniak
- Investigation performed at UPMC Freddie Fu Sports Medicine Center, Pittsburgh, Pennsylvania, USA
| | - Robert G Marx
- Investigation performed at UPMC Freddie Fu Sports Medicine Center, Pittsburgh, Pennsylvania, USA
| | - Gregory B Maletis
- Investigation performed at UPMC Freddie Fu Sports Medicine Center, Pittsburgh, Pennsylvania, USA
| | - Leo Pinczewski
- Investigation performed at UPMC Freddie Fu Sports Medicine Center, Pittsburgh, Pennsylvania, USA
| | - Anil Ranawat
- Investigation performed at UPMC Freddie Fu Sports Medicine Center, Pittsburgh, Pennsylvania, USA
| | - Bruce Reider
- Investigation performed at UPMC Freddie Fu Sports Medicine Center, Pittsburgh, Pennsylvania, USA
| | - Romain Seil
- Investigation performed at UPMC Freddie Fu Sports Medicine Center, Pittsburgh, Pennsylvania, USA
| | - Carola van Eck
- Investigation performed at UPMC Freddie Fu Sports Medicine Center, Pittsburgh, Pennsylvania, USA
| | - Brian R Wolf
- Investigation performed at UPMC Freddie Fu Sports Medicine Center, Pittsburgh, Pennsylvania, USA
| | - Patrick Yung
- Investigation performed at UPMC Freddie Fu Sports Medicine Center, Pittsburgh, Pennsylvania, USA
| | - Stefano Zaffagnini
- Investigation performed at UPMC Freddie Fu Sports Medicine Center, Pittsburgh, Pennsylvania, USA
| | - Ming Hao Zheng
- Investigation performed at UPMC Freddie Fu Sports Medicine Center, Pittsburgh, Pennsylvania, USA
| |
Collapse
|
10
|
Diermeier T, Meredith SJ, Irrgang JJ, Zaffagnini S, Kuroda R, Hochino Y, Samuelsson K, Smith CN, Popchak A, Musahl V, Sheean A, Burnham JM, Lian J, Smith C, Popchak A, Herbst E, Pfeiffer T, Araujo P, Oostdyk A, Guenther D, Ohashi B, Irrgang JJ, Fu FH, Nagamune K, Kurosaka M, Kuroda R, Hochino Y, Grassi A, Muccioli GMM, Lopomo N, Signorelli C, Raggi F, Zaffagnini S, Horvath A, Svantesson E, Senorski EH, Sundemo D, Bjoernsson H, Ahlden M, Desai N, Samuelsson K, Karlsson J. Patient-Reported and Quantitative Outcomes of Anatomic Anterior Cruciate Ligament Reconstruction With Hamstring Tendon Autografts. Orthop J Sports Med 2020; 8:2325967120926159. [PMID: 32685564 PMCID: PMC7343370 DOI: 10.1177/2325967120926159] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 02/19/2020] [Indexed: 01/17/2023] Open
Abstract
Background: The pivot-shift test has become more consistent and reliable and is a meaningful outcome measurement after anterior cruciate ligament reconstruction (ACLR). Purpose/Hypothesis: The purpose of this investigation was to assess patient-reported outcomes (PROs) and the quantitative pivot shift (QPS) preoperatively, at time zero immediately after anatomic ACLR, and after 24 months as well as the relationship between PROs and the QPS. It was hypothesized that anatomic ACLR would restore rotatory stability measured by the pivot-shift test and that QPS measurements would be positively correlated with PROs. Study Design: Cohort study; Level of evidence, 2. Methods: The ACL-injured and contralateral uninjured knees from 89 of 107 (83.2%) enrolled patients at 4 international centers were evaluated using a standardized pivot-shift test. Tibial acceleration was assessed with an inertial sensor, and lateral compartment translation was measured using an image analysis system preoperatively, at time zero immediately postoperatively, and at follow-up after 2 years. PROs were assessed at 12 and 24 months postoperatively with the International Knee Documentation Committee (IKDC) subjective knee form, Cincinnati Knee Rating System (CKRS), Marx activity rating scale, and activity of daily living score (ADLS). Results: The mean patient age at surgery was 27 years (range, 15-45 years). A positive pivot shift preoperatively (side-to-side difference in tibial acceleration, 2.6 ± 4.0 m/s2; side-to-side difference in anterior tibial translation, 2.0 ± 2.0 mm) was reduced at time zero postoperatively (side-to-side difference in tibial acceleration, –0.5 ± 1.3 m/s2; side-to-side difference in anterior tibial translation, –0.1 ± 1.0 mm). All PROs improved from preoperatively to final follow-up at 24 months: from 56.5 to 85.5 points for the IKDC (P = .0001), from 28.8 to 32.4 points for the CKRS (P = .04), from 11.2 to 7.9 points for the Marx (P < .0001), and from 75.7 to 91.6 points for the ADLS (P < .0001). Neither preoperative nor time zero postoperative rotatory laxity assessed by the pivot-shift test correlated with PROs at 24-month follow-up. A graft retear was observed in 4 patients (4.5%) within 2 years of follow-up. Conclusion: Anatomic ACLR resulted in significantly improved and acceptable PROs at 2-year follow-up and a low failure rate. Anatomic ACLR restored QPS measurements of anterior tibial translation and tibial acceleration to those of the contralateral knee immediately after surgery while still under anesthesia, but there was no correlation between the QPS preoperatively or at time zero after ACLR and PROs at 2-year follow-up.
Collapse
Affiliation(s)
- Theresa Diermeier
- Investigation performed at the University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Sean J Meredith
- Investigation performed at the University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - James J Irrgang
- Investigation performed at the University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Stefano Zaffagnini
- Investigation performed at the University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Ryosuke Kuroda
- Investigation performed at the University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Yuichi Hochino
- Investigation performed at the University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Kristian Samuelsson
- Investigation performed at the University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Clair Nicole Smith
- Investigation performed at the University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Adam Popchak
- Investigation performed at the University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Volker Musahl
- Investigation performed at the University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Andrew Sheean
- Investigation performed at the University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jeremy M Burnham
- Investigation performed at the University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jayson Lian
- Investigation performed at the University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Clair Smith
- Investigation performed at the University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Adam Popchak
- Investigation performed at the University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Elmar Herbst
- Investigation performed at the University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Thomas Pfeiffer
- Investigation performed at the University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Paulo Araujo
- Investigation performed at the University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Alicia Oostdyk
- Investigation performed at the University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Daniel Guenther
- Investigation performed at the University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Bruno Ohashi
- Investigation performed at the University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - James J Irrgang
- Investigation performed at the University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Freddie H Fu
- Investigation performed at the University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Kouki Nagamune
- Investigation performed at the University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Masahiro Kurosaka
- Investigation performed at the University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Ryosuke Kuroda
- Investigation performed at the University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Yuichi Hochino
- Investigation performed at the University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Alberto Grassi
- Investigation performed at the University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Nicola Lopomo
- Investigation performed at the University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Cecilia Signorelli
- Investigation performed at the University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Federico Raggi
- Investigation performed at the University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Stefano Zaffagnini
- Investigation performed at the University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Alexandra Horvath
- Investigation performed at the University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Eleonor Svantesson
- Investigation performed at the University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Eric Hamrin Senorski
- Investigation performed at the University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - David Sundemo
- Investigation performed at the University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Haukur Bjoernsson
- Investigation performed at the University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Mattias Ahlden
- Investigation performed at the University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Neel Desai
- Investigation performed at the University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Kristian Samuelsson
- Investigation performed at the University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jon Karlsson
- Investigation performed at the University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| |
Collapse
|
11
|
Non-invasive computer navigation can quantify the pivot shift maneuver with good to excellent reliability in healthy volunteers. J Exp Orthop 2020; 7:22. [PMID: 32303912 PMCID: PMC7163905 DOI: 10.1186/s40634-020-00239-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Accepted: 04/06/2020] [Indexed: 01/27/2023] Open
Abstract
PURPOSE The aim of this study was to determine the inter- and intra-observer reliability of knee laxity assessment using a non-invasive navigation system in a population of healthy young athletes. It was hypothesized that knee laxity parameters recorded using non-invasive computer navigation would demonstrate good inter- and intra-observer reliability. METHODS Healthy volunteers aged between 18 to 30 years were recruited to the study. Static and dynamic knee laxity parameters including anterior tibial translation and tibial rotation during the pivot shift test were recorded on awake patients using non-invasive computer navigation by two independent observers: at the first visit each athlete was evaluated by the consultant and resident surgeons independently; 6 weeks after the first visit all the participants were re-tested only by the resident surgeon. Inter- and intra-observer reliability was calculated and then interpreted according to Cicchetti's criteria. RESULTS One hundred healthy volunteers were recruited to the study, of these 38 were women (38%), and the average age was 25.5 ± 2.4 years. According to Cicchetti's criteria the intra- and inter-observer reliability for static measurements were fair for anterior tibial translation (0.572 and 0.529, respectively) and excellent for total passive tibial rotation (0.859 and 0.883, respectively). For the dynamic measurements of translation and rotation during the pivot shift maneuver both measurements demonstrated good to excellent reliability with intra and inter observer reliability ranging from 0.684 to 0.936. CONCLUSION Non-invasive navigation for the assessment of knee laxity is associated with fair to excellent inter- and intra-observer reliability in a population of healthy volunteers.
Collapse
|
12
|
Lian J, Diermeier T, Meghpara M, Popchak A, Smith CN, Kuroda R, Zaffagnini S, Samuelsson K, Karlsson J, Irrgang JJ, Musahl V. Rotatory Knee Laxity Exists on a Continuum in Anterior Cruciate Ligament Injury. J Bone Joint Surg Am 2020; 102:213-220. [PMID: 31876642 DOI: 10.2106/jbjs.19.00502] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this investigation was to compare the magnitude of rotatory knee laxity in patients with a partial anterior cruciate ligament (ACL) tear, those with a complete ACL tear, and those who had undergone a failed ACL reconstruction. It was hypothesized that rotatory knee laxity would increase with increasing injury grade, with knees with partial ACL tears demonstrating the lowest rotatory laxity and knees that had undergone failed ACL reconstruction demonstrating the highest rotatory laxity. METHODS A prospective multicenter study cohort of 354 patients who had undergone ACL reconstruction between 2012 and 2018 was examined. All patients had both injured and contralateral healthy knees evaluated using standardized, preoperative quantitative pivot shift testing, determined by a validated, image-based tablet software application and a surface-mounted accelerometer. Quantitative pivot shift was compared with the contralateral healthy knee in 20 patients with partial ACL tears, 257 patients with complete ACL tears, and 27 patients who had undergone a failed ACL reconstruction. Comparisons were made using 1-way analysis of variance (ANOVA) with post hoc 2-sample t tests with Bonferroni correction. Significance was set at p < 0.05. RESULTS There were stepwise increases in side-to-side differences in quantitative pivot shift in terms of lateral knee compartment translation for patients with partial ACL tears (mean [and standard deviation], 1.4 ± 1.5 mm), those with complete ACL tears (2.5 ± 2.1 mm), and those who had undergone failed ACL reconstruction (3.3 ± 1.9 mm) (p = 0.01) and increases in terms of lateral compartment acceleration for patients with partial ACL tears (0.7 ± 1.4 m/s), those with complete ACL tears (2.3 ± 3.1 m/s), and those who had undergone failed ACL reconstruction (2.4 ± 5.5 m/s) (p = 0.01). A significant difference in lateral knee compartment translation was found when comparing patients with partial ACL tears and those with complete ACL tears (1.2 ± 2.1 mm [95% confidence interval (CI), 0.2 to 2.1 mm]; p = 0.02) and patients with partial ACL tears and those who had undergone failed ACL reconstruction (1.9 ± 1.7 mm [95% CI, 0.8 to 2.9 mm]; p = 0.001), but not when comparing patients with complete ACL tears and those who had undergone failed ACL reconstruction (0.8 ± 2.1 [95% CI, -0.1 to 1.6 mm]; p = 0.09). Increased lateral compartment acceleration was found when comparing patients with partial ACL tears and those with complete ACL tears (1.5 ± 3.0 m/s [95% CI, 0.8 to 2.3 m/s]; p = 0.0002), but not when comparing patients with complete ACL tears and those who had undergone failed ACL reconstruction (0.1 ± 3.4 m/s [95% CI, -2.2 to 2.4 m/s]; p = 0.93) or patients with partial ACL tears and those who had undergone failed ACL reconstruction (1.7 ± 4.2 m/s [95% CI, -0.7 to 4.0 m/s]; p = 0.16). An increasing lateral compartment translation of the contralateral, ACL-healthy knee was found in patients with partial ACL tears (0.8 mm), those with complete ACL tears (1.2 mm), and those who had undergone failed ACL reconstruction (1.7 mm) (p < 0.05). CONCLUSIONS A progressive increase in rotatory knee laxity, defined by side-to-side differences in quantitative pivot shift, was observed in patients with partial ACL tears, those with complete ACL tears, and those who had undergone failed ACL reconstruction. These results may be helpful when assessing outcomes and considering indications for the management of high-grade rotatory knee laxity. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Jayson Lian
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.,Department of Orthopaedic Surgery, Montefiore Medical Center, New York, NY
| | - Theresa Diermeier
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.,Department of Orthopaedic Sport Medicine, Technical University Munich, Munich, Germany
| | - Mitchell Meghpara
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Adam Popchak
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Clair N Smith
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Stefano Zaffagnini
- Laboratorio di Biomeccanica e Innovazione Tecnologica, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Kristian Samuelsson
- Department of Orthopaedics, Sahlgrenska University Hospital, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Jón Karlsson
- Department of Orthopaedics, Sahlgrenska University Hospital, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - James J Irrgang
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.,Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Volker Musahl
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | | |
Collapse
|
13
|
Triaxial accelerometer evaluation is correlated with IKDC grade of pivot shift. Knee Surg Sports Traumatol Arthrosc 2020; 28:381-388. [PMID: 31201443 DOI: 10.1007/s00167-019-05563-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 06/07/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE The purpose of this study was to evaluate the correlation between tibial acceleration parameters measured by the KiRA device and the clinical grade of pivot shift. The secondary objective was to report the risk factors for pre-operative high-grade pivot shift. METHODS Two-hundred and ninety-five ACL deficient patients were examined under anesthesia. The pivot shift tests were performed twice by an expert surgeon. Clinical grading was performed using the International Knee Documentation Committee (IKDC) scale and tibial acceleration data was recorded using a triaxial accelerometer system (KiRA). The difference in the tibial acceleration range between injured and contralateral limbs was used in the analysis. Correlation coefficients were calculated using linear regression. Multivariate logistic regression was used to identify risk factors for high grade pivot shift. RESULTS The clinical grade of pivot shift and the side-to-side difference in delta tibial acceleration determined by KiRA were significantly correlated (r = 0.57; 95% CI 0.513-0.658, p < 0.0001). The only risk factor identified to have a significant association with high grade pivot shift was an antero-posterior side to side laxity difference > 6 mm (OR = 2.070; 95% CI (1.259-3.405), p = 0.0042). CONCLUSION Side-to-side difference in tibial acceleration range, as measured by KiRA, is correlated with the IKDC pivot shift grade in anaesthetized patients. Side-to-side A-P laxity difference greater than 6 mm is reported as a newly defined risk factor for high grade pivot shift in the ACL injured knee. DIAGNOSTIC STUDY Level II.
Collapse
|
14
|
Clinical outcomes after anterior cruciate ligament injury: panther symposium ACL injury clinical outcomes consensus group. Knee Surg Sports Traumatol Arthrosc 2020; 28:2415-2434. [PMID: 32767052 PMCID: PMC7429530 DOI: 10.1007/s00167-020-06061-x] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 05/10/2020] [Indexed: 01/16/2023]
Abstract
PURPOSE A stringent outcome assessment is a key aspect for establishing evidence-based clinical guidelines for anterior cruciate ligament (ACL) injury treatment. The aim of this consensus statement was to establish what data should be reported when conducting an ACL outcome study, what specific outcome measurements should be used and at what follow-up time those outcomes should be assessed. METHODS To establish a standardized approach to assessment of clinical outcome after ACL treatment, a consensus meeting including a multidisciplinary group of ACL experts was held at the ACL Consensus Meeting Panther Symposium, Pittsburgh, PA; USA, in June 2019. The group reached consensus on nine statements by using a modified Delphi method. RESULTS In general, outcomes after ACL treatment can be divided into four robust categories-early adverse events, patient-reported outcomes, ACL graft failure/recurrent ligament disruption and clinical measures of knee function and structure. A comprehensive assessment following ACL treatment should aim to provide a complete overview of the treatment result, optimally including the various aspects of outcome categories. For most research questions, a minimum follow-up of 2 years with an optimal follow-up rate of 80% is necessary to achieve a comprehensive assessment. This should include clinical examination, any sustained re-injuries, validated knee-specific PROs and Health-Related Quality of Life questionnaires. In the mid- to long-term follow-up, the presence of osteoarthritis should be evaluated. CONCLUSION This consensus paper provides practical guidelines for how the aforementioned entities of outcomes should be reported and suggests the preferred tools for a reliable and valid assessment of outcome after ACL treatment. LEVEL OF EVIDENCE V.
Collapse
|
15
|
Naendrup JH, Patel NK, Zlotnicki JP, Murphy CI, Debski RE, Musahl V. Education and repetition improve success rate and quantitative measures of the pivot shift test. Knee Surg Sports Traumatol Arthrosc 2019; 27:3418-3425. [PMID: 30715594 DOI: 10.1007/s00167-019-05370-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 01/24/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE Clinicians have different techniques and varying levels of experience with the pivot shift test, introducing variability into its performance. The purpose of this study was to evaluate the influence of teaching and repetition on the success rate and anterior translation of the lateral knee compartment during the pivot shift test in a cadaveric ACL injury model. METHODS Twenty-five participants (five each of medical students, orthopaedic surgery residents, physical therapists, athletic trainers, sports medicine fellows) were recruited and a senior orthopaedic surgeon served as gold standard examiner. Each participant performed 20 pivot shift tests on lower extremity cadaveric specimens with ACL deficiency and lateral meniscectomy: 5 prior to education (baseline), 10 after watching an instructional video (passive teaching), and 5 after an interactive education session (active teaching). The anterior translation of the lateral knee compartment was recorded during each pivot shift test using electromagnetic tracking system. RESULTS For medical students and orthopaedic surgery residents, significant improvement in success rate was found when compared to baseline (12% and 24%, respectively) after both passive (36% and 60%, respectively) and active teaching (52% and 72%, respectively) (p < 0.5). Medical students and residents were the only participants that independently achieved significant increases in anterior translation of the lateral knee compartment, each tripling the respective baseline value (p < 0.5). In the entire study population, significant increases in anterior translation of the lateral knee compartment and success rate of the pivot shift test were seen with continuous repetition (p < 0.5). However, the standard deviation of anterior translation of the lateral knee compartment was more than twice the gold standard examiner's standard deviation, indicating a high degree of variability. CONCLUSION Teaching of the pivot shift test plays a major role in the development of a proper technique. However, variability persisted despite teaching and repetition. New methods may be needed to improve the teaching of the pivot shift test.
Collapse
Affiliation(s)
- Jan-Hendrik Naendrup
- Department of Trauma and Orthopaedic Surgery, Cologne Merheim Medical Center, Witten/Herdecke University, Ostmerheimer Str. 200, 51109, Cologne, Germany. .,Orthopaedic Robotics Laboratory, Department of Bioengineering and Department of Orthopaedic Surgery, University of Pittsburgh, 300 Technology Drive, Pittsburgh, PA, 15219, USA.
| | - Neel K Patel
- Orthopaedic Robotics Laboratory, Department of Bioengineering and Department of Orthopaedic Surgery, University of Pittsburgh, 300 Technology Drive, Pittsburgh, PA, 15219, USA
| | - Jason P Zlotnicki
- Orthopaedic Robotics Laboratory, Department of Bioengineering and Department of Orthopaedic Surgery, University of Pittsburgh, 300 Technology Drive, Pittsburgh, PA, 15219, USA
| | - Conor I Murphy
- Orthopaedic Robotics Laboratory, Department of Bioengineering and Department of Orthopaedic Surgery, University of Pittsburgh, 300 Technology Drive, Pittsburgh, PA, 15219, USA
| | - Richard E Debski
- Orthopaedic Robotics Laboratory, Department of Bioengineering and Department of Orthopaedic Surgery, University of Pittsburgh, 300 Technology Drive, Pittsburgh, PA, 15219, USA
| | - Volker Musahl
- Orthopaedic Robotics Laboratory, Department of Bioengineering and Department of Orthopaedic Surgery, University of Pittsburgh, 300 Technology Drive, Pittsburgh, PA, 15219, USA
| |
Collapse
|
16
|
MajidiRad A, Yihun Y, Desai J, Hakansson NA. Simulation of Exoskeleton Alignment and its Effect on the Knee Extensor and Flexor Muscles. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2019; 2019:4093-4096. [PMID: 31946771 DOI: 10.1109/embc.2019.8856640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
This study presents the analysis of different knee joint impairments and their effects on the knee extensor and flexor muscles. Joint impairments can result from stroke, musculoskeletal diseases, or misalignment of an attached exoskeleton joint. Understanding the correlation between parameters involved in joint movement mechanisms as well as force interactions could provide insight to establish an appropriate design for exoskeletons. Joints can be powered or even be rectified in terms of alignment by exoskeletons to help a patient recover quickly. For the study, OpenSIM 4.0 was used to generate models and simulations of the human musculoskeletal structure with and without introduced knee joint impairments along the sagittal and transverse directions. A scenario to simulate the constraints of an exoskeleton designed with a single hinge joint to mimic the knee joint was also considered. Alterations to the knee joint axis within the range of +5.00 to -6.40 mm would result in a meaningful yet not a significant change in muscle stresses; the simulation outputs indicate that constraining the knee joint motion to the sagittal plane will only increase the force generated by the vastus lateralis muscle up to 4.3%.
Collapse
|
17
|
Distal femur morphology affects rotatory knee instability in patients with anterior cruciate ligament ruptures. Knee Surg Sports Traumatol Arthrosc 2019; 27:1514-1519. [PMID: 30374573 DOI: 10.1007/s00167-018-5269-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Accepted: 10/23/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE Distal femur morphology has been shown to influence knee joint kinematics and may affect rotatory knee laxity. The purpose of this study was to determine the relationship between rotatory knee laxity and distal femoral morphology in patients with complete anterior cruciate ligament (ACL) rupture. It was hypothesized that increased posterior femoral condylar depth on standard lateral radiographs, quantified as the "lateral femoral condyle ratio" would correlate with increased rotatory knee laxity, measured by a quantitative pivot shift test. METHODS Consecutive patients who underwent ACL reconstruction from 2014 to 2016 were retrospectively reviewed. A standardized pivot shift test was performed preoperatively on both knees and quantified using tablet technology. Using standard lateral radiographs of the knee, the ratio of posterior condylar distance over total condylar distance was defined as the lateral femoral condyle ratio. RESULTS Data sets were obtained for 57 patients. The mean anterior translation of the lateral knee compartment during a quantitative pivot shift test was found to be 4.0 ± 2.4 mm and 1.3 ± 0.9 mm for the injured and uninjured knees, respectively. The mean lateral femoral condyle ratio on X-ray was 63.2 ± 4.5%. There were significant correlations between the lateral femoral condyle ratio and the absolute quantitative (ρ = 0.370, p < 0.05) and side-to-side differences in anterior translation of the lateral knee compartment (ρ = 0.419, p < 0.05). CONCLUSION The most important finding from this study is that increased posterior femoral condylar depth, quantified as a lateral femoral condyle ratio, is associated with increased rotatory knee laxity in ACL-deficient patients. This suggests that distal femur morphology may influence rotatory knee laxity. This study may assist clinicians in evaluating ACL injuries and identifying patients at greater risk for persistent increased rotatory knee laxity after ACL reconstruction. LEVEL OF EVIDENCE III.
Collapse
|
18
|
Naendrup JH, Zlotnicki JP, Murphy CI, Patel NK, Debski RE, Musahl V. Influence of knee position and examiner-induced motion on the kinematics of the pivot shift. J Exp Orthop 2019; 6:11. [PMID: 30888526 PMCID: PMC6424983 DOI: 10.1186/s40634-019-0183-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 03/07/2019] [Indexed: 11/10/2022] Open
Abstract
Background Grading of the pivot shift test varies significantly depending on the examiner’s technique. Thus, the purpose of this study was to determine the influence of knee starting position and the magnitude of motion during the reduction event on the magnitude of the pivot shift test. Methods Twenty-five clinical providers each performed a total of twenty pivot shift tests on one of two fresh-frozen cadaveric full lower extremity specimens with different grades of rotatory knee laxity. By means of ACL transection and lateral meniscectomy, one specimen was prepared to have a high-grade pivot shift and one to have a low-grade pivot shift. Six-degree-of-freedom kinematics were recorded during each pivot shift test using an electromagnetic-tracking-system. Successful pivot shift tests were defined and selected using an automated, mathematical algorithm based on the exceeding of a threshold value of anterior translation of the lateral knee compartment. The kinematics were correlated with the magnitude of anterior translation of the lateral knee compartment based on varying degrees of rotatory knee laxity using the Pearson correlation coefficient. Results Only mild correlations between anterior translation of the lateral knee compartment and internal tibial rotation at the start of the reduction event were observed in both specimens. The ability to generate a successful reduction event was significantly dependent on the rotatory knee laxity, with a 54% success rate on the high-laxity specimen compared to a 30% success rate on the low-laxity specimen (p < 0.001). Nearly 80% of the variability of the anterior translation of the lateral knee compartment in both specimens was accounted for by external rotation during the reduction event (r = 0.847; p < 0.001). Varus rotation during the reduction event also showed a strong correlation with the anterior translation of the lateral knee compartment in the low-laxity specimen (r = 0.835; p < 0.001). Conclusion Magnitude of motion during the reduction event affected the magnitude of anterior translation of the lateral knee compartment more than the starting position. External rotation during the reduction event accounted for most of the variability in the pivot shift test. More uniform maneuvers and improved teaching are essential to generate repeatable quantitative results of the pivot shift test.
Collapse
Affiliation(s)
- Jan-Hendrik Naendrup
- Department of Trauma and Orthopaedic Surgery, Cologne Merheim Medical Center, Witten/Herdecke University, Cologne, Germany.,Orthopaedic Robotics Laboratory, Department of Bioengineering and Department of Orthopaedic Surgery, University of Pittsburgh, Center for Bioengineering - CNBIO, 300 Technology Drive, Pittsburgh, PA, 15219, USA
| | - Jason P Zlotnicki
- Orthopaedic Robotics Laboratory, Department of Bioengineering and Department of Orthopaedic Surgery, University of Pittsburgh, Center for Bioengineering - CNBIO, 300 Technology Drive, Pittsburgh, PA, 15219, USA
| | - Conor I Murphy
- Orthopaedic Robotics Laboratory, Department of Bioengineering and Department of Orthopaedic Surgery, University of Pittsburgh, Center for Bioengineering - CNBIO, 300 Technology Drive, Pittsburgh, PA, 15219, USA
| | - Neel K Patel
- Orthopaedic Robotics Laboratory, Department of Bioengineering and Department of Orthopaedic Surgery, University of Pittsburgh, Center for Bioengineering - CNBIO, 300 Technology Drive, Pittsburgh, PA, 15219, USA
| | - Richard E Debski
- Orthopaedic Robotics Laboratory, Department of Bioengineering and Department of Orthopaedic Surgery, University of Pittsburgh, Center for Bioengineering - CNBIO, 300 Technology Drive, Pittsburgh, PA, 15219, USA
| | - Volker Musahl
- Orthopaedic Robotics Laboratory, Department of Bioengineering and Department of Orthopaedic Surgery, University of Pittsburgh, Center for Bioengineering - CNBIO, 300 Technology Drive, Pittsburgh, PA, 15219, USA.
| |
Collapse
|
19
|
Lian J, Novaretti JV, Sheean AJ, Patel NK, Whaley S, Popchak A, Musahl V. Static Lateral Tibial Plateau Subluxation Predicts High-Grade Rotatory Knee Laxity in Anterior Cruciate Ligament-Deficient Knees. Am J Sports Med 2019; 47:277-284. [PMID: 30525899 DOI: 10.1177/0363546518812435] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND In anterior cruciate ligament-deficient (ACL-D) knees, injury pattern and bony morphologic features have been shown to influence both static anterior tibial subluxation relative to the femur and dynamic rotatory knee laxity. Therefore, the relationship between static anterior tibial subluxation and dynamic rotatory knee laxity was investigated. PURPOSE To determine whether static tibial subluxation as measured on magnetic resonance imaging (MRI) is associated with the grade of rotatory knee laxity in ACL-D knees. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS Two-hundred fifty-eight knees underwent preoperative, image-guided assessment of lateral knee compartment translation during quantitative pivot shift (QPS). Subluxations of the medial and lateral tibial plateaus were measured on preoperative MRI in a subset of primary ACL-D knees meeting criteria for high-grade (QPS > 5.2 mm) and low-grade (QPS < 2.4 mm) rotatory laxity. Tibial subluxations on MRI were compared between patients with high- and low-grade rotatory laxity through use of pairwise t test and were analyzed via univariate and multivariate logistic regression. Significance was set at P < .05. RESULTS On MRI, greater anterior subluxation of the lateral tibial plateau was observed in patients with high-grade compared with low-grade rotatory knee laxity (4.5 mm vs 2.3 mm; P < .05). No similar relationship was observed for the medial tibial plateau (-0.9 mm vs -0.4 mm; P > .05). Univariate logistic regression demonstrated that static subluxation of the lateral tibial plateau was associated with high-grade rotatory knee laxity (odds ratio [OR], 1.2; P < .05). An optimal cutoff of 2.95 mm of static lateral tibial subluxation was associated with high-grade rotatory knee laxity (sensitivity, 75%; specificity, 63%). Lateral meniscal injury was the first variable entered into a multivariate regression analysis and proved to be most associated with high-grade rotatory knee laxity (OR, 6.8; P < .05). When lateral meniscal injury was excluded from multivariate regression analysis, static anterior subluxation of the lateral tibial plateau alone was associated with high-grade rotatory knee laxity (OR, 1.2; P < .05). CONCLUSION Data from this MRI study of two distinct rotatory knee laxity groups showed that static anterior subluxation of the lateral tibial plateau of 2.95 mm or greater was associated with high-grade rotatory knee laxity, and each millimeter increase of lateral tibial plateau subluxation was associated with a 1.2-fold odds of high-grade rotatory knee laxity. Anterior subluxation of the lateral tibial plateau on MRI was not independently associated with high-grade rotatory knee laxity in the presence of concomitant lateral meniscal injury. Static measurements made preoperatively may aid in predicting high-grade rotatory knee laxity and refining the indications for individualized knee surgery.
Collapse
Affiliation(s)
- Jayson Lian
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.,Albert Einstein College of Medicine, Bronx, New York, USA
| | - João V Novaretti
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.,Orthopaedics and Traumatology Sports Center (CETE), Department of Orthopaedics and Traumatology, Paulista School of Medicine (EPM), Federal University of São Paulo, São Paulo, Brazil
| | - Andrew J Sheean
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Neel K Patel
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Sean Whaley
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Adam Popchak
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Volker Musahl
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| |
Collapse
|
20
|
Musahl V, Burnham J, Lian J, Popchak A, Svantesson E, Kuroda R, Zaffagnini S, Samuelsson K. High-grade rotatory knee laxity may be predictable in ACL injuries. Knee Surg Sports Traumatol Arthrosc 2018; 26:3762-3769. [PMID: 29931484 DOI: 10.1007/s00167-018-5019-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 06/07/2018] [Indexed: 01/26/2023]
Abstract
PURPOSE Lateral compartment acceleration and translation have been used to quantify rotatory knee laxity in the setting of anterior cruciate ligament (ACL) injury; however, their relationship remains elusive. The purpose of this study was to examine the correlation between lateral compartment acceleration and translation during pivot shift testing. It was hypothesized that a correlation would exist in ACL-injured and uninjured knees, irrespective of sex, but would be greatest in knees with combined ACL and lateral meniscus tear. METHODS Seventy-seven patients (34 females, 25.2 ± 9.0 years) undergoing primary single-bundle ACL reconstruction were prospectively enrolled in a 2-year study across four international centers. Patients underwent preoperative examination under anesthesia of the injured and uninjured knee using Image Analysis software and surface mounted accelerometer. RESULTS A moderate correlation between lateral compartment acceleration and translation was observed in ACL-injured knees [ρ = 0.36, p < 0.05), but not in uninjured knees (ρ = 0.17, not significant (n.s.)]. A moderate correlation between acceleration and translation was demonstrated in ACL-injured knees with lateral meniscus tears (ρ = 0.53, p < 0.05), but not in knees with isolated ACL-injury (ρ = 0.32, n.s.), ACL and medial meniscus tears (ρ = 0.14, n.s.), or ACL and combined medial and lateral meniscus tears (ρ = 0.40, n.s.). A moderate correlation between acceleration and translation was seen in males (ρ = 0.51, p < 0.05), but not in females (ρ = 0.21, n.s.). Largest correlations were observed in males with ACL and lateral meniscus tears (ρ = 0.75, p < 0.05). CONCLUSION Lateral compartment acceleration and translation were moderately correlated in ACL-injured knees, but largely correlated in males with combined ACL and lateral meniscus tears. ACL and lateral meniscus injury in males might, therefore, be suspected when both lateral compartment acceleration and translation are elevated. Surgeons should have a greater degree of suspicion for high-grade rotatory knee laxity in ACL-injured males with concomitant lateral meniscus tears. Future studies should investigate how these two distinct components of rotatory knee laxity-lateral compartment acceleration and translation-are correlated with patient outcomes and affected by ACL surgery. LEVEL OF EVIDENCE Prospective cohort study; Level of evidence II.
Collapse
Affiliation(s)
- Volker Musahl
- UPMC Center for Sports Medicine, Department of Orthopaedic Surgery, University of Pittsburgh, 3200 S Water Street, Pittsburgh, PA, 15203, USA.
| | - Jeremy Burnham
- UPMC Center for Sports Medicine, Department of Orthopaedic Surgery, University of Pittsburgh, 3200 S Water Street, Pittsburgh, PA, 15203, USA
| | - Jayson Lian
- UPMC Center for Sports Medicine, Department of Orthopaedic Surgery, University of Pittsburgh, 3200 S Water Street, Pittsburgh, PA, 15203, USA.,Albert Einstein College of Medicine, Bronx, NY, 10461, USA
| | - Adam Popchak
- UPMC Center for Sports Medicine, Department of Orthopaedic Surgery, University of Pittsburgh, 3200 S Water Street, Pittsburgh, PA, 15203, USA
| | - Eleonor Svantesson
- Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Orthopedics, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University, Kobe, Japan
| | - Stefano Zaffagnini
- Laboratorio di Biomeccanica e Innovazione Tecnologica, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Kristian Samuelsson
- Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Orthopedics, Sahlgrenska University Hospital, Mölndal, Sweden
| | | |
Collapse
|
21
|
Adhikari V, MajidRad A, Yihun Y, Desai J. Assist-as-Needed Controller to a Task-based Knee Rehabilitation Exoskeleton. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2018; 2018:3212-3215. [PMID: 30441075 DOI: 10.1109/embc.2018.8512850] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
This research aims to design and implement an assist-as-needed controller and patient recovery tracking system into a novel task based knee rehabilitation exoskeleton device. The level of support from the exoskeleton is measured through the force sensing resistors (FSR) placed in the interface of lower- leg and the exoskeleton. The signal from the FSR is used as a feedback to control the actuator torque. The intent of the user to start, stop, move left, and right are associated with muscle activities, surface electromyography (sEMG) signals in the upper-leg. The preliminary results have shown that the system has provided the user a visual display of the amount of recovery and history while providing full autonomy to control the exoskeleton device. The successful implementation of these features can eliminate the need of constant supervision, and hence saves time and reduces cost of the rehabilitation process; which can also be used in a home-based or telerehabilitation settings.
Collapse
|
22
|
The diagnostic reliability of the quantitative pivot-shift evaluation using an electromagnetic measurement system for anterior cruciate ligament deficiency was superior to those of the accelerometer and iPad image analysis. Knee Surg Sports Traumatol Arthrosc 2018; 26:2835-2840. [PMID: 29030647 DOI: 10.1007/s00167-017-4734-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 09/27/2017] [Indexed: 01/23/2023]
Abstract
PURPOSE Several non-invasive devices have been developed to obtain quantitative assessment of the pivot-shift test in clinical setting using similar but diverse measurement parameters. However, the clinical usability of those measurements has yet to be closely investigated and compared. The purpose of this study was to compare the diagnostic accuracy of three non-invasive measurement devices for the pivot-shift test. METHODS Thirty patients with unilateral anterior cruciate ligament (ACL) injury were enrolled. The pivot-shift test was performed under general anaesthesia. Three devices, an accelerometer system (KiRA), an image analysis iPad application (iPad), and electromagnetic measurement system (EMS), were used simultaneously to provide two parameters, namely tibial acceleration monitored using KiRA and EMS, and tibial translation recorded using iPad and EMS. Side-to-side differences in each parameter and correlation between the measurements were tested, and a receiver-operating characteristic (ROC) curve analysis was conducted to compare their measurement accuracy. RESULTS Significant side-to-side differences were successfully detected using any of the measurements (all p < 0.01). KiRA demonstrated moderate correlation with the EMS for tibial acceleration (r = 0.54; p < 0.01), while poor correlation was observed between iPad and the EMS for the translation (r = 0.28; p < 0.01). The ROC curve analysis demonstrated better accuracy for the detection of ACL insufficiency in the EMS than KiRA and iPad for tibial acceleration and translation, respectively. CONCLUSIONS Although all three measurements were similarly capable of detecting ACL deficiency, the EMS has the advantage of comprehensive evaluation of the pivot-shift test by evaluating both tibial acceleration and translation with higher accuracy than those of KiRA and iPad. It could be suggested that any of those measurement tools might improve the clinical diagnosis of ACL insufficiency. LEVEL OF EVIDENCE Diagnostic study of consecutive patients with a universally applied gold standard, Level Ib.
Collapse
|
23
|
Kanakamedala AC, Burnham JM, Pfeiffer TR, Herbst E, Kowalczuk M, Popchak A, Irrgang J, Fu FH, Musahl V. Lateral femoral notch depth is not associated with increased rotatory instability in ACL-injured knees: a quantitative pivot shift analysis. Knee Surg Sports Traumatol Arthrosc 2018; 26:1399-1405. [PMID: 29119285 DOI: 10.1007/s00167-017-4770-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 10/30/2017] [Indexed: 11/27/2022]
Abstract
PURPOSE A deep lateral femoral notch (LFN) on lateral radiographs is indicative of ACL injury. Prior studies have suggested that a deep LFN may also be a sign of persistent rotatory instability and a concomitant lateral meniscus tear. Therefore, the purpose of this study was to evaluate the relationship between LFN depth and both quantitative measures of rotatory knee instability and the incidence of lateral meniscus tears. It was hypothesized that greater LFN depth would be correlated with increased rotatory instability, quantified by lateral compartment translation and tibial acceleration during a quantitative pivot shift test, and incidence of lateral meniscus tears. METHODS ACL-injured patients enrolled in a prospective ACL registry from 2014 to 2016 were analyzed. To limit confounders, patients were only included if they had primary ACL tears, no concurrent ligamentous or bony injuries requiring operative treatment, and no previous knee injuries or surgeries to either knee. Eighty-four patients were included in the final analysis. A standardized quantitative pivot shift test was performed pre-operatively under anesthesia in both knees, and rotatory instability, specifically lateral compartment translation and tibial acceleration, was quantified using tablet image analysis software and accelerometer sensors. Standard lateral radiographs and sagittal magnetic resonance images (MRI) of the injured knee were evaluated for LFN depth. RESULTS There were no significant correlations between LFN depth on either imaging modality and ipsilateral lateral compartment translation or tibial acceleration during a quantitative pivot shift test or side-to-side differences in these measurements. Patients with lateral meniscus tears were found to have significantly greater LFN depths than those without on conventional radiograph and MRI (1.0 vs. 0.6 mm, p < 0.05; 1.2 vs. 0.8 mm, p < 0.05, respectively). CONCLUSION There was no correlation between lateral femoral notch depth on conventional radiographs or MRI and quantitative measures of rotatory instability. Concomitant lateral meniscus injury was associated with significantly greater LFN depth. Based on these findings, LFN depth should not be used as an indicator of excessive rotatory instability, but may be an indicator of lateral meniscus injury in ACL-injured patients. LEVEL OF EVIDENCE Prognostic level IV.
Collapse
Affiliation(s)
- Ajay C Kanakamedala
- Department of Orthopaedic Surgery, Center for Sports Medicine, UPMC Rooney Sports Complex, University of Pittsburgh Medical Center, 3200 S Water Street, Pittsburgh, PA, 15203, USA
| | - Jeremy M Burnham
- Department of Orthopaedic Surgery, Center for Sports Medicine, UPMC Rooney Sports Complex, University of Pittsburgh Medical Center, 3200 S Water Street, Pittsburgh, PA, 15203, USA
| | - Thomas R Pfeiffer
- Department of Orthopaedic Surgery, Trauma Surgery and Sports Medicine, Cologne Merheim Medical Center, Witten/Herdecke University, 51109, Cologne, Germany
| | - Elmar Herbst
- Department of Orthopaedic Sports Medicine, Technical University Munich, 81675, Munich, Germany
| | - Marcin Kowalczuk
- Department of Orthopaedic Surgery, Center for Sports Medicine, UPMC Rooney Sports Complex, University of Pittsburgh Medical Center, 3200 S Water Street, Pittsburgh, PA, 15203, USA
| | - Adam Popchak
- Department of Orthopaedic Surgery, Center for Sports Medicine, UPMC Rooney Sports Complex, University of Pittsburgh Medical Center, 3200 S Water Street, Pittsburgh, PA, 15203, USA
| | - James Irrgang
- Department of Orthopaedic Surgery, Center for Sports Medicine, UPMC Rooney Sports Complex, University of Pittsburgh Medical Center, 3200 S Water Street, Pittsburgh, PA, 15203, USA
| | - Freddie H Fu
- Department of Orthopaedic Surgery, Center for Sports Medicine, UPMC Rooney Sports Complex, University of Pittsburgh Medical Center, 3200 S Water Street, Pittsburgh, PA, 15203, USA
| | - Volker Musahl
- Department of Orthopaedic Surgery, Center for Sports Medicine, UPMC Rooney Sports Complex, University of Pittsburgh Medical Center, 3200 S Water Street, Pittsburgh, PA, 15203, USA.
| |
Collapse
|
24
|
Female sex is associated with greater rotatory knee laxity in collegiate athletes. Knee Surg Sports Traumatol Arthrosc 2018; 26:1319-1325. [PMID: 28823037 DOI: 10.1007/s00167-017-4684-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 08/16/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE/HYPOTHESIS The purpose of this observational study was to determine which factors, including sex, are associated with increased rotatory knee laxity in collegiate athletes with no history of knee injuries. It was hypothesized that increased rotatory knee laxity, measured by a quantitative pivot shift test, would correlate with female sex, increased anterior translation during the Lachman test, generalized ligamentous laxity, and knee hyperextension. METHODS Ninety-eight collegiate athletes with a median age of 20 (range 18-25) years with no history of knee injuries were tested. IKDC and Marx activity scores were obtained and subjects underwent measurement of anterior translation during the Lachman test with a Rolimeter and measurement of knee hyperextension with a goniometer for both knees. A standardized pivot shift test was performed in both knees and quantified using image analysis technology. Generalized ligamentous laxity was assessed using the modified Beighton score. RESULTS The average anterior translation of the lateral compartment during the pivot shift test was 1.6 mm (range 0.1-7.1) with a mean side-to-side difference of 0.6 mm (range 0-2.7). The average anterior translation during the Lachman test was 9.0 (range 2-15). The anterior translation of the lateral compartment during the pivot shift test was significantly higher in females (median, 1.6; range 0.3-4.9) than in males (1.1, 0.1-7.1 mm) (p < 0.05). Anterior translation of the lateral compartment during the pivot shift test was significantly correlated with anterior translation during the Lachman test (r = 0.34; p < 0.05). There was no significant correlation between anterior translation of the lateral compartment during the pivot shift test and knee hyperextension or modified Beighton score (n.s). CONCLUSION The data from this study show that female sex is associated with increased rotatory knee laxity measured during the pivot shift test and anterior translation during the Lachman test in collegiate athletes. In the future, these data may be helpful in diagnosing and managing ACL injuries in athletes and could be used in the clinic as a baseline by which to compare and identify patients who might exhibit increased rotatory laxity. LEVEL OF EVIDENCE Diagnostic level II.
Collapse
|
25
|
Svantesson E, Hamrin Senorski E, Mårtensson J, Zaffagnini S, Kuroda R, Musahl V, Karlsson J, Samuelsson K. Static anteroposterior knee laxity tests are poorly correlated to quantitative pivot shift in the ACL-deficient knee: a prospective multicentre study. J ISAKOS 2018. [DOI: 10.1136/jisakos-2017-000196] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
|
26
|
Sundemo D, Blom A, Hoshino Y, Kuroda R, Lopomo NF, Zaffagnini S, Musahl V, Irrgang JJ, Karlsson J, Samuelsson K. Correlation between quantitative pivot shift and generalized joint laxity: a prospective multicenter study of ACL ruptures. Knee Surg Sports Traumatol Arthrosc 2018; 26:2362-2370. [PMID: 29150746 PMCID: PMC6061776 DOI: 10.1007/s00167-017-4785-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 10/30/2017] [Indexed: 12/16/2022]
Abstract
PURPOSE To investigate whether an increased magnitude of quantitative rotatory knee laxity is associated with a greater level of generalized joint laxity in ACL-injured and contralateral knees. METHODS A total of 103 patients were enrolled across four international centers to undergo anatomic ACL reconstruction. Rotatory knee laxity was evaluated preoperatively, both in the awake state and under anesthesia, using the standardized pivot shift test. Two devices were used to quantify rotatory knee laxity; an inertial sensor, measuring the joint acceleration, and an image analysis system, measuring the lateral compartment translation of the tibia. The presence of generalized joint laxity was determined using the Beighton Hypermobility Score. The correlation between the level of generalized joint laxity and the magnitude of rotatory knee laxity was calculated for both the involved knee and the non-involved knee. Further, patients were dichotomized into low (0-4) or high (5-9) Beighton Score groups. Alpha was set at < 0.05. RESULTS Ninety-six patients had complete datasets, 83 and 13 in the low and high Beighton Score groups respectively. In anesthetized patients, there was a significant correlation between the degree of Beighton Score and quantitative pivot shift when analyzing the non-involved knee using the image analysis system (r = 0.235, p < 0.05). When analyzing the same knee, multivariate analysis adjusted for meniscal injury, age and gender revealed an increased odds ratio for patients with increased lateral compartment translation to be part of the high Beighton Score group (OR 1.86, 95% CI 1.10-3.17, p < 0.05). No other correlation was significant. When analyzing the dichotomized subgroups, no significant correlations could be established. CONCLUSION The findings in this study suggest that there is a weak correlation between generalized joint laxity and the contralateral healthy knee, indicating increased rotatory knee laxity in these patients. Generalized joint laxity does not appear to correlate with rotatory knee laxity in ACL-injured knees. LEVEL OF EVIDENCE Prospective cohort study; level of evidence, 2.
Collapse
Affiliation(s)
- David Sundemo
- Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Anna Blom
- Närhälsan Torslanda Rehabilitation Center, Torslanda, Sweden
| | - Yuichi Hoshino
- Department of Orthopaedic Surgery, Kobe University, Kobe, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University, Kobe, Japan
| | - Nicola Francesco Lopomo
- Dipartimento di Ingengeria dell’Informazione, Università degli Studi di Brescia, Brescia, Italy ,Laboratorio di Biomeccanica e Innovazione Tecnologica, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Stefano Zaffagnini
- Laboratorio di Biomeccanica e Innovazione Tecnologica, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Volker Musahl
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA USA
| | - James J. Irrgang
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA USA
| | - Jón Karlsson
- Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden ,Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Kristian Samuelsson
- Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden ,Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden
| | | |
Collapse
|
27
|
Analysis of the influence of anaesthesia on the clinical and quantitative assessment of the pivot shift: a multicenter international study. Knee Surg Sports Traumatol Arthrosc 2017; 25:3004-3011. [PMID: 27095250 DOI: 10.1007/s00167-016-4130-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 04/05/2016] [Indexed: 01/18/2023]
Abstract
PURPOSE The main goal of this work was to evaluate the pivot shift test in awake and anesthetized patients by using two different quantitative methodologies and comparing the results with the standard clinical grading, taking advantage of a multicenter international study. METHODS Patients between 16 and 50 years of age undergoing primary unilateral single-bundle anterior cruciate ligament (ACL) reconstruction were considered eligible. The pivot shift test was performed pre-operatively, with the patient awake and again with the patient under general anaesthesia. The pivot shift test was clinically graded as defined by the International Knee Documentation Committee. The instrumented assessment was performed by using two non-invasive acquisition systems; specifically, a system exploiting an inertial sensor and a video-based application developed on a commercial tablet using skin markers. Lateral compartment translation and the tibial acceleration reached during joint reduction were used as quantitative parameters. RESULTS A total of 103 patients were enrolled in the study. Statistically significant difference was found between the distributions of clinical grade evaluated in awake patients and those under general anaesthesia (P < 0.01). Comparing awake patients to those under general anaesthesia, lower values were found both for tibial acceleration (3.7 ± 1.5 vs 6.0 ± 4.6 m/s2, P < 0.01) and lateral compartment translation of the involved limb (2.2 ± 1.7 vs 3.0 ± 2.2 mm, P < 0.01). CONCLUSIONS This study indicated that significant differences in the grading of the pivot shift test exist between awake and anesthetized patients, regardless of the use of quantitative instruments during the evaluation. Actual clinical assessment reported indeed its weakness, presenting subjective variability and dependence on tester's experience. However, several factors might influence the validity of awake examination such as experience level of examiner and cultural factors, as seen in this international multicenter study. LEVEL OF EVIDENCE Prospective comparative study, Level II.
Collapse
|
28
|
Sonnery-Cottet B, Daggett M, Fayard JM, Ferretti A, Helito CP, Lind M, Monaco E, de Pádua VBC, Thaunat M, Wilson A, Zaffagnini S, Zijl J, Claes S. Anterolateral Ligament Expert Group consensus paper on the management of internal rotation and instability of the anterior cruciate ligament - deficient knee. J Orthop Traumatol 2017; 18:91-106. [PMID: 28220268 PMCID: PMC5429259 DOI: 10.1007/s10195-017-0449-8] [Citation(s) in RCA: 146] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Purpose of this paper is to provide an overview of the latest research on the anterolateral ligament (ALL) and present the consensus of the ALL Expert Group on the anatomy, radiographic landmarks, biomechanics, clinical and radiographic diagnosis, lesion classification, surgical technique and clinical outcomes. A consensus on controversial subjects surrounding the ALL and anterolateral knee instability has been established based on the opinion of experts, the latest publications on the subject and an exchange of experiences during the ALL Experts Meeting (November 2015, Lyon, France). The ALL is found deep to the iliotibial band. The femoral origin is just posterior and proximal to the lateral epicondyle; the tibial attachment is 21.6 mm posterior to Gerdy's tubercle and 4-10 mm below the tibial joint line. On a lateral radiographic view the femoral origin is located in the postero-inferior quadrant and the tibial attachment is close to the centre of the proximal tibial plateau. Favourable isometry of an ALL reconstruction is seen when the femoral position is proximal and posterior to the lateral epicondyle, with the ALL being tight upon extension and lax upon flexion. The ALL can be visualised on ultrasound, or on T2-weighted coronal MRI scans with proton density fat-suppressed evaluation. The ALL injury is associated with a Segond fracture, and often occurs in conjunction with acute anterior cruciate ligament (ACL) injury. Recognition and repair of the ALL lesions should be considered to improve the control of rotational stability provided by ACL reconstruction. For high-risk patients, a combined ACL and ALL reconstruction improves rotational control and reduces the rate of re-rupture, without increased postoperative complication rates compared to ACL-only reconstruction. In conclusion this paper provides a contemporary consensus on all studied features of the ALL. The findings warrant future research in order to further test these early observations, with the ultimate goal of improving the long-term outcomes of ACL-injured patients. Level of evidence Level V-Expert opinion.
Collapse
Affiliation(s)
- Bertrand Sonnery-Cottet
- Centre Orthopédique Paul Santy, FIFA Medical Center of Excellence, Groupe Ramsay-Generale de Santé, 24 avenue Paul Santy, 69008 Lyon, France
| | | | - Jean-Marie Fayard
- Centre Orthopédique Paul Santy, FIFA Medical Center of Excellence, Groupe Ramsay-Generale de Santé, 24 avenue Paul Santy, 69008 Lyon, France
| | - Andrea Ferretti
- Orthopaedic Unit and Kirk Kilgour Sports Injury Center, Sant’Andrea University Hospital, “Sapienza” University of Rome, Rome, Italy
| | | | - Martin Lind
- Division of Sportstraumatology, Department of Orthopedics, Aarhus University Hospital, Tage Hansens Gade 2, 8000 Aarhus C, Denmark
| | - Edoardo Monaco
- Orthopaedic Unit and Kirk Kilgour Sports Injury Center, Sant’Andrea University Hospital, “Sapienza” University of Rome, Rome, Italy
| | - Vitor Barion Castro de Pádua
- Associação Beneficente Hospital Universitário de Marilia-SP Brazil, Cidade Universitária, Rua Dr Prospero Cecilio Coimbra 80, Marilia, SP 17525-160 Brazil
| | - Mathieu Thaunat
- Centre Orthopédique Paul Santy, FIFA Medical Center of Excellence, Groupe Ramsay-Generale de Santé, 24 avenue Paul Santy, 69008 Lyon, France
| | - Adrian Wilson
- Department of Sport and Exercise, Sport and Exercise Research Centre, University of Winchester, Winchester, SO22 4NR UK
| | - Stefano Zaffagnini
- Dipartimento Rizzoli Sicilia, Ortopedia e Traumatologia, Università di Bologna, SS 113 al km 246, 90011 Bagheria, PA Italy
| | - Jacco Zijl
- St. Antonius Hospital, Soestwetering 1, 3543 AZ Utrecht, The Netherlands
| | - Steven Claes
- Department of Orthopaedic Surgery and Traumatology, AZ Herentals, Herentals, Belgium
| |
Collapse
|
29
|
Abstract
This article reviews the evidence for the roles of the anterolateral soft-tissue structures in rotatory stability of the knee, including their structural properties, isometry, and contributions to resisting tibial internal rotation. These data then lead to a biomechanical demonstration that the ilio-tibial band is the most important structure for the restraint of anterolateral rotatory instability. Level of evidence V.
Collapse
Affiliation(s)
- Andrew A Amis
- Biomechanics Group, Mechanical Engineering Department, Imperial College London, London, SW7 2AZ, UK.
- Musculoskeletal Surgery Group, Department of Surgery and Cancer, Imperial College London School of Medicine, London, W6 8RF, UK.
| |
Collapse
|
30
|
Rahnemai-Azar AA, Abebe ES, Johnson P, Labrum J, Fu FH, Irrgang JJ, Samuelsson K, Musahl V. Increased lateral tibial slope predicts high-grade rotatory knee laxity pre-operatively in ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 2017; 25:1170-1176. [PMID: 27154279 DOI: 10.1007/s00167-016-4157-3] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2015] [Accepted: 04/27/2016] [Indexed: 01/28/2023]
Abstract
PURPOSE To determine the influence of anatomical features of both the tibia and femur on quantitative pivot shift of anterior cruciate ligament (ACL)-injured patients. METHODS Fifty-three consecutive ACL-injured patients (mean age 26 ± 10.1 years, 36 males) who underwent ACL reconstruction were prospectively enrolled. Two blinded observers measured the parameters of medial and lateral tibial slope, femoral condyle width, notch width, bicondylar width and tibial plateau width on magnetic resonance imaging. The same examiner performed pivot shift under anaesthesia, while a previously validated image analysis technique was used to quantify knee kinematics during examination. The median lateral compartment translation detected during pivot shift testing (2.8 mm) was used to classify patients into "low-grade rotatory laxity" (≤2.8 mm) and "high-grade rotatory laxity" (>2.8 mm) groups. RESULTS Twenty-nine subjects were grouped as "low-grade rotatory laxity", and 24 subjects were grouped as "high-grade rotatory laxity". Of the tested bone morphologic parameters, lateral tibial plateau slope was significantly greater in "high-grade rotatory laxity" group (9.3° ± 3.4°) compared to "low-grade rotatory laxity" group (6.1° ± 3.7°) (p < 0.05). Lateral tibial plateau slope was a significant predictor of "high-grade rotatory laxity" (odds ratio 1.27, p < 0.05). A tibial slope of 9° and greater predicted "high-grade rotatory laxity" (sensitivity 63 %; specificity 72 %). CONCLUSION Increased slope of the lateral tibial plateau might be an important anatomical variable predicting high-grade rotatory laxity in patients with ACL injury. The finding can be useful in the clinical setting in predicting potential non-copers to conservative therapy and aid in the individualization of the reconstructive procedures of patients. LEVEL OF EVIDENCE Prospective diagnostic study, Level II.
Collapse
Affiliation(s)
- Ata A Rahnemai-Azar
- Department of Orthopaedic Surgery, Center for Sports Medicine, University of Pittsburgh, 3200 S Water Street, Pittsburgh, PA, 15203, USA.,Orthopaedic Robotics Laboratory, Departments of Orthopaedic Surgery and Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Ermias S Abebe
- Department of Orthopaedic Surgery, Center for Sports Medicine, University of Pittsburgh, 3200 S Water Street, Pittsburgh, PA, 15203, USA
| | - Paul Johnson
- Department of Orthopaedic Surgery, Center for Sports Medicine, University of Pittsburgh, 3200 S Water Street, Pittsburgh, PA, 15203, USA
| | - Joseph Labrum
- Department of Orthopaedic Surgery, Center for Sports Medicine, University of Pittsburgh, 3200 S Water Street, Pittsburgh, PA, 15203, USA
| | - Freddie H Fu
- Department of Orthopaedic Surgery, Center for Sports Medicine, University of Pittsburgh, 3200 S Water Street, Pittsburgh, PA, 15203, USA
| | - James J Irrgang
- Department of Orthopaedic Surgery, Center for Sports Medicine, University of Pittsburgh, 3200 S Water Street, Pittsburgh, PA, 15203, USA
| | - Kristian Samuelsson
- Department of Orthopedic Surgery, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Volker Musahl
- Department of Orthopaedic Surgery, Center for Sports Medicine, University of Pittsburgh, 3200 S Water Street, Pittsburgh, PA, 15203, USA. .,Orthopaedic Robotics Laboratory, Departments of Orthopaedic Surgery and Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA.
| |
Collapse
|
31
|
Gatti G. Conceptual design and implantation of an external fixator with improved mobility for knee rehabilitation. Comput Methods Biomech Biomed Engin 2017; 20:884-892. [PMID: 28332404 DOI: 10.1080/10255842.2017.1307342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
A hinged external fixator is used to allow early knee rehabilitation in case of injury or trauma, as an alternative approach to immobilization. It is mainly adopted for the treatment of dislocations, which involve tearing of the ligaments, and it basically consists of two links connected to each other by a revolute joint. Each link is fixed to the femur and tibia via pin fixation, and the revolute joint is approximately aligned to the knee flexion-extension (FE) axis. The advantage in its implantation is to protect ligament reconstruction, while allowing for an aggressive rehabilitation. Traditional fixators only accommodate the functional flexion movement in a limited range, i.e. where the anatomical movement is closer to a planar circular trajectory. This paper presents the conceptual design and implantation procedure of a double-axis fixator, which accommodates both FE and longitudinal internal-external rotation. The procedure is based on accurate knee kinematics measurements and on computer-aided multibody simulations to assist clinicians in the implantation. An experimental test is presented using an artificial knee, and guidelines are given for in vitro studies. The proposed technique may allow for a better understanding of knee kinematics and have the potential advantage to increase the range of motion in postoperative rehabilitation.
Collapse
Affiliation(s)
- Gianluca Gatti
- a Department of Mechanical, Energy and Management Engineering , University of Calabria , Arcavacata di Rende (CS) , Italy
| |
Collapse
|
32
|
Musahl V, Rahnemai-Azar AA, Costello J, Arner JW, Fu FH, Hoshino Y, Lopomo N, Samuelsson K, Irrgang JJ. The Influence of Meniscal and Anterolateral Capsular Injury on Knee Laxity in Patients With Anterior Cruciate Ligament Injuries. Am J Sports Med 2016; 44:3126-3131. [PMID: 27507843 DOI: 10.1177/0363546516659649] [Citation(s) in RCA: 128] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The role of the anterolateral capsule (ALC) as a secondary restraint to quantitative rotatory laxity of patients with an anterior cruciate ligament (ACL) injury is currently debated. PURPOSE/HYPOTHESIS The purpose was to determine the influence of concomitant ALC injuries as well as injuries to other soft tissue structures on rotatory knee laxity in patients with an ACL injury. It was hypothesized that a concomitant ALC injury would be associated with increased rotatory knee laxity as measured during a quantitative pivot-shift test. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS Forty-one patients with an ACL injury (average age, 23 ± 6.9 years) were enrolled. Two blinded musculoskeletal radiologists reviewed magnetic resonance imaging (MRI) scans for the presence of ACL injuries and concomitant soft tissue injuries including the ALC, medial collateral ligament, lateral collateral ligament, posterolateral corner, medial meniscus, and lateral meniscus. A standardized pivot-shift test was performed under anesthesia, and rotatory laxity was quantified according to anterior translation of the lateral tibial compartment during the pivot-shift maneuver. The Student t test was used to analyze the data. Statistical significance was set at P < .05. RESULTS A complete ACL rupture was confirmed in all of the patients. MRI evidence of an ALC injury was observed in 21 (51%) of the patients. Patients with MRI evidence of an ALC injury had significantly higher rotatory knee laxity (3.6 ± 1.5 mm) compared with those without an ALC injury (2.7 ± 1.5 mm; P = .04). Lateral and medial meniscus injuries were detected in 17 (41%) and 19 (46%) patients, respectively. Patients with MRI evidence of either a medial meniscus injury or lateral meniscus injury had significantly higher rotatory knee laxity compared with patients without these injuries (medial meniscus: 3.7 ± 1.4 mm vs 2.7 ± 1.6 mm, respectively; lateral meniscus: 3.7 ± 1.7 mm vs 2.7 ± 1.3 mm, respectively) (P = .03 for both). CONCLUSION MRI evidence of a concomitant injury to the ALC, medial meniscus, or lateral meniscus is associated with increased knee rotatory laxity in patients with an ACL injury. These structures may function as important secondary stabilizers in an ACL-injured knee. Careful assessment and proper treatment of injuries to these secondary stabilizers should be considered, especially in knees with a high level of the pivot shift.
Collapse
Affiliation(s)
- Volker Musahl
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Ata A Rahnemai-Azar
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Joanna Costello
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Justin W Arner
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Freddie H Fu
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Yuichi Hoshino
- Department of Orthopaedic Surgery, Kobe University, Kobe, Japan
| | | | - Kristian Samuelsson
- Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden
| | - James J Irrgang
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| |
Collapse
|
33
|
Herbst E, Naendrup JH, Pfeiffer T, Debski RE, Musahl V. Neue App zur Quantifizierung des Pivot-shift-Tests. ARTHROSKOPIE 2016. [DOI: 10.1007/s00142-016-0096-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
34
|
Abstract
Anterior cruciate ligament (ACL) reconstruction aims to restore the translational and rotational motion to the knee joint that is lost after injury. However, despite technical advancements, clinical outcomes are less than ideal, particularly in return to previous activity level. A major issue is the inability to standardize treatment protocols due to variations in materials and approaches used to accomplish ACL reconstruction. These include surgical techniques such as the transtibial and anteromedial portal methods that are currently under use and the wide availability of graft types that will be used to reconstruct the ACL. In addition, concomitant soft tissue injuries to the menisci and capsule are frequently present after ACL injury and, if left unaddressed, can lead to persistent instability even after the ACL has been reconstructed. Advances in the field of biomechanics that help to objectively measure motion of the knee joint may provide more precise data than current subjective clinical measurements. These technologies include extra-articular motion capture systems that measure the movement of the tibia in relation to the femur. With data gathered from these devices, a threshold for satisfactory knee stability may be established in order to correctly identify a successful reconstruction following ACL injury.
Collapse
|
35
|
Grassi A, Lopomo NF, Rao AM, Abuharfiel AN, Zaffagnini S. No proof for the best instrumented device to grade the pivot shift test: a systematic review. J ISAKOS 2016. [DOI: 10.1136/jisakos-2015-000047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
36
|
Musahl V, Griffith C, Irrgang JJ, Hoshino Y, Kuroda R, Lopomo N, Zaffagnini S, Samuelsson K, Karlsson J. Validation of Quantitative Measures of Rotatory Knee Laxity. Am J Sports Med 2016; 44:2393-8. [PMID: 27371547 DOI: 10.1177/0363546516650667] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
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/s(2); side-to-side difference: 4.2 ± 5.4 m/s(2)) compared with patients in the low-grade group (involved knee: 4.2 ± 1.6 m/s(2); side-to-side difference: 1.2 ± 1.2 m/s(2)) (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.
Collapse
Affiliation(s)
| | - Chad Griffith
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - James J Irrgang
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | | | | | | | | | | | - Jon Karlsson
- Sahlgrenska University Hospital, Göteborg, Sweden
| | | |
Collapse
|
37
|
Zaffagnini S, Signorelli C, Grassi A, Yue H, Raggi F, Urrizola F, Bonanzinga T, Marcacci M. Assessment of the pivot shift using inertial sensors. Curr Rev Musculoskelet Med 2016; 9:160-3. [PMID: 26970757 DOI: 10.1007/s12178-016-9333-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The pivot shift test is an important clinical tool used to assess the stability of the knee following an injury to the anterior cruciate ligament (ACL). Previous studies have shown that significant variability exists in the performance and interpretation of this manoeuvre. Accordingly, a variety of techniques aimed at standardizing and quantifying the pivot shift test have been developed. In recent years, inertial sensors have been used to measure the kinematics of the pivot shift. The goal of this study is to present a review of the literature and discuss the principles of inertial sensors and their use in quantifying the pivot shift test.
Collapse
Affiliation(s)
- Stefano Zaffagnini
- Laboratorio di Biomeccanica e Innovazione Tecnologica, Istituto Ortopedico Rizzoli, Via Di Barbiano 1/10, Bologna, BO, Italy.
| | - Cecilia Signorelli
- Laboratorio di Biomeccanica e Innovazione Tecnologica, Istituto Ortopedico Rizzoli, Via Di Barbiano 1/10, Bologna, BO, Italy
| | - Alberto Grassi
- Laboratorio di Biomeccanica e Innovazione Tecnologica, Istituto Ortopedico Rizzoli, Via Di Barbiano 1/10, Bologna, BO, Italy
| | - Han Yue
- Laboratorio di Biomeccanica e Innovazione Tecnologica, Istituto Ortopedico Rizzoli, Via Di Barbiano 1/10, Bologna, BO, Italy
| | - Federico Raggi
- Laboratorio di Biomeccanica e Innovazione Tecnologica, Istituto Ortopedico Rizzoli, Via Di Barbiano 1/10, Bologna, BO, Italy
| | - Francisco Urrizola
- Laboratorio di Biomeccanica e Innovazione Tecnologica, Istituto Ortopedico Rizzoli, Via Di Barbiano 1/10, Bologna, BO, Italy.,Servicio Traumatologia, Hospital Las Higueras, Talcahuano, Chile
| | - Tommaso Bonanzinga
- Laboratorio di Biomeccanica e Innovazione Tecnologica, Istituto Ortopedico Rizzoli, Via Di Barbiano 1/10, Bologna, BO, Italy
| | - Maurilio Marcacci
- Laboratorio di Biomeccanica e Innovazione Tecnologica, Istituto Ortopedico Rizzoli, Via Di Barbiano 1/10, Bologna, BO, Italy
| |
Collapse
|
38
|
Abstract
Motion at the knee joint is a complex mechanical phenomenon. Stability is provided by a combination of static and dynamic structures that work in concert to prevent excessive movement or instability that is inherent in various knee injuries. The anterior cruciate ligament (ACL) is a main stabilizer of the knee, providing both translational and rotatory constraint. Despite the high volume of research directed at native ACL function, pathogenesis and surgical reconstruction of this structure, a gold standard for objective quantification of injury and subsequent repair, has not been demonstrated. Furthermore, recent studies have suggested that novel anatomic structures may play a significant role in knee stability. The use of biomechanical principles and testing techniques provides essential objective/quantitative information on the function of bone, ligaments, joint capsule, and other contributing soft tissues in response to various loading conditions. This review discusses the principles of biomechanics in relation to knee stability, with a focus on the objective quantification of knee stability, the individual contributions of specific knee structures to stability, and the most recent technological advances in the biomechanical evaluation of the knee joint.
Collapse
Affiliation(s)
- Jason P Zlotnicki
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, Pittsburgh, PA, 15213, USA
- Orthopaedic Robotics Laboratory, University of Pittsburgh, 408 Center for Bioengineering, 300 Technology Drive, Pittsburgh, PA, 15219, USA
| | - Jan-Hendrik Naendrup
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, Pittsburgh, PA, 15213, USA
- Orthopaedic Robotics Laboratory, University of Pittsburgh, 408 Center for Bioengineering, 300 Technology Drive, Pittsburgh, PA, 15219, USA
| | - Gerald A Ferrer
- Orthopaedic Robotics Laboratory, University of Pittsburgh, 408 Center for Bioengineering, 300 Technology Drive, Pittsburgh, PA, 15219, USA
- Department of Bioengineering, University of Pittsburgh, 300 Technology Drive, Pittsburgh, PA, 15219, USA
| | - Richard E Debski
- Orthopaedic Robotics Laboratory, University of Pittsburgh, 408 Center for Bioengineering, 300 Technology Drive, Pittsburgh, PA, 15219, USA.
- Department of Bioengineering, University of Pittsburgh, 300 Technology Drive, Pittsburgh, PA, 15219, USA.
| |
Collapse
|
39
|
Rahnemai-Azar AA, Naendrup JH, Soni A, Olsen A, Zlotnicki J, Musahl V. Knee instability scores for ACL reconstruction. Curr Rev Musculoskelet Med 2016; 9:170-7. [PMID: 26980119 PMCID: PMC4896882 DOI: 10.1007/s12178-016-9339-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Despite abundant biological, biomechanical, and clinical research, return to sport after anterior cruciate ligament (ACL) injury remains a significant challenge. Residual rotatory knee laxity has been identified as one of the factors responsible for poor functional outcome. To improve and standardize the assessment of knee instability, a variety of instability scoring systems is available. Recently, devices to objectively quantify static and dynamic clinical exams have been developed to complement traditional subjective grading systems. These devices enable an improved evaluation of knee instability and possible associated injuries. This additional information may promote the development of new treatment algorithms and allow for individualized treatment. In this review, the different subjective laxity scores as well as complementary objective measuring systems are discussed, along with an introduction of injury to an individualized treatment algorithm.
Collapse
Affiliation(s)
- Ata A Rahnemai-Azar
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, Pittsburgh, PA, 15213, USA
- Orthopaedic Robotics Laboratory, Center for Bioengineering, University of Pittsburgh, 300 Technology Drive, Pittsburgh, PA, 15219, USA
| | - Jan-Hendrik Naendrup
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, Pittsburgh, PA, 15213, USA
- Orthopaedic Robotics Laboratory, Center for Bioengineering, University of Pittsburgh, 300 Technology Drive, Pittsburgh, PA, 15219, USA
| | - Ashish Soni
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, Pittsburgh, PA, 15213, USA
| | - Adam Olsen
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, Pittsburgh, PA, 15213, USA
| | - Jason Zlotnicki
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, Pittsburgh, PA, 15213, USA
- Orthopaedic Robotics Laboratory, Center for Bioengineering, University of Pittsburgh, 300 Technology Drive, Pittsburgh, PA, 15219, USA
| | - Volker Musahl
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, Pittsburgh, PA, 15213, USA.
- Orthopaedic Robotics Laboratory, Center for Bioengineering, University of Pittsburgh, 300 Technology Drive, Pittsburgh, PA, 15219, USA.
| |
Collapse
|