Dipartimento di Ingegneria dell'Informazione, Università degli Studi di Brescia, Brescia, Italy.
Laboratorio di Biomeccanica e Innovazione Tecnologica, Istituto Ortopedico Rizzoli, Bologna, Italy.
Knee Surg Sports Traumatol Arthrosc. 2017 Oct;25(10):3004-3011. doi: 10.1007/s00167-016-4130-1. Epub 2016 Apr 19.
The main goal of this work was to evaluate the pivot shift test in awake and anesthetized patients by using two different quantitative methodologies and comparing the results with the standard clinical grading, taking advantage of a multicenter international study.
Patients between 16 and 50 years of age undergoing primary unilateral single-bundle anterior cruciate ligament (ACL) reconstruction were considered eligible. The pivot shift test was performed pre-operatively, with the patient awake and again with the patient under general anaesthesia. The pivot shift test was clinically graded as defined by the International Knee Documentation Committee. The instrumented assessment was performed by using two non-invasive acquisition systems; specifically, a system exploiting an inertial sensor and a video-based application developed on a commercial tablet using skin markers. Lateral compartment translation and the tibial acceleration reached during joint reduction were used as quantitative parameters.
A total of 103 patients were enrolled in the study. Statistically significant difference was found between the distributions of clinical grade evaluated in awake patients and those under general anaesthesia (P < 0.01). Comparing awake patients to those under general anaesthesia, lower values were found both for tibial acceleration (3.7 ± 1.5 vs 6.0 ± 4.6 m/s, P < 0.01) and lateral compartment translation of the involved limb (2.2 ± 1.7 vs 3.0 ± 2.2 mm, P < 0.01).
This study indicated that significant differences in the grading of the pivot shift test exist between awake and anesthetized patients, regardless of the use of quantitative instruments during the evaluation. Actual clinical assessment reported indeed its weakness, presenting subjective variability and dependence on tester's experience. However, several factors might influence the validity of awake examination such as experience level of examiner and cultural factors, as seen in this international multicenter study.
Prospective comparative study, Level II.
本研究旨在利用两种不同的定量方法，在清醒和麻醉患者中评估膝关节前交叉韧带（ACL）重建术患者的“枢轴点移位试验”，并利用多中心国际研究的优势，将结果与标准临床分级进行比较。
年龄在 16 岁至 50 岁之间，接受初次单侧单束 ACL 重建的患者符合条件。术前，患者清醒时进行“枢轴点移位试验”，并在全身麻醉下再次进行。“枢轴点移位试验”根据国际膝关节文献委员会的定义进行临床分级。仪器评估采用两种非侵入性采集系统进行；具体来说，一种系统利用惯性传感器，另一种系统利用商业平板电脑上的基于视频的应用程序和皮肤标记物。关节复位时的外侧间隔平移和胫骨加速度被用作定量参数。
共纳入 103 例患者。在清醒患者和全身麻醉患者的临床分级分布之间发现了统计学上的显著差异（P<0.01）。与全身麻醉患者相比，清醒患者的胫骨加速度（3.7±1.5 对 6.0±4.6m/s，P<0.01）和患侧的外侧间隔平移（2.2±1.7 对 3.0±2.2mm，P<0.01）均较低。
这项研究表明，在评估时使用定量仪器与否，清醒和麻醉患者的“枢轴点移位试验”分级存在显著差异。实际的临床评估确实存在其弱点，表现出主观性和对评估者经验的依赖性。然而，在这项国际多中心研究中，许多因素可能会影响清醒检查的有效性，如检查者的经验水平和文化因素。
前瞻性比较研究，Ⅱ级。
