Pivot shift intraoperative quantitative assessment using a smartphone accelerometer in ACL deficient knees
Open Access
- 25 January 2023
- journal article
- research article
- Published by Wiley in Journal of Experimental Orthopaedics
- Vol. 10 (1), 1-8
- https://doi.org/10.1186/s40634-023-00570-7
Abstract
The Pivot Shift (PS) test is a complex clinical sign that assesses the internal rotation and anterior tibial translation, which occurs abnormally in ACL deficient-knees. Because of the high inter-observer variability, different devices have been designed to characterize this complex movement in quantitative variables. The objective of this pilot study is to validate the reproducibility of intraoperative quantitative assessment of the PS with a smartphone accelerometer. Twelve ACL-injured knees were included and compared with the contralateral uninjured side. The PS was measured by two independent observers utilizing a smartphone accelerometer and graded according to the IKDC classification. Measurements were taken preoperatively, intraoperatively and postoperatively. Intraoperative readings were taken during each stage of reconstruction or repair of meniscoligamentous lesions including meniscal lesions, ramp lesions, ACL reconstruction and lateral tenodesis. Reproducibility of the measurements were evaluated according to an intraclass correlation coefficient (ICC). The intra-observer reliability was good for the first examiner and excellent for the second examiner, with the ICC 0.89 [0.67, 0.98] p < 0,001 and ICC 0.97 [0.91, 1.0] p < 0,001 respectively. The inter-observer reliability was excellent between the two observers with the ICC 0.99 [0.97, 1.0] p < 0,001. The mean tibial acceleration measured 3.45 m.s2 (SD = 1.71) preoperatively on the injured knees and 1.03 m.s2 (SD = 0.36) on the healthy knees, demonstrating a significant difference following univariate analysis p < 0.001. Postoperatively, no significant difference was observed between healthy and reconstructed knees The magnitudes of tibial acceleration values were correlated with the PS IKDC grade. The smartphone accelerometer is a reproducible device to quantitatively assess the internal rotation and anterior tibial translation during ACL reconstruction surgery. The measurements are influenced by the different surgical steps. Other larger cohort studies are needed to evaluate the specific impact of each step of the ACL reconstruction and meniscal repair on this measurement. An external validation using other technologies are needed to validate the reliability of this device to assess the PS test. Level IV, case series, pilot study.Keywords
This publication has 32 references indexed in Scilit:
- Risk Factors Associated With Grade 3 Pivot Shift After Acute Anterior Cruciate Ligament InjuriesThe American Journal of Sports Medicine, 2015
- Is triaxial accelerometer reliable in the evaluation and grading of knee pivot-shift phenomenon?Knee Surgery, Sports Traumatology, Arthroscopy, 2013
- An original clinical methodology for non-invasive assessment of pivot-shift testComputer Methods in Biomechanics and Biomedical Engineering, 2012
- The pivot shift: a global user guideKnee Surgery, Sports Traumatology, Arthroscopy, 2012
- Standardized pivot shift test improves measurement accuracyKnee Surgery, Sports Traumatology, Arthroscopy, 2011
- Posterior horn instability of the medial meniscus a sign of posterior meniscotibial ligament insufficiencyKnee Surgery, Sports Traumatology, Arthroscopy, 2011
- Lateral compartment translation predicts the grade of pivot shift: a cadaveric and clinical analysisKnee Surgery, Sports Traumatology, Arthroscopy, 2010
- Pivot‐shift test: Analysis and quantification of knee laxity parameters using a navigation systemJournal of Orthopaedic Research, 2009
- Relationships between Objective Assessment of Ligament Stability and Subjective Assessment of Symptoms and Function after Anterior Cruciate Ligament ReconstructionThe American Journal of Sports Medicine, 2004
- The Lateral Pivot ShiftClinical Orthopaedics and Related Research, 1980