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Published in: Knee Surgery, Sports Traumatology, Arthroscopy 4/2011

01-04-2011 | Knee

Gravity-assisted pivot-shift test can predict the function of the reconstructed anterior cruciate ligament

Authors: Hiroya Sakai, Hisatada Hiraoka, Motohisa Yashiki

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 4/2011

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Abstract

Purpose

The gravity-assisted pivot-shift (GAPS) test is a newly advocated test for anterior cruciate ligament (ACL) injury. We retrospectively investigated the relationships between the result of preoperative GAPS test and the function of the reconstructed ACL using autogenous hamstring tendon grafts.

Methods

Seventy-eight patients with unilateral ACL injury and a minimum of 1-year follow-up were enrolled in this study. According to the result of preoperative GAPS test, they were divided into two groups, i.e., positive test group (Group P) and negative test group (Group N). At the time of follow-up, the operated knee was examined manually and using KT-1000 arthrometer. According to these results, the function of the reconstructed ACL was classified.

Results

The proportion of the knees with a negative abnormal laxity test was less in Group P than Group N with the significant difference in Lachman test (P = 0.0029) and N-test (P = 0.0081). The proportion of the cases having greater than 3 mm of the side-to-side difference in anterior knee laxity using KT-1000 arthrometer was greater in Group P, in spite of no statistically significant difference. Regarding the classification of the function of the reconstructed ACL, Group P was worse than Group N (P = 0.0187), and all 4 knees classified as failed belonged to Group P.

Conclusion

The knees with a preoperative positive GAPS test showed worse postoperative function of the reconstructed ACL than those with a negative test. Preoperative positive GAPS test is considered to be a predisposing factor to poor functional outcome after ACL reconstruction. It is possible that the use of hamstring tendons as a graft source should be avoided for the ACL-injured patients with a positive GAPS test.
Literature
1.
go back to reference Aagaard P, Simonsen EB, Andersen JL, Magnusson SP, Bojsen-Møller F, Dyhre-Poulsen P (2000) Antagonist muscle coactivation during isokinetic knee extension. Scand J Med Sci Sports 10:58–67PubMedCrossRef Aagaard P, Simonsen EB, Andersen JL, Magnusson SP, Bojsen-Møller F, Dyhre-Poulsen P (2000) Antagonist muscle coactivation during isokinetic knee extension. Scand J Med Sci Sports 10:58–67PubMedCrossRef
2.
go back to reference Ageberg E, Roos HP, Silbernagel KG, Thomeé R, Roos EM (2009) Knee extension and flexion muscle power after anterior cruciate ligament reconstruction with patellar tendon graft or hamstring tendon graft: a cross sectional comparison 3 years post surgery. Knee Surg Sports Traumatol Arthrosc 17:162–169PubMedCrossRef Ageberg E, Roos HP, Silbernagel KG, Thomeé R, Roos EM (2009) Knee extension and flexion muscle power after anterior cruciate ligament reconstruction with patellar tendon graft or hamstring tendon graft: a cross sectional comparison 3 years post surgery. Knee Surg Sports Traumatol Arthrosc 17:162–169PubMedCrossRef
3.
go back to reference Aglietti P, Buzzi R, Menchetti PM, Giron F (1996) Arthroscopically assisted semitendinosus and gracilis tendon graft in reconstruction for acute anterior cruciate ligament injuries in athletes. Am J Sports Med 24:726–731PubMedCrossRef Aglietti P, Buzzi R, Menchetti PM, Giron F (1996) Arthroscopically assisted semitendinosus and gracilis tendon graft in reconstruction for acute anterior cruciate ligament injuries in athletes. Am J Sports Med 24:726–731PubMedCrossRef
4.
go back to reference Allen CR, Giffin JR, Harner CD (2003) Revision anterior cruciate ligament reconstruction. Orthop Clin N Am 34:79–98CrossRef Allen CR, Giffin JR, Harner CD (2003) Revision anterior cruciate ligament reconstruction. Orthop Clin N Am 34:79–98CrossRef
5.
go back to reference Barber-Westin SD, Noyes FR, Andrew M (1997) A rigorous comparison between the sexes of results and complications after anterior cruciate ligament reconstructions. Am J Sports Med 25:514–526PubMedCrossRef Barber-Westin SD, Noyes FR, Andrew M (1997) A rigorous comparison between the sexes of results and complications after anterior cruciate ligament reconstructions. Am J Sports Med 25:514–526PubMedCrossRef
6.
go back to reference Beynnon BD, Johnson RJ, Abate JA, Fleming BC, Nichols CE (2005) Treatment of anterior cruciate ligament injuries, Part 2. Am J Sports Med 33:1751–1767PubMedCrossRef Beynnon BD, Johnson RJ, Abate JA, Fleming BC, Nichols CE (2005) Treatment of anterior cruciate ligament injuries, Part 2. Am J Sports Med 33:1751–1767PubMedCrossRef
7.
go back to reference Biau DJ, Katsahian S, Kartus J, Harilainen A, Feller JA, Sajovic M, Ejerhed L, Zaffagnini S, Röpke M, Nizard R (2009) Patellar tendon versus hamstring tendon autografts for reconstructing the anterior cruciate ligament. A meta-analysis based on individual patient data. Am J Sports Med 37:2470–2478PubMedCrossRef Biau DJ, Katsahian S, Kartus J, Harilainen A, Feller JA, Sajovic M, Ejerhed L, Zaffagnini S, Röpke M, Nizard R (2009) Patellar tendon versus hamstring tendon autografts for reconstructing the anterior cruciate ligament. A meta-analysis based on individual patient data. Am J Sports Med 37:2470–2478PubMedCrossRef
8.
go back to reference Cheatham SA, Johnson DL (2010) Anatomic revision ACL reconstruction. Sports Med Arthrosc Rev 18:33–39CrossRef Cheatham SA, Johnson DL (2010) Anatomic revision ACL reconstruction. Sports Med Arthrosc Rev 18:33–39CrossRef
9.
go back to reference de Jong SN, van Caspel DR, van Haeff MJ, Saris DBF (2007) Functional assessment and muscle strength before and after reconstruction of chronic anterior cruciate ligament lesions. Arthroscopy 23:21–28PubMed de Jong SN, van Caspel DR, van Haeff MJ, Saris DBF (2007) Functional assessment and muscle strength before and after reconstruction of chronic anterior cruciate ligament lesions. Arthroscopy 23:21–28PubMed
10.
go back to reference Fu FH, Bennet CH, Benjamin C, Menetrey J, Lattermann C (2000) Current trends in anterior cruciate ligament reconstruction. Part II. Operative procedure and clinical correlations. Am J Sports Med 28:124–130PubMed Fu FH, Bennet CH, Benjamin C, Menetrey J, Lattermann C (2000) Current trends in anterior cruciate ligament reconstruction. Part II. Operative procedure and clinical correlations. Am J Sports Med 28:124–130PubMed
11.
go back to reference Galway RD, Beaupré A, MacIntosh DL (1972) Pivot shift: a clinical sign of symptomatic anterior cruciate insufficiency. J Bone Joint Surg 54B:763–764 Galway RD, Beaupré A, MacIntosh DL (1972) Pivot shift: a clinical sign of symptomatic anterior cruciate insufficiency. J Bone Joint Surg 54B:763–764
12.
go back to reference George MS, Dunn WR, Spindler KP (2006) Current concepts review: revision anterior cruciate ligament reconstruction. Am J Sports Med 34:2026–2037PubMedCrossRef George MS, Dunn WR, Spindler KP (2006) Current concepts review: revision anterior cruciate ligament reconstruction. Am J Sports Med 34:2026–2037PubMedCrossRef
13.
go back to reference Giffin JR, Harner CD (2001) Failed anterior cruciate ligament surgery. Am J Knee Surg 14:185–192PubMed Giffin JR, Harner CD (2001) Failed anterior cruciate ligament surgery. Am J Knee Surg 14:185–192PubMed
14.
go back to reference Hefti F, Müller W, Jakob RP, Stäubli HU (1993) Evaluation of knee ligament injuries with the IKDC form. Knee Surg Sports Traumatol Arthrosc 1:226–234PubMedCrossRef Hefti F, Müller W, Jakob RP, Stäubli HU (1993) Evaluation of knee ligament injuries with the IKDC form. Knee Surg Sports Traumatol Arthrosc 1:226–234PubMedCrossRef
15.
go back to reference Hiemstra LA, Webber S, MacDonald PB, Kriellaars DJ (2004) Hamstring and quadriceps strength balance in normal and hamstring anterior cruciate ligament-reconstructed subjects. Clin J Sport Med 14:274–280PubMedCrossRef Hiemstra LA, Webber S, MacDonald PB, Kriellaars DJ (2004) Hamstring and quadriceps strength balance in normal and hamstring anterior cruciate ligament-reconstructed subjects. Clin J Sport Med 14:274–280PubMedCrossRef
16.
go back to reference Hiraoka H, Yashiki M, Sakai H (2008) Contributory factors to the results of gravity-assisted pivot-shift test for anterior cruciate ligament injury: the significance of muscle torque around the knee. Knee Surg Sports Traumatol Arthrosc 16:279–285PubMedCrossRef Hiraoka H, Yashiki M, Sakai H (2008) Contributory factors to the results of gravity-assisted pivot-shift test for anterior cruciate ligament injury: the significance of muscle torque around the knee. Knee Surg Sports Traumatol Arthrosc 16:279–285PubMedCrossRef
17.
go back to reference Howell SM, Clark JA, Farley TE (1991) A rationale for predicting anterior cruciate graft impingement by the intercondylar roof. A magnetic resonance imaging study. Am J Sports Med 19:276–282PubMedCrossRef Howell SM, Clark JA, Farley TE (1991) A rationale for predicting anterior cruciate graft impingement by the intercondylar roof. A magnetic resonance imaging study. Am J Sports Med 19:276–282PubMedCrossRef
18.
go back to reference Howell SM, Gottlieb JE (1996) Endoscopic fixation of a double-looped semitendinosus and gracilis anterior cruciate ligament graft using Bone Mulch Screw. Oper Tech Orthop 6:152–160CrossRef Howell SM, Gottlieb JE (1996) Endoscopic fixation of a double-looped semitendinosus and gracilis anterior cruciate ligament graft using Bone Mulch Screw. Oper Tech Orthop 6:152–160CrossRef
19.
go back to reference Hughston JC, Andrews JR, Cross MJ, Moschi A (1976) Classification of knee ligament instabilities. Part I. The medial compartment and cruciate ligaments. Part II. The lateral compartment. J Bone Joint Surg 58A(159–172):173–179 Hughston JC, Andrews JR, Cross MJ, Moschi A (1976) Classification of knee ligament instabilities. Part I. The medial compartment and cruciate ligaments. Part II. The lateral compartment. J Bone Joint Surg 58A(159–172):173–179
20.
go back to reference Kålund S, Sinkjaer T, Arendt-Nielsen L, Simonsen O (1990) Altered timing of hamstring muscle action in anterior cruciate ligament deficient patients. Am J Sports Med 18:245–248PubMedCrossRef Kålund S, Sinkjaer T, Arendt-Nielsen L, Simonsen O (1990) Altered timing of hamstring muscle action in anterior cruciate ligament deficient patients. Am J Sports Med 18:245–248PubMedCrossRef
21.
go back to reference Landes S, Nyland J, Elmlinger B, Tillett E, Caborn D (2010) Knee flexor strength after ACL reconstruction: comparison between hamstring autograft, tibialis anterior allograft, and non-injured controls. Knee Surg Sports Traumatol Arthrosc 18:317–324PubMedCrossRef Landes S, Nyland J, Elmlinger B, Tillett E, Caborn D (2010) Knee flexor strength after ACL reconstruction: comparison between hamstring autograft, tibialis anterior allograft, and non-injured controls. Knee Surg Sports Traumatol Arthrosc 18:317–324PubMedCrossRef
22.
go back to reference Lewis PB, Parameswaran AD, Rue JPH, Bach BR Jr (2008) Systemic review of single-bundle anterior cruciate ligament reconstruction outcomes. A baseline assessment for consideration of double-bundle techniques. Am J Sport Med 36:2028–2036CrossRef Lewis PB, Parameswaran AD, Rue JPH, Bach BR Jr (2008) Systemic review of single-bundle anterior cruciate ligament reconstruction outcomes. A baseline assessment for consideration of double-bundle techniques. Am J Sport Med 36:2028–2036CrossRef
23.
go back to reference Losee RE, Johnson TR, Southwick WO (1978) Anterior subluxation of the lateral tibial plateau. A diagnostic test and operative repair. J Bone Joint Surg 60A:1015–1030 Losee RE, Johnson TR, Southwick WO (1978) Anterior subluxation of the lateral tibial plateau. A diagnostic test and operative repair. J Bone Joint Surg 60A:1015–1030
24.
go back to reference Maeda A, Shino K, Horibe S, Nakata K, Buccafusca G (1996) Anterior cruciate ligament reconstruction with multistranded autogenous semitendinosus tendon. Am J Sports Med 24:504–509PubMedCrossRef Maeda A, Shino K, Horibe S, Nakata K, Buccafusca G (1996) Anterior cruciate ligament reconstruction with multistranded autogenous semitendinosus tendon. Am J Sports Med 24:504–509PubMedCrossRef
25.
go back to reference Nakajima H, Kondo M, Kurosawa H, Fukubayashi T (1979) Insufficiency of the anterior cruciate ligament. Review of our 118 cases. Arch Orthop Trauma Surg 95:233–240PubMedCrossRef Nakajima H, Kondo M, Kurosawa H, Fukubayashi T (1979) Insufficiency of the anterior cruciate ligament. Review of our 118 cases. Arch Orthop Trauma Surg 95:233–240PubMedCrossRef
26.
go back to reference Noojin FK, Barrett GR, Hartzog CW, Nach CR (2000) Clinical comparison of intraarticular anterior cruciate ligament reconstruction using autogenous semitendinosus and gracilis tendons in men versus women. Am J Sports Med 28:783–789PubMed Noojin FK, Barrett GR, Hartzog CW, Nach CR (2000) Clinical comparison of intraarticular anterior cruciate ligament reconstruction using autogenous semitendinosus and gracilis tendons in men versus women. Am J Sports Med 28:783–789PubMed
27.
go back to reference Noyes FR, Barber-Westin SD (1995) The treatment of acute combined ruptures of the anterior cruciate and medial ligaments of the knee. Am J Sports Med 23:380–391PubMedCrossRef Noyes FR, Barber-Westin SD (1995) The treatment of acute combined ruptures of the anterior cruciate and medial ligaments of the knee. Am J Sports Med 23:380–391PubMedCrossRef
28.
go back to reference Orchard J, Seward H, McGivern J, Hood S (2001) Intrinsic and extrinsic risk factors for anterior cruciate ligament injury in Australian footballers. Am J Sports Med 29:196–200PubMed Orchard J, Seward H, McGivern J, Hood S (2001) Intrinsic and extrinsic risk factors for anterior cruciate ligament injury in Australian footballers. Am J Sports Med 29:196–200PubMed
29.
go back to reference Reinhardt KR, Hetsroni I, Marx RG (2010) Graft selection for anterior cruciate ligament reconstruction: a level 1 systematic review comparing failure rates and functional outcomes. Orthop Clin N Am 41:249–262CrossRef Reinhardt KR, Hetsroni I, Marx RG (2010) Graft selection for anterior cruciate ligament reconstruction: a level 1 systematic review comparing failure rates and functional outcomes. Orthop Clin N Am 41:249–262CrossRef
30.
go back to reference Sakai H, Yajima H, Kobayashi N, Kanda T, Tamai K, Saotome K (2002) Gravity-assisted pivot-shift test for anterior cruciate ligament injury: a new procedure to elicit anterior rotatory instability. J Jpn knee Soc 26:48–51 (in Japanese) Sakai H, Yajima H, Kobayashi N, Kanda T, Tamai K, Saotome K (2002) Gravity-assisted pivot-shift test for anterior cruciate ligament injury: a new procedure to elicit anterior rotatory instability. J Jpn knee Soc 26:48–51 (in Japanese)
31.
go back to reference Sakai H, Yajima H, Akutu J, Kobayashi N, Tamai K, Saotome K (2003) Gravity-assisted pivot-shift test for anterior cruciate ligament injury. J Jpn knee Soc 28:18–20 (in Japanese) Sakai H, Yajima H, Akutu J, Kobayashi N, Tamai K, Saotome K (2003) Gravity-assisted pivot-shift test for anterior cruciate ligament injury. J Jpn knee Soc 28:18–20 (in Japanese)
32.
go back to reference Sakai H, Yajima H, Hiraoka H, Fukuda A, Tamai K, Saotome K (2004) The influence of tibial fixation on tunnel enlargement after hamstring tendon anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 12:364–370PubMedCrossRef Sakai H, Yajima H, Hiraoka H, Fukuda A, Tamai K, Saotome K (2004) The influence of tibial fixation on tunnel enlargement after hamstring tendon anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 12:364–370PubMedCrossRef
33.
go back to reference Sakai H, Yajima H, Kobayashi N, Kanda T, Hiraoka H, Tamai K, Saotome K (2006) Gravity-assisted pivot-shift test for anterior cruciate ligament injury: a new procedure to detect anterolateral rotatory instability of the knee joint. Knee Surg Sports Traumatol Arthrosc 14:2–6PubMedCrossRef Sakai H, Yajima H, Kobayashi N, Kanda T, Hiraoka H, Tamai K, Saotome K (2006) Gravity-assisted pivot-shift test for anterior cruciate ligament injury: a new procedure to detect anterolateral rotatory instability of the knee joint. Knee Surg Sports Traumatol Arthrosc 14:2–6PubMedCrossRef
34.
go back to reference Salmon L, Russell V, Musgrove T, Pinczewski L, Refshauge K (2005) Incidence and risk factors for graft rupture and contralateral rupture after anterior cruciate ligament reconstruction. Arthroscopy 21:948–957PubMedCrossRef Salmon L, Russell V, Musgrove T, Pinczewski L, Refshauge K (2005) Incidence and risk factors for graft rupture and contralateral rupture after anterior cruciate ligament reconstruction. Arthroscopy 21:948–957PubMedCrossRef
35.
go back to reference Salmon LJ, Refshauge KM, Russell VJ, Roe JP, Linklater J, Pinczewski LA (2006) Gender difference in outcome after anterior cruciate ligament reconstruction with hamstring tendon autograft. Am J Sports Med 34:621–629PubMedCrossRef Salmon LJ, Refshauge KM, Russell VJ, Roe JP, Linklater J, Pinczewski LA (2006) Gender difference in outcome after anterior cruciate ligament reconstruction with hamstring tendon autograft. Am J Sports Med 34:621–629PubMedCrossRef
36.
go back to reference Shelbourne KD, Gray T, Haro M (2009) Incidence of subsequent injury to either knee within 5 years after anterior cruciate ligament reconstruction with patellar tendon autograft. Am J Sports Med 37:246–251PubMedCrossRef Shelbourne KD, Gray T, Haro M (2009) Incidence of subsequent injury to either knee within 5 years after anterior cruciate ligament reconstruction with patellar tendon autograft. Am J Sports Med 37:246–251PubMedCrossRef
37.
go back to reference Slocum DB, James SL, Larson RL, Singer KM (1976) Clinical test for anterolateral rotatory instability of the knee. Clin Orthop Relat Res 118:63–69PubMed Slocum DB, James SL, Larson RL, Singer KM (1976) Clinical test for anterolateral rotatory instability of the knee. Clin Orthop Relat Res 118:63–69PubMed
38.
go back to reference Solomonow M, Baratta R, Zhou BH, Shoji H, Bose W, Beck C, D’Ambrosia R (1987) The synergistic action of the anterior cruciate ligament and thigh muscles in maintaining joint stability. Am J Sports Med 15:207–213PubMedCrossRef Solomonow M, Baratta R, Zhou BH, Shoji H, Bose W, Beck C, D’Ambrosia R (1987) The synergistic action of the anterior cruciate ligament and thigh muscles in maintaining joint stability. Am J Sports Med 15:207–213PubMedCrossRef
39.
go back to reference Williams RJ 3rd, Hyman J, Petrigliano F, Rozental T, Wickiewicz TL (2004) Anterior cruciate ligament reconstruction with a four-strand hamstring tendon autograft. J Bone Joint Surg Am 86:225–232PubMedCrossRef Williams RJ 3rd, Hyman J, Petrigliano F, Rozental T, Wickiewicz TL (2004) Anterior cruciate ligament reconstruction with a four-strand hamstring tendon autograft. J Bone Joint Surg Am 86:225–232PubMedCrossRef
40.
go back to reference Wolf EM (1999) Hamstring anterior cruciate ligament reconstruction using femoral cross-pin fixation. Oper Tech Sports Med 7:214–222CrossRef Wolf EM (1999) Hamstring anterior cruciate ligament reconstruction using femoral cross-pin fixation. Oper Tech Sports Med 7:214–222CrossRef
41.
go back to reference Wright RW, Andrish JT, Bergfeld J, Kaeding CC, Marx RG, McCarty EC, Parker RD, Wolcott M, Wolf BR, Spindler KP (2007) Risk of tearing the intact anterior cruciate ligament in the contralateral knee and rupturing the anterior cruciate ligament graft during the first 2 years after anterior cruciate ligament reconstruction. A prospective MOON cohort study. Am J Sports Med 35:1131–1134PubMedCrossRef Wright RW, Andrish JT, Bergfeld J, Kaeding CC, Marx RG, McCarty EC, Parker RD, Wolcott M, Wolf BR, Spindler KP (2007) Risk of tearing the intact anterior cruciate ligament in the contralateral knee and rupturing the anterior cruciate ligament graft during the first 2 years after anterior cruciate ligament reconstruction. A prospective MOON cohort study. Am J Sports Med 35:1131–1134PubMedCrossRef
42.
go back to reference Yasuda K, Sasaki T (1987) Exercise after anterior cruciate ligament reconstruction. The force exerted on the tibia by the separate isometric contractions of the quadriceps and hamstrings. Clin Orthop Relat Res 220:275–283PubMed Yasuda K, Sasaki T (1987) Exercise after anterior cruciate ligament reconstruction. The force exerted on the tibia by the separate isometric contractions of the quadriceps and hamstrings. Clin Orthop Relat Res 220:275–283PubMed
Metadata
Title
Gravity-assisted pivot-shift test can predict the function of the reconstructed anterior cruciate ligament
Authors
Hiroya Sakai
Hisatada Hiraoka
Motohisa Yashiki
Publication date
01-04-2011
Publisher
Springer-Verlag
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 4/2011
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-010-1279-x

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