ArticleJournal of experimental orthopaedics2026
Difference in anterior tibial subluxation measured with the bone axis method predicts high-grade pivot shift in ACL-deficient knees: A multicenter cohort study.
Article in Journal of experimental orthopaedics, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Purpose: To determine which magnetic resonance imaging (MRI)-based anterior tibial subluxation (ATS) measurement best reflects rotational instability under anaesthesia in anterior cruciate ligament (ACL)-injured patients. Methods: This retrospective multicenter cohort study included 291 patients who underwent ACL reconstruction between October 2022 and December 2024. Preoperative MRI measurements of lateral ATS (L-ATS) and difference between lateral and medial ATS (D-ATS) were obtained using the plateau method (PM) and the bone axis method (BAM). Rotational instability was assessed under anaesthesia using the pivot shift test and categorized as low-grade (LG-PS) or high-grade (HG-PS). Receiver operating characteristic (ROC) curve analysis was performed to evaluate the discriminative ability of each measurement. Using the cutoff value derived from the Youden index of the ATS parameter that demonstrated the largest ROC-AUC, multivariate logistic regression identified independent predictors of HG-PS. Results: Compared with the LG-PS group, D-ATS measured with PM ( Conclusions: Among MRI-based methods for measuring ATS in ACL-injured knees, D-ATS measured with BAM best reflected pivot shift grade under anaesthesia and was an independent predictor of HG-PS. A D-ATS measured with BAM value ≥ 3.8 mm may help identify patients at risk of rotational instability and, in combination with other clinical factors, assist preoperative surgical planning. Level of Evidence: Level III, cohort study.
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