Batty Lachlan M, Firth Andrew, Moatshe Gilbert, Bryant Dianne M, Heard Mark, McCormack Robert G, Rezansoff Alex, Peterson Devin C, Bardana Davide, MacDonald Peter B, Verdonk Peter C M, Spalding Tim, Getgood Alan M J, Willits Kevin, Birmingham Trevor, Hewison Chris, Wanlin Stacey, Firth Andrew, Pinto Ryan, Martindale Ashley, O'Neill Lindsey, Jennings Morgan, Daniluk Michal, Boyer Dory, Zomar Mauri, Moon Karyn, Pritchett Raely, Payne Krystan, Fan Brenda, Mohan Bindu, Buchko Gregory M, Hiemstra Laurie A, Kerslake Sarah, Tynedal Jeremy, Stranges Greg, Mcrae Sheila, Gullett LeeAnne, Brown Holly, Legary Alexandra, Longo Alison, Christian Mat, Ferguson Celeste, Mohtadi Nick, Barber Rhamona, Chan Denise, Campbell Caitlin, Garven Alexandra, Pulsifer Karen, Mayer Michelle, Simunovic Nicole, Duong Andrew, Robinson David, Levy David, Skelly Matt, Shanmugaraj Ajaykumar, Howells Fiona, Tough Murray, Thompson Pete, Metcalfe Andrew, Asplin Laura, Dube Alisen, Clarkson Louise, Brown Jaclyn, Bolsover Alison, Bradshaw Carolyn, Belgrove Larissa, Millan Francis, Turner Sylvia, Verdugo Sarah, Lowe Janet, Dunne Debra, McGowan Kerri, Suddens Charlie-Marie, Declercq Geert, Vuylsteke Kristien, Van Haver Mieke
Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada.
Orthop J Sports Med. 2021 Apr 6;9(4):23259671211000038. doi: 10.1177/23259671211000038. eCollection 2021 Apr.
A spectrum of anterolateral rotatory laxity exists in anterior cruciate ligament (ACL)-injured knees. Understanding of the factors contributing to a high-grade pivot shift continues to be refined.
To investigate factors associated with a high-grade preoperative pivot shift and to evaluate the relationship between this condition and baseline patient-reported outcome measures (PROMs).
Cross-sectional study; Level of evidence, 3.
A post hoc analysis was performed of 618 patients with ACL deficiency deemed high risk for reinjury. A binary logistic regression model was developed, with high-grade pivot shift as the dependent variable. Age, sex, Beighton score, chronicity of the ACL injury, posterior third medial or lateral meniscal injury, and tibial slope were selected as independent variables. The importance of knee hyperextension as a component of the Beighton score was assessed using receiver operator characteristic curves. Baseline PROMs were compared between patients with and without a high-grade pivot.
Six factors were associated with a high-grade pivot shift: Beighton score (each additional point; odds ratio [OR], 1.17; 95% CI, 1.06-1.30; = .002), male sex (OR, 2.30; 95% CI, 1.28-4.13; = .005), presence of a posterior third medial (OR, 2.55; 95% CI, 1.11-5.84; = .03) or lateral (OR, 1.76; 95% CI, 1.01-3.08; = .048) meniscal injury, tibial slope >9° (OR, 2.35; 95% CI, 1.09-5.07; = .03), and chronicity >6 months (OR, 1.70; 95% CI, 1.00-2.88; = .049). The presence of knee hyperextension improved the diagnostic utility of the Beighton score as a predictor of a high-grade pivot shift. Tibial slope <9° was associated with only a high-grade pivot in the presence of a posterior third medial meniscal injury. Patients with a high-grade pivot shift had higher baseline 4-Item Pain Intensity Measure scores than did those without a high-grade pivot shift (mean ± SD, 11 ± 13 vs 8 ± 14; = .04); however, there was no difference between groups in baseline International Knee Documentation Committee, ACL Quality of Life, Knee injury and Osteoarthritis Outcome Score, or Knee injury and Osteoarthritis Outcome Score subscale scores.
Ligamentous laxity, male sex, posterior third medial or lateral meniscal injury, increased posterior tibial slope, and chronicity were associated with a high-grade pivot shift in this population deemed high risk for repeat ACL injury. The effect of tibial slope may be accentuated by the presence of meniscal injury, supporting the need for meniscal preservation. Baseline PROMs were similar between patients with and without a high-grade pivot shift.
前交叉韧带（ACL）损伤的膝关节存在一系列前外侧旋转松弛。对导致严重轴移的因素的理解仍在不断完善。
研究与术前严重轴移相关的因素，并评估这种情况与患者报告的基线结局指标（PROMs）之间的关系。
横断面研究；证据等级，3级。
对618例被认为再次受伤风险高的ACL缺损患者进行事后分析。建立二元逻辑回归模型，以严重轴移作为因变量。选择年龄、性别、Beighton评分、ACL损伤的慢性程度、后内侧或外侧半月板后三分之一损伤以及胫骨坡度作为自变量。使用受试者工作特征曲线评估膝关节过伸作为Beighton评分组成部分的重要性。比较有和没有严重轴移的患者的基线PROMs。
六个因素与严重轴移相关：Beighton评分（每增加一分；比值比[OR]，1.17；95%置信区间[CI]，1.06 - 1.30；P = 0.002）、男性（OR，2.30；95% CI，1.28 - 4.13；P = 0.005）、存在后内侧（OR，2.55；95% CI，1.11 - 5.84；P = 0.03）或后外侧（OR，1.76；95% CI，1.01 - 3.08；P = 0.048）半月板后三分之一损伤、胫骨坡度>9°（OR，2.35；95% CI，1.09 - 5.07；P = 0.03）以及慢性程度>6个月（OR，1.70；95% CI，1.00 - 2.88；P = 0.049）。膝关节过伸的存在提高了Beighton评分作为严重轴移预测指标的诊断效用。仅在存在后内侧半月板后三分之一损伤时，胫骨坡度<9°与严重轴移相关。有严重轴移的患者的基线4项疼痛强度测量得分高于没有严重轴移的患者（均值±标准差，11±13 vs 8±14；P = 0.04）；然而，两组在基线国际膝关节文献委员会、ACL生活质量、膝关节损伤和骨关节炎结局评分或膝关节损伤和骨关节炎结局评分子量表得分方面没有差异。
在这个被认为重复ACL损伤风险高的人群中，韧带松弛、男性、后内侧或后外侧半月板后三分之一损伤、胫骨后倾增加以及慢性程度与严重轴移相关。半月板损伤的存在可能会加重胫骨坡度的影响，支持半月板保留的必要性。有和没有严重轴移的患者的基线PROMs相似。
