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

Miho Tanaka, D. Vyas, G. Moloney, A. Bedi, A. D. Pearle, V. Musahl

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)737-742
Number of pages6
JournalKnee Surgery, Sports Traumatology, Arthroscopy
Volume20
Issue number4
DOIs
StatePublished - Apr 2012
Externally publishedYes

Fingerprint

Knee
Wounds and Injuries
Tibial Meniscus
Joint Instability
Knee Joint
Osteoarthritis
Capsules
Anterior Cruciate Ligament Injuries

Keywords

  • ACL
  • Pivot shift
  • Rotatory laxity
  • Secondary stabilizers

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Surgery

Cite this

Tanaka, M., Vyas, D., Moloney, G., Bedi, A., Pearle, A. D., & Musahl, V. (2012). What does it take to have a high-grade pivot shift? Knee Surgery, Sports Traumatology, Arthroscopy, 20(4), 737-742. https://doi.org/10.1007/s00167-011-1866-5

What does it take to have a high-grade pivot shift? / Tanaka, Miho; Vyas, D.; Moloney, G.; Bedi, A.; Pearle, A. D.; Musahl, V.

In: Knee Surgery, Sports Traumatology, Arthroscopy, Vol. 20, No. 4, 04.2012, p. 737-742.

Research output: Contribution to journalArticle

Tanaka, M, Vyas, D, Moloney, G, Bedi, A, Pearle, AD & Musahl, V 2012, 'What does it take to have a high-grade pivot shift?', Knee Surgery, Sports Traumatology, Arthroscopy, vol. 20, no. 4, pp. 737-742. https://doi.org/10.1007/s00167-011-1866-5
Tanaka, Miho ; Vyas, D. ; Moloney, G. ; Bedi, A. ; Pearle, A. D. ; Musahl, V. / What does it take to have a high-grade pivot shift?. In: Knee Surgery, Sports Traumatology, Arthroscopy. 2012 ; Vol. 20, No. 4. pp. 737-742.
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