Bai Wenbin, Shi Weili, Xu Chenzhao, Zhang Zhiyu, Gao Yitian, Yao Jinpeng, Tang Sirui, Gong Xi, Meng Qingyang, Wang Cheng
Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China.
Beijing Key Laboratory of Sports Injuries, Beijing, China.
Knee Surg Sports Traumatol Arthrosc. 2025 Jul 18. doi: 10.1002/ksa.12747.
To perform a systematic review and meta-analysis on the incidence rate and risk factors for high-grade pivot shift in patients with anterior cruciate ligament (ACL) injury. It was hypothesised that the risk factors associated with high-grade pivot shift can be successfully identified.
Pubmed, Scopus, Embase and Web of Science databases were systematically searched from inception to March 22, 2025, to identify relevant studies. Comparative studies reporting risk factors for high-grade pivot shift were included in this analysis. A random-effects model was utilised to assess the pooled effect and identify risk factors significantly associated with high-grade pivot shift.
A total of 16 studies investigating risk factors for high-grade pivot shift (nine defined as grade ≥II and seven defined as grade III) involving 6051 patients were included in this analysis. The overall pooled incidence rate of high-grade pivot shift was 55.8% (95% confidence interval [CI]: 40.1%, 71.5%) for grade ≥II pivot shift and 23.0% (95% CI: 15.8%, 30.3%) for grade III pivot shift. Lower body mass index (BMI; mean difference [MD], -0.42), higher Beighton score (odds ratio [OR], 1.15), complete ACL tear (OR, 6.23), and concomitant injuries to medial collateral ligament (MCL; OR, 2.86), anterolateral complex (ALC; OR, 6.66), lateral meniscus (OR, 1.62), lateral meniscus posterior horn (OR, 2.39), medial meniscus (OR, 1.32) and medial meniscus posterior horn (OR, 1.75) were identified as risk factors for high-grade pivot shift in patients with ACL injury.
Lower BMI, higher Beighton score, complete ACL tear, concomitant injuries to MCL, ALC, lateral meniscus, lateral meniscus posterior horn, medial meniscus and medial meniscus posterior horn were significantly associated with an increase of risk for high-grade pivot shift in patients with ACL injury. Clinicians are supposed to pay more attention to these risk factors to effectively identify patients with potential rotational instability.
Level III.
对前交叉韧带（ACL）损伤患者中重度轴移的发生率及危险因素进行系统评价和荟萃分析。假设与重度轴移相关的危险因素能够被成功识别。
从数据库建库至2025年3月22日，系统检索PubMed、Scopus、Embase和Web of Science数据库，以识别相关研究。本分析纳入报告重度轴移危险因素的比较研究。采用随机效应模型评估合并效应，并识别与重度轴移显著相关的危险因素。
本分析共纳入16项研究，涉及6051例患者，这些研究调查了重度轴移（9项定义为II级及以上，7项定义为III级）的危险因素。II级及以上轴移的总体合并发生率为55.8%（95%置信区间[CI]：40.1%，71.5%），III级轴移为23.0%（95%CI：15.8%，30.3%）。较低的体重指数（BMI；平均差[MD]，-0.42）、较高的Beighton评分（比值比[OR]，1.15）、ACL完全撕裂（OR，6.23）以及合并内侧副韧带（MCL；OR，2.86）、前外侧复合体（ALC；OR，6.66）、外侧半月板（OR，1.62）、外侧半月板后角（OR，2.39）、内侧半月板（OR，1.32）和内侧半月板后角（OR，1.75）损伤被确定为ACL损伤患者发生重度轴移的危险因素。
较低的BMI、较高的Beighton评分、ACL完全撕裂、合并MCL、ALC、外侧半月板、外侧半月板后角、内侧半月板和内侧半月板后角损伤与ACL损伤患者发生重度轴移的风险增加显著相关。临床医生应更加关注这些危险因素，以有效识别潜在旋转不稳定的患者。
III级。
