ArticleKnee surgery, sports traumatology, arthroscopy : official journal of the ESSKA2022
Grade III pivot shift as an early sign of knee decompensation in chronic ACL-injured knees with bimeniscal tears.
Article in Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.
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6 citing papers in PubMed, 18 citations in OpenAlex.
- The posterior cruciate ligament-posterior femoral cortex angle (PCL-PCA): A precise indicator of knee decompensation in skeletally immature anterior cruciate ligament-injured patients.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2026Article
- Lateral Extra-articular Tenodesis Notably Reduced Residual Knee Instability and Anterior Tibial Translation in Patients With an Anterior Cruciate Ligament Injury Combined With a High-Grade Pivot-Shift Phenomenon.Orthopaedic journal of sports medicine · 2025Article
- The posterior cruciate ligament-posterior femoral cortex angle (PCL-PCA) and the lateral collateral ligament (LCL) sign are useful parameters to indicate the progression of knee decompensation over time after an ACL injury.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2023Article
- Chronic ACL-injured patients show increased medial and global anterior tibial subluxation measured on 1-year postoperative MR images after primary single-bundle ACL reconstruction.Journal of orthopaedic surgery and research · 2023Article
- The anterior cruciate ligament injury severity scale (ACLISS) is an effective tool to document and categorize the magnitude of associated tissue damage in knees after primary ACL injury and reconstruction.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2023Article
- [Knee injuries in winter sports].Orthopadie (Heidelberg, Germany) · 2022Review
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Authors and funding
5 authors at 2 institutions in 2 countries.
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No grant is acknowledged in the PubMed record.
Abstract
purposeTo analyse possible associations between the preoperative pivot shift (PS) test and both patient and injury characteristics in anterior cruciate ligament (ACL)-injured knees, considering previously neglected meniscal injuries such as ramp and root tears. The hypothesis was that a preoperative grade III PS was associated with the amount of intra-articular soft-tissue damage and chronicity of the injury.
methodsThe cohort involved 376 patients who underwent primary ACL reconstruction (239 males/137 females; median age 26). Patients were examined under anesthesia before surgery, using the PS test. During arthroscopy, intra-articular soft-tissue damage of the injured knee was classified as: (1) partial ACL tear; (2) complete isolated ACL tear; (3) complete ACL tear with one meniscus tear; and (4) complete ACL and bimeniscal tears. Chi-square and Mann-Whitney U tests were used to evaluate whether sex, age, body mass index, sport at injury, mechanism of injury, time from injury and intra-articular damage (structural damage of ACL and menisci) were associated with a grade III PS. Intra-articular damage was further analyzed for two sub-cohorts: acute (time from injury ≤ 6 months) and chronic injuries (> 6 months).
resultsA grade III PS test was observed in 26% of patients. A significant association with PS grading was shown for age, time from injury and intra-articular soft-tissue damage (p < 0.05). Further analyses showed that grade III PS was associated with intra-articular damage in chronic injuries only (p < 0.01). In complete ACL and bimeniscal tears, grade III PS was more frequent in chronic (53%) than in acute knee injuries (26%; p < 0.01). Patients with chronic complete ACL and bimeniscal tears had a grade III PS 3.3 [1.3-8.2] times more often than patients in the acute sub-cohort.
conclusionIn ACL-injured patients, a preoperative grade III PS was mainly associated with a higher amount of intra-articular soft-tissue damage and chronicity of the injury. Patients with complete chronic ACL injuries and bimeniscal tears were more likely to have a preoperative grade III PS than their acute counterparts. This suggests that grade III PS may be an early sign of knee decompensation of dynamic rotational knee laxity in chronic ACL-injured knees with bimeniscal lesions. LEVEL OF EVIDENCE: Level III.
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