Abstract
The anterolateral ligament (ALL) has been suggested as an important secondary knee restrain on the dynamic laxity in anterior cruciate ligament- (ACL-) deficient knees. Nevertheless, its kinematical contribution to the pivot-shift (PS) phenomenon has not been clearly and objectively defined, and noninvasive sensor technology could give a crucial contribution in this direction. The aim of the present study was to quantify in vitro the PS phenomenon in order to investigate the differences between an ACL-deficient knee and an ACL+ALL-deficient knee. Ten fresh-frozen paired human cadaveric knees (n = 20) were included in this controlled laboratory study. Intact, ACL-deficient, and ACL+ALL-deficient knees were subjected to a manual PS test quantified by a noninvasive triaxial accelerometer (KiRA, OrthoKey). Kinematic data (i.e., posterior acceleration of the tibial lateral compartment) were recorded and compared among the three statuses. Pairwise Student's t-test was used to compare the single groups (p < 0.05). Intact knees, ACL-deficient knees, and ACL+ALL-deficient knees showed an acceleration of 5.3 ± 2.1 m/s2, 6.3 ± 2.3 m/s2, and 7.8 ± 2.1 m/s2, respectively. Combined sectioning of ACL and ALL resulted in a statistically significant acceleration increase compared to both the intact state (p < 0.01) and the ACL-deficient state (p < 0.01). The acceleration increase determined by isolated ACL resection compared to the intact state was not statistically significant (p > 0.05). The ALL sectioning increased the rotatory laxity during the PS after ACL sectioning as measured through a user-friendly, noninvasive triaxial accelerometer.
Highlights
The pivot-shift (PS) phenomenon has been described as anterior subluxation of the lateral tibial plateau followed by its sudden reduction during combined stresses [1]
The aim of this study was to investigate in a cadaveric setting the effect of anterolateral ligament (ALL) sectioning on the dynamic laxity parameters of the anterior cruciate ligament- (ACL-)deficient knee using noninvasive skin fixed inertial sensors
The results for the intact, anterior cruciate ligament (ACL)-deficient, and ACL+ALL-deficient statuses were reported as mean ± SD
Summary
The pivot-shift (PS) phenomenon has been described as anterior subluxation of the lateral tibial plateau followed by its sudden reduction during combined stresses [1]. The pivot-shift test has been defined as a combination of valgus stress and internal tibial rotation during limb flexion [2]. This phenomenon has been widely identified as one of the essential signs of functional anterior cruciate ligament (ACL) insufficiency [2, 3]. Literature reports that the grade of pivot-shift correlates more closely with patient satisfaction and symptoms of functional instability than Lachman and drawer tests that address only static joint laxity [4]. Since the pivot-shift phenomenon has been associated with dynamic instability of the joint [1], clinicians have been trying to recreate this abnormality by applying combined stresses to the limb to highlight its presence. Clinical and basic research on the PS test has increased over the past decade [5], and the importance of the secondary restraints of the knee emphasized [6], suggesting the anterolateral ligament (ALL) as an important restrain to control rotational laxity [7]
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