UPMC Freddie Fu Sports Medicine Center, Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Ave #1010, Pittsburgh, PA, USA.
Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA.
Knee Surg Sports Traumatol Arthrosc. 2023 Jul;31(7):2802-2809. doi: 10.1007/s00167-022-07232-8. Epub 2022 Nov 17.
Quantitative pivot shift (QPS) testing using PIVOT technology can detect high- and low-grade rotatory knee instability following anterior cruciate ligament injury or reconstruction (ACLR). The aim of this project was to determine if preoperative QPS correlates with postoperative knee kinematics in the operative and contralateral, healthy extremity following ACLR with or without lateral extraarticular tenodesis (LET) using a highly precise in vivo analysis system. A positive correlation between preoperative QPS and postoperative tibial translation and rotation following ACLR with or without LET in the operative and healthy, contralateral extremity was hypothesized.
Twenty patients with ACL injury and high-grade rotatory knee instability were randomized to undergo anatomic ACLR with or without LET as part of a prospective randomized trial. At 6 and 12 months postoperatively, in vivo kinematic data were collected using dynamic biplanar radiography superimposed with high-resolution computed tomography scans of patients' knees during downhill running. Total anterior-posterior (AP) tibial translation and internal-external tibial rotation were measured during the gait cycle. Spearman's rho was calculated for preoperative QPS and postoperative kinematics.
In the contralateral, healthy extremity, a significant positive correlation was seen between preoperative QPS and total AP tibial translation at 12 months postoperatively (r = 0.6, p < 0.05). There were no additional significant correlations observed between preoperative QPS and postoperative knee kinematics at 6 and 12 months postoperatively in the operative and contralateral, healthy extremity for combined isolated ACLR and ACLR with LET patients as well as isolated ACLR patients or ACLR with LET patients analyzed separately.
The main finding of this study was that there was a significant positive correlation between preoperative QPS and total AP tibial translation at 12 months postoperatively in the contralateral, healthy extremity. There were no significant correlations between preoperative QPS and postoperative in vivo kinematics at 6 and 12 months following ACLR with or without LET. This suggests that QPS as measured with PIVOT technology does correlate with healthy in vivo knee kinematics, but QPS does not correlate with in vivo kinematics following ACLR with or without LET.
使用 PIVOT 技术进行定量髌股关节（QPS）测试可检测到前交叉韧带损伤或重建（ACLR）后高等级和低等级的旋转性膝关节不稳定。本项目的目的是确定在 ACLR 术后的手术侧和健康的对侧肢体中，是否存在术前 QPS 与术后膝关节运动学之间存在相关性，这些 ACLR 病例使用了高度精确的体内分析系统，包括接受或不接受外侧关节外肌腱固定术（LET）的病例。假设在接受或不接受 LET 的 ACLR 术后手术侧和健康对侧肢体中，术前 QPS 与术后胫骨平移和旋转之间存在正相关。
20 名前交叉韧带损伤和高等级旋转性膝关节不稳定患者作为前瞻性随机试验的一部分，被随机分为接受解剖学 ACLR 加或不加 LET。在术后 6 个月和 12 个月时，通过动态双平面放射照相术采集患者下坡跑步过程中膝关节的高分辨率计算机断层扫描的叠加的体内运动学数据。在步态周期内测量总前-后（AP）胫骨平移和内-外胫骨旋转。使用 Spearman's rho 计算术前 QPS 和术后运动学之间的相关性。
在健康的对侧肢体中，在术后 12 个月时，术前 QPS 与总 AP 胫骨平移之间存在显著正相关（r=0.6，p<0.05）。在手术侧和健康的对侧肢体中，在接受 ACLR 加或不加 LET 的患者、单独接受 ACLR 的患者或接受 LET 的患者中，在术后 6 个月和 12 个月时，术前 QPS 与术后膝关节运动学之间没有观察到其他显著相关性。
本研究的主要发现是，在健康的对侧肢体中，在术后 12 个月时，术前 QPS 与总 AP 胫骨平移之间存在显著正相关。在接受或不接受 LET 的 ACLR 术后 6 个月和 12 个月时，术前 QPS 与体内运动学之间没有显著相关性。这表明，使用 PIVOT 技术测量的 QPS 与健康的体内膝关节运动学确实相关，但 QPS 与接受或不接受 LET 的 ACLR 后的体内运动学无关。
