Laboratorio di Biomeccanica e Innovazione Tecnologica, Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136, Bologna, Italy.
Knee Surg Sports Traumatol Arthrosc. 2013 Apr;21(4):767-83. doi: 10.1007/s00167-013-2435-x. Epub 2013 Mar 2.
This study aims to identify and summarize the evidence on the biomechanical parameters and the corresponding technologies which have been used to quantify the pivot shift test during the clinical and functional assessment of anterior cruciate ligament (ACL) injury and surgical reconstruction.
Search strategy Internet search of indexed scientific articles on the PubMed database, Web of Science and references on published manuscripts. No year restriction was used. Selection criteria Articles included were written only in English and related to search terms: "pivot shift" AND (OR "ACL"). The reviewers independently selected only those studies that included at least one quantitative parameter for the analysis of the pivot shift test, including both in vitro and in vivo analyses performed on human joint. Those studies that analysed only clinical grading were excluded from the analysis. Analysis After evaluating the methodological quality of the articles, the parameters found were summarized.
Six hundred and eight studies met the inclusion criteria, and finally, 68 unique studies were available for the systematic review. Quantitative results were heterogeneous. The pivot shift test has been quantified by means of 25 parameters, but most of the studies focused on anterior-posterior translations, internal-external rotation and acceleration in anterior-posterior direction.
Several methodologies have been identified and developed to quantify pivot shift test. However, clinical professionals are still lacking a 'gold standard' method for the quantification of knee joint dynamic laxity. A widespread adoption of a standardized pivot shift manoeuvre and measurement method to allow objective comparison of the results of ACL reconstructions is therefore desirable. Further development of measurement methods is indeed required to achieve this goal in a routine clinical scenario.
本研究旨在确定和总结用于量化前交叉韧带（ACL）损伤和手术重建的临床和功能评估中的枢轴转移试验的生物力学参数和相应技术的证据。
在 PubMed 数据库、Web of Science 及已发表手稿的参考文献中进行索引科学文章的互联网搜索，未使用年限限制。选择标准：仅纳入英文撰写且与搜索词“枢轴转移”和（或）“ACL”相关的文章。审查员独立选择仅包括用于枢轴转移试验分析的至少一个定量参数的研究，包括对人体关节进行的体外和体内分析。那些仅分析临床分级的研究被排除在分析之外。
在评估文章的方法学质量后，总结了发现的参数。
符合纳入标准的有 608 项研究，最终有 68 项独特的研究可用于系统评价。定量结果存在异质性。枢轴转移试验已通过 25 个参数进行量化，但大多数研究集中在前-后平移、内-外旋转和前-后方向的加速度上。
已经确定和开发了几种方法来量化枢轴转移试验。然而，临床医生仍然缺乏量化膝关节动态松弛的“金标准”方法。因此，需要广泛采用标准化的枢轴转移操作和测量方法，以允许对 ACL 重建的结果进行客观比较。为了在常规临床环境中实现这一目标，确实需要进一步开发测量方法。
