Factors Affecting the Quantitative Value of the Pivot Shift Test Using a Navigation System in Anterior Cruciate...

This study aimed to identify factors associated with greater quantitative pivot shift in anterior cruciate ligament (ACL)-injured knees by quantitatively assessing the pivot shift under anesthesia using a navigation system prior to ACL reconstruction. A total of 114 patients (66 males and 48 females) who underwent ACL reconstruction were included. Prior to reconstruction, the pivot shift test was performed under anesthesia and measured using a navigation system. The maximum difference in the anterior-posterior position of the tibia during knee flexion-extension without stress and during the pivot shift test-termed peak coupled anterior tibial translation (peak c-ATT)-was recorded as the quantitative value. Multiple regression analysis was used to determine factors associated with the quantitative pivot shift value, with nine independent variables: Sex, age, preoperative side-to-side difference in anterior knee laxity, time from injury to surgery, presence of medial and lateral meniscus injuries, knee extension angle, femorotibial angle, and preinjury Tegner activity score. Among the 114 participants, 80 (70.2%) had normal lateral menisci, and 34 (29.8%) had damaged lateral menisci. Multiple linear regression identified three variables significantly associated with greater quantitative pivot shift: Time from injury to surgery (standardized partial regression coefficient [β] = 0.38, p = 0.000), knee extension angle (β = 0.29, p = 0.001), and presence of lateral meniscus injury (β = 0.29, p = 0.001). Other variables-including age, sex, anterior laxity, medial meniscus injury, femorotibial angle, and Tegner score-did not reach statistical significance. Three factors-prolonged time from injury to surgery, knee hyperextension, and lateral meniscus injury-were significantly associated with greater quantitative pivot shift in ACL-injured knees. The strongest predictor was the time elapsed between injury and surgery.

The level of evidence was IV: A diagnostic study of nonconsecutive patients.