The PIVOT App: A User Guide.

Area of Science:

• Orthopedic Surgery
• Sports Medicine
• Biomechanical Analysis

Background:

• The pivot shift test is crucial for diagnosing anterior cruciate ligament (ACL) injuries but lacks standardization.
• Physician variability in performing the pivot shift test can lead to inconsistent diagnostic accuracy.
• Objective quantification of knee laxity is needed to supplement clinical examination.

Purpose of the Study:

• To introduce and validate the PIVOT App for objective measurement of tibial translation during the pivot shift maneuver.
• To enhance the standardization and accuracy of diagnosing rotatory knee laxity in ACL-deficient or reconstructed knees.
• To provide a tool for both clinical and intraoperative settings.

Main Methods:

• The PIVOT App quantifies lateral tibial translation relative to the lateral femoral epicondyle using markers.
• Three markers are placed on specific bony landmarks of the lateral knee: lateral epicondyle, Gerdy's tubercle, and a pivot point.
• The pivot shift maneuver is recorded, and the app analyzes tibial reduction distance and time.

Main Results:

• The PIVOT App accurately distinguishes between normal, low-grade, and high-grade pivot shifts.
• Increasing grades of pivot shift correlate with increased lateral tibial translation.
• The PIVOT App has been validated and utilized globally for standardized pivot shift measurement.

Conclusions:

• The PIVOT App is a validated tool for quantifying lateral tibial translation and reduction during the pivot shift.
• Proper application use and mitigation of potential complications enhance diagnostic accuracy for rotatory knee laxity.
• The PIVOT App aids clinicians in the precise diagnosis of knee instability following ACL injury.