What it takes to have a high-grade pivot shift-focus on bony morphology.

Dadoo, Sahil; Ozbek, Emre Anil; Nukuto, Koji; Runer, Armin; Keeling, Laura E; Grandberg, Camila; Kuroda, Ryosuke; Zaffagnini, Stefano; Karlsson, Jon; Hughes, Jonathan D; Irrgang, James J; Musahl, Volker

doi:10.1007/s00167-023-07472-2

Benutzer: Gast

journal article

Dokumenttyp:: Article; Early Access; Journal Article
Autor(en):: Dadoo, Sahil; Ozbek, Emre Anil; Nukuto, Koji; Runer, Armin; Keeling, Laura E; Grandberg, Camila; Kuroda, Ryosuke; Zaffagnini, Stefano; Karlsson, Jon; Hughes, Jonathan D; Irrgang, James J; Musahl, Volker
Titel:: What it takes to have a high-grade pivot shift-focus on bony morphology.
Abstract:: PURPOSE: Variations in femoral and tibial bony morphology have been associated with higher clinical grading and increased quantitative tibial translation, but not tibial acceleration, during the pivot shift test following anterior cruciate ligament (ACL) injury. The purpose of this study was to determine the impact of femoral and tibial bony morphology, including a measurement influenced by both parameters (the Lateral Tibiofemoral Articular Distance (LTAD)), on the degree of quantitative tibial acceleration during the pivot shift test and rates of future ACL injury. METHODS: All patients who underwent primary ACL reconstruction from 2014 to 2019 by a senior orthopedic surgeon with available quantitative tibial acceleration data were retrospectively reviewed. All patients underwent a pivot shift examination under anesthesia with a triaxial accelerometer. Measurements of femoral and tibial bony morphology were performed by two fellowship-trained orthopedic surgeons using preoperative magnetic resonance imaging and lateral radiographs. RESULTS: Fifty-one patients were included at a mean follow-up of 4.4 years. The mean quantitative tibial acceleration during the pivot shift was 13.8 m/s2 (range: 4.9-52.0 m/s2). A larger Posterior Condylar Offset Ratio (r = 0.30, p = 0.045), smaller medial-to-lateral width of the medial tibial plateau (r = - 0.29, p = 0.041), lateral tibial plateau (r = - 0.28, p = 0.042), and lateral femoral condyle (r = - 0.29, p = 0.037), and a decreased LTAD (r = - 0.53, p < 0.001) significantly correlated with increased tibial acceleration during the pivot shift. Linear regression analysis demonstrated an increase in tibial acceleration of 1.24 m/s2 for every 1 mm decrease in LTAD. Nine patients (17.6%) sustained ipsilateral graft rupture and 10 patients (19.6%) sustained contralateral ACL rupture. No morphologic measurements were associated with rates of future ACL injury. CONCLUSION: Increased convexity and smaller bony morphology of the lateral femur and tibia were significantly associated with increased tibial acceleration during the pivot shift. Additionally, a measurement, termed the LTAD, was found to have the strongest association with increased tibial acceleration. Based on the results of this study, surgeons can utilize these measurements to preoperatively identify patients at risk of increased rotatory knee instability. LEVEL OF EVIDENCE: Level IV.
Zeitschriftentitel:: Knee Surg Sports Traumatol Arthrosc
Jahr:: 2023
Band / Volume:: 31
Heft / Issue:: 10
Seitenangaben Beitrag:: 4080-4089
Volltext / DOI:: doi:10.1007/s00167-023-07472-2
PubMed:: http://view.ncbi.nlm.nih.gov/pubmed/37410122
Print-ISSN:: 0942-2056
TUM Einrichtung:: Klinik und Poliklinik für Orthopädie und Sportorthopädie (Prof. von Eisenhart-Rothe)
BibTeX

Vorkommen:

mediaTUM Gesamtbestand Einrichtungen Schools TUM School of Medicine and Health Departments Clinical Medicine Klinik und Poliklinik für Orthopädie und Sportorthopädie (Prof. von Eisenhart-Rothe)2023