Lima Luiz Henrique Pires de, Gomes João Luiz Ellera
Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil.
Rev Bras Ortop (Sao Paulo). 2024 Mar 21;59(1):e82-e87. doi: 10.1055/s-0044-1779316. eCollection 2024 Feb.
Rupture of the anterior cruciate ligament (ACL) is one of the most common injuries in athletes and is often associated with damage to anterolateral structures. This combination of injuries presents itself clinically as a high-grade pivot shift test. The hypothesis of this study is that patients with ACL deficiency and high-grade pivot shift test should have an increased internal knee rotation. Twenty-two patients were tested. After effective spinal anesthesia, two tests were performed with the patient in supine position. First, the bilateral pivot shift test was performed manually, and its grade was recorded. Then, with the knee flexed to 90 degrees, the examiner drew the projection of the foot in a neutral position and in maximum internal rotation, and the angle of internal rotation was measured from the axes built between the central point of the heel and the hallux. In the ACL-deficient knee, it was observed that there is a statistically significant average internal rotation (IR) delta of 10.5 degrees between the groups when not adjusted for age, and 10.6 degrees when adjusted for age. Knees with ACL deficiency and with pivot shift test grade I do not show increased internal rotation in relation to knees with intact ACL. Knees with ACL deficiency and with pivot shift test grades II and III show increased internal rotation in comparison to healthy knees.
前交叉韧带（ACL）断裂是运动员中最常见的损伤之一，且常与前外侧结构损伤相关。这种损伤组合在临床上表现为高度的轴移试验阳性。本研究的假设是，ACL功能不全且轴移试验高度阳性的患者膝关节内旋增加。
对22名患者进行了测试。在有效的脊髓麻醉后，让患者仰卧位进行两项测试。首先，手动进行双侧轴移试验，并记录其分级。然后，将膝关节屈曲至90度，检查者画出足部在中立位和最大内旋位的投影，并从足跟中心点与拇趾之间建立的轴线测量内旋角度。
在ACL功能不全的膝关节中，未校正年龄时，两组之间平均内旋（IR）差值有统计学意义，为10.5度；校正年龄后为10.6度。
ACL功能不全且轴移试验为I级的膝关节与ACL完整的膝关节相比，未显示出内旋增加。ACL功能不全且轴移试验为II级和III级的膝关节与健康膝关节相比，内旋增加。
