Lucie R S, Wiedel J D, Messner D G
Am J Sports Med. 1984 May-Jun;12(3):189-91. doi: 10.1177/036354658401200303.
The pivot shift test and its various modifications has been well described for evaluation of chronic anterolateral rotatory insufficiency of the knee. Fifty knees with acute traumatic hemarthrosis were examined under general anesthesia to assess the reliability of the pivot shift in the acute injury. The pivot shift test as described by Galway and MacIntosh was employed. No patients with a history of previous knee injuries were included. Arthrotomy or arthroscopy was performed following the examination in all cases. There were 38 knees with positive shifts, 35 with complete anterior cruciate tears, and 3 with significant partial tears or attenuation of the ligament. The 12 knees with negative shift demonstrated five normal anterior cruciates, five partial tears and two complete tears of the anterior cruciate. Both of the complete tears were associated with complete medial collateral ligament tears and were clinically apparent by drawer and Lachman tests. A positive pivot shift in this study was very accurate for significant anterior cruciate tears. A negative pivot shift ruled out complete anterior cruciate ligament tears but did not preclude the presence of a partial tear. Partial tears associated with a negative pivot shift retained ligament competence. We conclude that: (1) the pivot shift is a direct test of cruciate competence; (2) the pivot shift is present acutely in a very high percentage of cases and does not necessarily develop over time; (3) the pivot shift exam performed under general anesthesia is a very reliable test for significant tears of the anterior cruciate; and (4) the arthroscope remains a useful tool in the evaluation of acute traumatic hemarthrosis, but is not always necessary in establishing competence of the anterior cruciate ligament.
针对膝关节慢性前外侧旋转不稳的评估，枢轴偏移试验及其各种改良方法已有详尽描述。对50例急性创伤性关节积血的膝关节在全身麻醉下进行检查，以评估急性损伤时枢轴偏移的可靠性。采用了Galway和MacIntosh所描述的枢轴偏移试验。纳入的患者均无既往膝关节损伤史。所有病例在检查后均进行了关节切开术或关节镜检查。有38例膝关节出现阳性偏移，其中35例存在完全性前交叉韧带撕裂，3例存在明显的部分撕裂或韧带松弛。12例阴性偏移的膝关节中，5例前交叉韧带正常，5例部分撕裂，2例完全撕裂。这2例完全撕裂均伴有内侧副韧带完全撕裂，通过抽屉试验和拉赫曼试验在临床上可明显看出。本研究中，阳性枢轴偏移对于明显的前交叉韧带撕裂非常准确。阴性枢轴偏移可排除完全性前交叉韧带撕裂，但不能排除部分撕裂的存在。与阴性枢轴偏移相关的部分撕裂仍保留韧带功能。我们得出以下结论：（1）枢轴偏移是对交叉韧带功能的直接检测；（2）枢轴偏移在很高比例的病例中急性出现，不一定随时间发展；（3）在全身麻醉下进行的枢轴偏移检查对于前交叉韧带的明显撕裂是一项非常可靠的检测；（4）关节镜仍是评估急性创伤性关节积血的有用工具，但在确定前交叉韧带功能时并非总是必要的。
