Evaluation of Pivot Shift under Anesthesia in Anterior Cruciate Ligament (ACL) Deficient knees

Abstract

Background: Knee injuries are common injuries sustained in sports or accidents (domestic, road traffic, etc.).These injuries affect the different structures of the knees, affecting the skin, muscles, bone, ligaments, tendons, etc. Some of the structures are extra-articular and others are intra-articular. There are a lot of different ways that the anterior cruciate ligament (ACL) can be torn. The most common are low-speed, non-contact, deceleration, and contact injuries with a rotational component. Contact sports can also cause twisting, valgus stress, or hyperextension from direct contact or collision-related ACL secondary injuries. The pivot is one of these injuries. The shift test for anterolateral stability of the knee It is a painful test, so most of the patients will not cooperate if not under anesthesia. Objective: This study evaluates the angle of displacement of the tibia in relation to the femur at 30-degree knee flexion, knee extension, and the difference between knee flexion and knee extension. It also determined the angular estimation as outlined above after reconstruction. To compare the angular displacement in the pivot shift before and after reconstruction in an ACL-deficient knee. Methods: This study was conducted in the department of orthopedics, arthroscopy, and sports medicine at Aware Global Hospital, Hyderabad, India. The study was initiated from January 2015 to March 2015. Through inclusion criteria, 15 patients with knee instability were included in the study. Results: After completing the pivot shift test using spinal anesthesia, the knee was flexed to 30 degrees. Three K-wires are placed in three key locations. Compared to the affected knee, the angular displacement in flexed and extended knees is a more reliable and sensitive method for screening anterior instability of the knee due to ACL tear. It is also a low-cost method when specialized medical diagnostic tests are not available. Compared to MRI, it is a dynamic modality and has proven to be just as reliable in diagnosing ACL injuries.