Lateral compartment translation predicts the grade of pivot shift: a cadaveric and clinical analysis

Anterior translation of the lateral compartment was hypothesized to correlate with the clinical grade of a pivot shift maneuver. Using a computer-assisted navigation system, this hypothesis was tested by recording the maximum anterior tibial translation in the medial and lateral compartment as well as the arc of rotation during the pivot shift maneuver. One hundred and fifty-four pivot shift examinations were performed on cadavers with various degrees of instability, and 24 pivot shift exams were performed on patients under anesthesia before and after ACL reconstruction. In all positive pivot shift exams, anterior tibial translations were found to be higher on in the lateral compartment compared to the medial compartment. In addition, an excellent correlation was found between the amount of lateral compartment translation and the clinical grade of the pivot shift; medial compartment translations and amount of knee rotation could not distinguish between clinical grades. Finally, a threshold of 6-7 mm of anterior tibial translation in the lateral compartment was necessary to produce a positive pivot shift. Taken together, these data suggest that monitoring lateral compartment translations during a pivot shift exam may be a convenient means to evaluate the outcomes of ACL surgery and that requisite increases in anterior translation of the lateral compartment are necessary for each progressive clinical grade of the pivot shift examination.