The diagnostic reliability of the quantitative pivot-shift evaluation using an electromagnetic measurement system for anterior cruciate ligament deficiency was superior to those of the accelerometer and iPad image analysis.

Abstract

Several non-invasive devices have been developed to obtain quantitative assessment of the pivot-shift test in clinical setting using similar but diverse measurement parameters. However, the clinical usability of those measurements has yet to be closely investigated and compared. The purpose of this study was to compare the diagnostic accuracy of three non-invasive measurement devices for the pivot-shift test. Thirty patients with unilateral anterior cruciate ligament (ACL) injury were enrolled. The pivot-shift test was performed under general anaesthesia. Three devices, an accelerometer system (KiRA), an image analysis iPad application (iPad), and electromagnetic measurement system (EMS), were used simultaneously to provide two parameters, namely tibial acceleration monitored using KiRA and EMS, and tibial translation recorded using iPad and EMS. Side-to-side differences in each parameter and correlation between the measurements were tested, and a receiver-operating characteristic (ROC) curve analysis was conducted to compare their measurement accuracy. Significant side-to-side differences were successfully detected using any of the measurements (all p < 0.01). KiRA demonstrated moderate correlation with the EMS for tibial acceleration (r = 0.54; p < 0.01), while poor correlation was observed between iPad and the EMS for the translation (r = 0.28; p < 0.01). The ROC curve analysis demonstrated better accuracy for the detection of ACL insufficiency in the EMS than KiRA and iPad for tibial acceleration and translation, respectively. Although all three measurements were similarly capable of detecting ACL deficiency, the EMS has the advantage of comprehensive evaluation of the pivot-shift test by evaluating both tibial acceleration and translation with higher accuracy than those of KiRA and iPad. It could be suggested that any of those measurement tools might improve the clinical diagnosis of ACL insufficiency. Diagnostic study of consecutive patients with a universally applied gold standard, Level Ib.