Preoperative Knee Instability Affects Residual Instability as Evaluated by Quantitative Pivot-Shift Measurements During Double-Bundle ACL Reconstruction
Yusuke Kawanishi, Masahiro Nozaki, Makoto Kobayashi, Sanshiro Yasuma, Hiroaki Fukushima, Atsunori Murase, Tetsuya Takenaga, Masahito Yoshida, Gen Kuroyanagi, Yohei Kawaguchi, Yuko Waguri‐Nagaya, Hideki Murakami
Abstract
BACKGROUND: The pivot-shift test is an important indicator of functional outcomes after anterior cruciate ligament (ACL) reconstruction (ACLR). Preoperative instability as indicated by the pivot-shift test is associated with residual instability after ACLR. Few studies have used quantitative means to evaluate the pivot shift after ACLR. PURPOSE: To investigate the relationship between preoperative and residual instability and to identify the risk factors for residual instability by using quantitative measurements of the pivot shift. STUDY DESIGN: Case-control study; Level of evidence, 3. METHODS: A total of 91 patients undergoing primary double-bundle ACLR were retrospectively enrolled. Quantitative measurements of instability for ACL-deficient knees (ACLD) and uninjured contralateral knees (intact) preoperatively, as well as ACLR knees intraoperatively, were performed under general anesthesia using the pivot-shift test, with inertial sensors to measure acceleration and external rotational (ER) angular velocity. The ratios of intact to ACLD (ACLD/I) and intact to ACLR (ACLR/I) were measured. Patients who showed an ACLR/I of >1 were classified into the residual instability group, and those with an ACLR/I of ≤1 were classified into the noninstability group. Regarding demographic, surgical, and quantitative measurement factors, between-group comparisons and multivariate logistic regression were conducted for predictors of residual instability. Receiver operating characteristic curves were used to evaluate the correlations between ACLD/I and ACLR/I and the cutoff value of ACLD/I in predicting residual instability. RESULTS: < .001). The cutoff points for ACLD/I were 4.9 for acceleration (sensitivity, 65.1%; specificity, 85.7%; area under the curve [AUC], 0.76) and 2.4 for ER angular velocity (sensitivity, 80.0%; specificity, 50.0%; AUC, 0.74). CONCLUSION: Greater preoperative instability was a risk factor for residual instability as measured intraoperatively by a quantitatively evaluation in the pivot shift during ACL reconstruction. Quantitative measurements of instability during the pivot shift mechanism under general anesthesia may enable surgeons to predict postoperative residual instability.