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Knee Surgery, Sports Traumatology, Arthroscopy
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 4/2012

01-04-2012 | Knee

What does it take to have a high-grade pivot shift?

Authors: M. Tanaka, D. Vyas, G. Moloney, A. Bedi, A. D. Pearle, V. Musahl

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 4/2012

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Abstract

The pivot shift is the most specific clinical test to assess pathological knee joint rotatory laxity following ACL injury. This article attempts to describe the anatomic structures responsible for creating a high-grade pivot shift and their potential role in customizing ACL reconstruction. A review of the literature demonstrates that disruption of the secondary stabilizers of anterior translation of the lateral compartment including the lateral meniscus, anterolateral capsule, and IT band contributes to a high-grade pivot shift in the ACL-deficient knee. The morphology of the lateral tibial plateau, including increased posteroinferior tibial slope and small size, can also contribute to high-grade pivot shift. Factors that may decrease the grade of the pivot shift include medial compartment injury, MCL injury, patient guarding, and osteoarthritis. In conclusion, a high-grade pivot shift in the ACL-deficient knee is often associated with incompetence of the lateral soft tissue envelope. Rotatory laxity as assessed by the pivot shift may also be falsely underestimated by concomitant injuries.
Level of evidence IV.
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Metadata
Title
What does it take to have a high-grade pivot shift?
Authors
M. Tanaka
D. Vyas
G. Moloney
A. Bedi
A. D. Pearle
V. Musahl
Publication date
01-04-2012
Publisher
Springer-Verlag
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 4/2012
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-011-1866-5

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