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Risk Factors for Grade 3 Pivot Shift in Knees With Acute Anterior Cruciate Ligament Injuries: A Comprehensive Evaluation of the Importance of Osseous and Soft Tissue Parameters From the SANTI Study Group
- Source :
- The American Journal of Sports Medicine. 48:2408-2417
- Publication Year :
- 2020
- Publisher :
- SAGE Publications, 2020.
-
Abstract
- Background:Preoperative grade 3 pivot shift has been reported to be associated with higher rates of anterior cruciate ligament (ACL) failure, persistent instability, and inferior patient-reported outcomes. The etiology of a high-grade pivot shift is multifactorial, and numerous factors have been suggested to be responsible. More attention has recently been focused on injury to the anterolateral structures (ALS) as a risk factor for a grade 3 pivot shift.Purpose:To determine risk factors for grade 3 pivot shift, including soft tissue and osseous parameters.Study Design:Cross-sectional study; Level of evidence, 3.Methods:A prospective evaluation was undertaken of 200 consecutive patients undergoing acute ACL reconstruction (within 10 days of injury). An open exploration of the lateral side of the injured knee was performed at the time of the index procedure. Details regarding patient and injury characteristics were recorded, as were details of soft tissue injuries, including meniscal tears, ALS lesions, medial collateral ligament tears, and chondral injuries. Osseous parameters (tibial slope and condylar ratios) were determined per established magnetic resonance imaging protocols. A multivariate logistic regression with penalized maximum likelihood was used to identify risk factors associated with International Knee Documentation Committee (IKDC) grade 3 pivot shift.Results:The mean ± SD age of the population was 28.3 ± 9.8 years; 67.5% of patients were male. Among patients, 35 (17.5%) had a high-grade pivot shift (IKDC grade 3), and 165 (82.5%) had a low-grade pivot shift (IKDC grades 1 and 2). Univariate and multivariate logistic regression analysis demonstrated that injury to the ALS was the only significant risk factor for grade 3 pivot shift (odds ratio, 13.49; 95% CI, 1.80-1725.53).Conclusion:This comprehensive evaluation of soft tissue and osseous factors has identified that injury to the ALS is the most important risk factor for grade 3 pivot shift in acute ACL-injured knees.
- Subjects :
- Adult
Joint Instability
Male
Knee Joint
Anterior cruciate ligament
Pivot shift
ACL
ALS
pivot shift
tibial slope
Physical Therapy, Sports Therapy and Rehabilitation
Young Adult
03 medical and health sciences
0302 clinical medicine
Risk Factors
Humans
Medicine
Orthopedics and Sports Medicine
Prospective Studies
Orthodontics
030222 orthopedics
business.industry
Anterior Cruciate Ligament Injuries
Soft tissue
030229 sport sciences
Cross-Sectional Studies
medicine.anatomical_structure
Female
business
Subjects
Details
- ISSN :
- 15523365 and 03635465
- Volume :
- 48
- Database :
- OpenAIRE
- Journal :
- The American Journal of Sports Medicine
- Accession number :
- edsair.doi.dedup.....3aea5341854b640b86d1e1608b4444cf