Lower body mass index, higher Beighton score, complete anterior cruciate ligament tear, concomitant injuries to medial collateral ligament, anterolateral complex and meniscus especially posterior horn are risk factors for preoperative high-grade pivot shift under anaesthesia of patients with anterior cruciate ligament injury: A systematic review and meta-analysis.

PURPOSE

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.

METHODS

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.

RESULTS

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.

CONCLUSION

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 OF EVIDENCE

Level III.