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van Eijck SC, Vugts MMJ, Janssen RPA, Hoogendoorn I, Ito K, van der Steen MC. Wearable sensor systems measure differences in knee laxity between healthy and affected knees during dynamic exercise activities: A systematic review. J Exp Orthop 2024; 11:e12094. [PMID: 39055395 PMCID: PMC11269365 DOI: 10.1002/jeo2.12094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Accepted: 06/03/2024] [Indexed: 07/27/2024] Open
Abstract
Purpose Knee laxity can be experienced as knee instability which may lead to a limitation in the activity of patients. Current methods to determine knee instability are performed in a static setting, which does not always correlate with dynamic knee laxity during activities. Wearables might be able to measure knee laxity in a dynamic setting and could be of added value in the diagnosis and treatment of excessive knee laxity. Therefore, the aim of this systematic review is to provide an overview of the wearables that have been developed and their ability to measure knee laxity during dynamic activities. Methods The PRISMA guidelines for systematic reviews were followed. A literature search was conducted in EMBASE, PubMed and Cochrane databases. Included studies assessed patients with knee instability using a non-invasive wearable sensor system during dynamic activity, with comparison to a reference system or healthy knees. Data extraction was performed by two authors via a predefined format. The risk of bias was assessed by The Dutch checklist for diagnostic tests. Results A total of 4734 articles were identified. Thirteen studies were included in the review. The studies showed a great variety of patients, sensor systems, reference tests, outcome measures and performed activities. Nine of the included studies were able to measure differences in patients with knee instability, all including a tri-axial accelerometer. Differences were not measurable in all parameters and activities in these studies. Conclusions Wearables, including at least a tri-axial accelerometer, seem promising for measuring dynamic knee laxity in the anterior-posterior and mediolateral direction. At this stage, it remains unclear if the measured outcomes completely reflect the knee instability that patients experience in daily life. Level of Evidence Level III.
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Affiliation(s)
- Sander C. van Eijck
- Department of Orthopedic Surgery & TraumaMáxima Medical CenterVeldhovenThe Netherlands
- Orthopedic Biomechanics, Department of Biomedical EngineeringEindhoven University of TechnologyVeldhovenThe Netherlands
| | - Marly M. J. Vugts
- Department of Orthopedic Surgery & TraumaMáxima Medical CenterVeldhovenThe Netherlands
- Orthopedic Biomechanics, Department of Biomedical EngineeringEindhoven University of TechnologyVeldhovenThe Netherlands
| | - Rob P. A. Janssen
- Department of Orthopedic Surgery & TraumaMáxima Medical CenterVeldhovenThe Netherlands
- Orthopedic Biomechanics, Department of Biomedical EngineeringEindhoven University of TechnologyVeldhovenThe Netherlands
- Health, Innovations & Technology, Department of Paramedical SciencesFontys University of Applied SciencesEindhovenThe Netherlands
| | | | - Keita Ito
- Orthopedic Biomechanics, Department of Biomedical EngineeringEindhoven University of TechnologyVeldhovenThe Netherlands
| | - Maria C. van der Steen
- Department of Orthopedic Surgery & TraumaMáxima Medical CenterVeldhovenThe Netherlands
- Department of Orthopedic Surgery & TraumaCatharina HospitalEindhovenThe Netherlands
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2
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Caracciolo G, Yáñez R, Silvestre R, De la Fuente C, Zamorano H, Ossio A, Strömbäck L, Abusleme S, P Carpes F. Intraoperative pivot-shift accelerometry combined with anesthesia improves the measure of rotatory knee instability in anterior cruciate ligament injury. J Exp Orthop 2021; 8:80. [PMID: 34561730 PMCID: PMC8463650 DOI: 10.1186/s40634-021-00396-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 08/27/2021] [Indexed: 01/11/2023] Open
Abstract
Purpose The knee stiffness acquired following an Anterior Cruciate Ligament (ACL) injury might affect clinical knee tests, i.e., the pivot-shift maneuver. In contrast, the motor effects of spinal anesthesia could favor the identification of rotatory knee deficiencies prior to ACL reconstruction. Hence, we hypothesized that the intra-operative pivot-shift maneuver under spinal anesthesia generates more acceleration in the lateral tibial plateau of patients with an injured ACL than without. Methods Seventy patients with unilateral and acute ACL rupture (62 men and 8 women, IKDC of 55.1 ± 13.8 pts) were assessed using the pivot-shift maneuver before and after receiving spinal anesthesia. A triaxial accelerometer was attached to the skin between Gerdys’ tubercle and the anterior tuberosity to measure the subluxation and reduction phases. Mixed ANOVA and multiple comparisons were performed considering the anesthesia and leg as factors (alpha = 5%). Results We found a higher acceleration in the injured leg measured under anesthesia compared to without anesthesia (5.12 ± 1.56 m.s− 2 vs. 2.73 ± 1.19 m.s− 2, p < 0.001), and compared to the non-injured leg (5.12 ± 1.56 m.s− 2 vs. 3.45 ± 1.35 m.s− 2, p < 0.001). There was a presence of significant interaction between leg and anesthesia conditions (p < 0.001). Conclusions The pivot-shift maneuver performed under anesthesia identifies better rotatory instability than without anesthesia because testing the pivot-shift without anesthesia underestimates the rotatory subluxation of the knee by an increased knee stiffness. Thus, testing under anesthesia provides a unique opportunity to determine the rotational instability prior to ACL reconstruction.
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Affiliation(s)
- Gastón Caracciolo
- Clínica MEDS, Santiago, RM, 7691236, Chile.,Centro de investigación en Medicina, Ejercicio, Deporte y Salud, Clínica MEDS, Santiago, RM, 7691236, Chile
| | - Roberto Yáñez
- Clínica MEDS, Santiago, RM, 7691236, Chile.,Centro de investigación en Medicina, Ejercicio, Deporte y Salud, Clínica MEDS, Santiago, RM, 7691236, Chile
| | - Rony Silvestre
- Clínica MEDS, Santiago, RM, 7691236, Chile.,Centro de investigación en Medicina, Ejercicio, Deporte y Salud, Clínica MEDS, Santiago, RM, 7691236, Chile
| | - Carlos De la Fuente
- Centro de investigación en Medicina, Ejercicio, Deporte y Salud, Clínica MEDS, Santiago, RM, 7691236, Chile.,Applied Neuromechanics Research Group, Laboratory of Neuromechanics, Federal University of Pampa, Uruguaiana, RS, 97500-970, Brazil.,Carrera de Kinesiología, Departamento de Cs. de la Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, RM, 7820436, Chile
| | - Héctor Zamorano
- Clínica MEDS, Santiago, RM, 7691236, Chile.,Centro de investigación en Medicina, Ejercicio, Deporte y Salud, Clínica MEDS, Santiago, RM, 7691236, Chile
| | - Alejandra Ossio
- Clínica MEDS, Santiago, RM, 7691236, Chile.,Centro de investigación en Medicina, Ejercicio, Deporte y Salud, Clínica MEDS, Santiago, RM, 7691236, Chile
| | - Lars Strömbäck
- Clínica MEDS, Santiago, RM, 7691236, Chile.,Centro de investigación en Medicina, Ejercicio, Deporte y Salud, Clínica MEDS, Santiago, RM, 7691236, Chile
| | - Sebastian Abusleme
- Clínica MEDS, Santiago, RM, 7691236, Chile.,Centro de investigación en Medicina, Ejercicio, Deporte y Salud, Clínica MEDS, Santiago, RM, 7691236, Chile
| | - Felipe P Carpes
- Applied Neuromechanics Research Group, Laboratory of Neuromechanics, Federal University of Pampa, Uruguaiana, RS, 97500-970, Brazil.
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3
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Napier RJ, Feller JA, Devitt BM, McClelland JA, Webster KE, Thrush CSJ, Whitehead TS. Is the KiRA Device Useful in Quantifying the Pivot Shift in Anterior Cruciate Ligament-Deficient Knees? Orthop J Sports Med 2021; 9:2325967120977869. [PMID: 33553458 PMCID: PMC7841684 DOI: 10.1177/2325967120977869] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 08/04/2020] [Indexed: 01/26/2023] Open
Abstract
Background: Various technologies have been developed to quantify the pivot shift, as it is regarded as a key indicator of anterolateral rotatory laxity of the knee. Purpose: To determine the usefulness of a commercially available triaxial accelerometer (Kinematic Rapid Assessment [KiRA]) in numerically quantifying the pivot shift in patients under anesthesia with an anterior cruciate ligament (ACL)–deficient knee. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: Both knees of 50 patients (26 male [mean age, 30.4 years], 24 female [mean age, 26.6 years]) under anesthesia were assessed immediately before unilateral ACL reconstruction by an orthopaedic fellow and 1 of 3 experienced knee surgeons. The pivot-shift grade and 2 KiRA outputs (range of acceleration and slope of acceleration change) were compared. Results: The surgeon and fellow recorded the same pivot-shift grade for 45 of 50 patients (90%). Data from the 5 patients with no agreement and 1 patient with extreme outlying data were excluded from subsequent analysis. Using the KiRA range and slope data, the surgeon identified the injured knee in 74% and 76% of patients, respectively, while the fellow’s rate of injured knee identification was 74% and 80%, respectively. A correlation could be found only between pivot-shift grade and surgeon-derived range data (ρ = 0.40; P < .01) but not slope data or any fellow-derived outputs. Using the surgeon-derived range data, there was a significant difference between a grade 3 pivot (>5 m/s2) and a grade 1 or 2 pivot (<5 m/s2) (P = .01). Conclusion: Although a correlation between KiRA output data and pivot-shift grade was found when the device was used by an experienced surgeon, there was no correlation when used by a well-trained but less experienced orthopaedic fellow. Furthermore, the KiRA output data identified the ACL-deficient knee correctly in only 74% of patients. Although a threshold acceleration range value could be identified, above which the value was associated with a grade 3 pivot shift, this was dependent on the examiner, and distinction between other grades could not be made.
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Affiliation(s)
- Richard J Napier
- Orthopaedic Research Unit, Musgrave Park Hospital, Belfast, Northern Ireland
| | - Julian A Feller
- OrthoSport Victoria Research Unit, Epworth HealthCare, Melbourne, Australia.,School of Allied Health, La Trobe University, Melbourne, Australia
| | - Brian M Devitt
- OrthoSport Victoria Research Unit, Epworth HealthCare, Melbourne, Australia
| | | | - Kate E Webster
- School of Allied Health, La Trobe University, Melbourne, Australia
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4
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Sports medicine: bespoke player management. Digit Health 2021. [DOI: 10.1016/b978-0-12-818914-6.00021-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Hiramatsu K, Mae T, Mitsuoka T, Tachibana Y, Nakagawa S, Shino K. Anterior tibial loading on the calf enhances anterior tibial translation in the anterior cruciate ligament deficient knee in the anterior gravity radiographic view. Knee 2020; 27:1764-1771. [PMID: 33197815 DOI: 10.1016/j.knee.2020.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 08/17/2020] [Accepted: 09/15/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Lateral radiograph in the prone position with the knee flexed at 15° (anterior gravity view (AGV)) is useful as a screening for anterior cruciate ligament (ACL) injuries, while it is sometimes difficult to find the side-to-side difference (SSD) in anterior tibial translation. Thus, we applied a weight (three kilograms) around the lower leg to increase anterior tibial translation. We aimed to determine whether weight load confers an advantage in visualizing anterior knee laxity in ACL injuries. METHODS Fifty-eight patients with confirmed unilateral ACL tears from February 2012 to April 2014 had consented to participate in this study. Lateral radiographs for both knees were taken in AGV and in AGV with a three-kilogram weight load applied to the proximal lower leg. Then, the SSD of tibial position related to the femur was measured in these radiographs. RESULTS The SSD with the weight was significantly greater than that without the weight (5.9 ± 2.1 and 3.5 ± 1.6 mm, respectively, p < 0.01). The ratio of patients with SSD of three millimeters or more in AGV with the weight was also significantly larger than that without the weight (p < 0.01). CONCLUSIONS The anterior laxity in AGV with the three-kilogram weight is larger than that without the weight. Thus, the AGV with the weight could be one of the helpful radiographic technique for auxiliary diagnosis of ACL injury. Level of evidence Cohort study, Level IV.
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Affiliation(s)
- Kunihiko Hiramatsu
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2, Yamada-oka, Suita City, Osaka 565-0871, Japan; Department of Orthopaedic Surgery, Tamai Hospital, Han-nan City, Osaka, Japan.
| | - Tatsuo Mae
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2, Yamada-oka, Suita City, Osaka 565-0871, Japan
| | - Tomoki Mitsuoka
- Department of Orthopaedic Surgery, Yao Municipal Hospital, Yao City, Osaka, Japan
| | - Yuta Tachibana
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2, Yamada-oka, Suita City, Osaka 565-0871, Japan
| | - Shigeto Nakagawa
- Sports Orthopaedic Center, Yukioka Hospital, 2-2-3, Ukita, Kita-ku, Osaka City, Osaka, Japan
| | - Konsei Shino
- Sports Orthopaedic Center, Yukioka Hospital, 2-2-3, Ukita, Kita-ku, Osaka City, Osaka, Japan
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Abstract
The pivot shift test is utilized for assessment of rotatory instability in the anterior cruciate ligament (ACL) deficient knee. There are multiple reports of the pivot shift maneuver, and there is a lack of consensus among clinicians as to a standardized maneuver. Measurement devices are a feasible option to evaluate rotatory knee instability, objectively or quantitatively. Traditionally, measurement systems have been invasive systems. More recently, electromagnetic system, inertial sensor, or imaging analysis systems, specifically with the utilization of a tablet computer, have emerged as noninvasive, and more importantly, validated options. It is important to recognize that anatomic structures other than the ACL contribute to rotatory knee stability. Addressing the tibial slope, anterolateral structures of the knee, specifically the iliotibial band, and menisci during ACL surgery may decrease residual pivot shift in an attempt to improve clinical outcomes and prevent reinjury. This review article describes the pivot shift maneuver, objective measurement tools, and clinical applications of the pivot shift test.
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Vaidya RK, Yoo CW, Lee J, Han HS, Lee MC, Ro DH. Quantitative assessment of the pivot shift test with smartphone accelerometer. Knee Surg Sports Traumatol Arthrosc 2020; 28:2494-2501. [PMID: 31840191 DOI: 10.1007/s00167-019-05826-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Accepted: 12/10/2019] [Indexed: 12/21/2022]
Abstract
PURPOSE The pivot shift (PS) test is commonly used to diagnose and evaluate the dynamic instability of the knee joint in cases of anterior cruciate ligament (ACL) tear. There is a need of a reliable and inexpensive tool which is easily available to measure PS objectively in a clinical setting. The purpose of this study was to evaluate the use of a smartphone, which is readily available, to assess the PS phenomenon. METHODS Seventeen patients with unilateral ACL-injured knees, undergoing ACL reconstruction, were enrolled in the study. PS was initially graded according to the International Knee Documentation Committee classification by two observers. The PS test was then performed by them in normal and injured knees under anaesthesia using a smartphone attached to Gerdy's tubercle. Acceleration changes during the PS test were recorded using the smartphone accelerometer application. Intra-observer and inter-observer reliability of the test among the two observers were evaluated. Acceleration changes were compared between the injured and normal knees, and also between the clinical grades of PS. Diagnostic utility of the smartphone accelerometer was examined by a receiver operating characteristic curve analysis. RESULTS Intra-observer and inter-observer reliability were high for the smartphone accelerometer. The acceleration change was higher in the ACL-injured knees than in normal knees. The mean acceleration change was 2.54 m/s2 (SD = 0.97) in ACL-injured knees and 0.73 m/s2 (SD = 0.19) in normal knees (p < 0.001). The mean acceleration change of Grade 1 knees was 1.89 m/s2 (SD = 0.57), and that of knees of Grade 2 and above were 2.99 m/s2 (SD = 0.95) (p < 0.05). Sensitivity was 94% and specificity was 100% for the acceleration change required to detect ACL injury, i.e., 1.24 m/s2. CONCLUSIONS The results show that a smartphone can be used to evaluate the PS quantitatively and reliably, in the diagnosis of ACL injury. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Rupesh Kumar Vaidya
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea
| | - Cheol Whan Yoo
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea
| | - Joonhee Lee
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea
| | - Hyuk-Soo Han
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea
| | - Myung Chul Lee
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea
| | - Du Hyun Ro
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea.
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8
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Dejour D, Pungitore M, Valluy J, Nover L, Saffarini M, Demey G. Preoperative laxity in ACL-deficient knees increases with posterior tibial slope and medial meniscal tears. Knee Surg Sports Traumatol Arthrosc 2019; 27:564-572. [PMID: 30269166 DOI: 10.1007/s00167-018-5180-3] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 09/20/2018] [Indexed: 01/26/2023]
Abstract
PURPOSE The aim of this study was to determine patient and anatomic factors that influence anteroposterior and rotational laxity in knees with ACL tears. Based on the findings of biomechanical studies, we hypothesized that static and dynamic anterior tibial translation (ATT) as well as positive pivot shift would increase with female gender, tibial slope, and meniscal tears. METHODS The authors prospectively collected preoperative data and intraoperative findings of 417 patients that underwent ACL reconstruction. The exclusion criteria were: revision ACL procedures (n = 53), other surgical antecedents (n = 27), prior osteotomies (n = 7) or concomitant ligament tears on the ipsilateral knee (n = 34), and history of ACL tears in the contralateral knee (n = 45), leaving a study cohort of 251 patients. Their preoperative anteroposterior knee laxity was assessed objectively using 'static' monopodal weight-bearing radiographs and 'dynamic' instrumented differential measurements of ATT. Rotational laxity was assessed subjectively using the pivot shift test. RESULTS Multivariable regression showed that static ATT increases only with tibial slope (β = 0.30; p < 0.001), but dynamic ATT increases with tibial slope (β = 0.19; p = 0.041), medial meniscal tears (β = 1.27; p = 0.007), complete ACL tears (β = 2.06; p < 0.001), and to decrease with age (β = - 0.09; p < 0.001). Multivariable regression also indicated that high-grade pivot shift decreases with age (OR 0.94; p < 0.001) and for women (OR 0.25; p < 0.001), and to be higher for knees with complete ACL tears (OR 3.04; p = 0.002) or medial meniscal tears (OR 2.28; p = 0.010). CONCLUSION Contrary to expectations based on biomechanical studies, static ATT was only affected by high posterior tibial slope, while dynamic ATT was affected by both high posterior tibial slopes and medial meniscal tears, but not by gender or lateral meniscal tears. Likewise, pivot shift was affected by gender and medial meniscal tears, but not lateral meniscal tears or posterior tibial slope. These findings are relevant to guide surgeons in optimizing their surgical procedures, such as conserving the menisci when possible, and rehabilitation protocols, by delaying full weight-bearing and return to sports in patients with anatomic and lesional risk factors. LEVEL OF EVIDENCE Cohort study, Level IV.
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Affiliation(s)
- David Dejour
- Lyon-Ortho-Clinic, Clinique de la Sauvegarde, 8 Avenue Ben Gourion, 69009, Lyon, France
| | - Marco Pungitore
- Lyon-Ortho-Clinic, Clinique de la Sauvegarde, 8 Avenue Ben Gourion, 69009, Lyon, France
| | - Jeremy Valluy
- ReSurg SA, Chemin de Vuarpilliere 35, 1260, Nyon, Switzerland
| | - Luca Nover
- ReSurg SA, Chemin de Vuarpilliere 35, 1260, Nyon, Switzerland
| | - Mo Saffarini
- ReSurg SA, Chemin de Vuarpilliere 35, 1260, Nyon, Switzerland.
| | - Guillaume Demey
- Lyon-Ortho-Clinic, Clinique de la Sauvegarde, 8 Avenue Ben Gourion, 69009, Lyon, France
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Zaffagnini S, Signorelli C, Grassi A, Hoshino Y, Kuroda R, de Sa D, Sundemo D, Samuelsson K, Musahl V, Karlsson J, Sheean A, Burnham JM, Lian J, Smith C, Popchak A, Herbst E, Pfeiffer T, Araujo P, Oostdyk A, Guenther D, Ohashi B, Irrgang JJ, Fu FH, Nagamune K, Kurosaka M, Marcheggiani Muccioli GM, Lopomo N, Raggi F, Svantesson E, Hamrin Senorski E, Bjoernsson H, Ahlden M, Desai N. Anatomic Anterior Cruciate Ligament Reconstruction Using Hamstring Tendons Restores Quantitative Pivot Shift. Orthop J Sports Med 2018; 6:2325967118812364. [PMID: 30574514 PMCID: PMC6299314 DOI: 10.1177/2325967118812364] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Background: It is still uncertain how surgical reconstruction of the anterior cruciate
ligament (ACL) is able to restore rotatory laxity of the involved joint. The
desired amount of restraint applied by the ACL graft, as compared with the
healthy knee, has not been fully clarified. Purpose: To quantify the ability of single-bundle anatomic ACL reconstruction using
hamstring tendons in reducing the pivot-shift phenomenon immediately after
surgery under anesthesia. Study Design: Case series; Level of evidence, 4. Methods: An inertial sensor and image analysis were used at 4 international centers to
measure tibial acceleration and lateral compartment translation of the knee,
respectively. The standardized pivot-shift test was quantified in terms of
the side-to-side difference in laxity both preoperatively and
postoperatively with the patient under anesthesia. The reduction in both
tibial acceleration and lateral compartment translation after surgery and
the side-to-side difference were evaluated using the Wilcoxon signed-rank
test. Alpha was set at P < .05. Results: A total of 107 patients were recruited for the study, and data were available
for 89 patients. There was a statistically significant reduction in
quantitative rotatory knee laxity between preoperatively (inertial sensor,
2.55 ± 4.00 m/s2; image analysis, 2.04 ± 2.02 mm) and
postoperatively (inertial sensor, –0.54 ± 1.25 m/s2; image
analysis, –0.10 ± 1.04 mm) between the involved and healthy joints, as
measured by the 2 devices (P < .001 for both).
Postoperatively, both devices detected a lower rotatory laxity value in the
involved joint compared with the healthy joint (inertial sensor, 2.45 ± 0.89
vs 2.99 ± 1.10 m/s2, respectively [P < .001];
image analysis, 0.99 ± 0.83 vs 1.09 ± 0.92 mm, respectively
[P = .38]). Conclusion: The data from this study indicated a significant reduction in the pivot shift
when compared side to side. Both the inertial sensor and image analysis used
for the quantitative assessment of the pivot-shift test could successfully
detect restoration of the pivot shift after anatomic single-bundle ACL
reconstruction. Future research will examine how pivot-shift control is
maintained over time and correlation of the pivot shift with return to full
activity in patients with an ACL injury.
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Affiliation(s)
- Stefano Zaffagnini
- Investigation performed at IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Cecilia Signorelli
- Investigation performed at IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Alberto Grassi
- Investigation performed at IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Yuichi Hoshino
- Investigation performed at IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Ryosuke Kuroda
- Investigation performed at IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Darren de Sa
- Investigation performed at IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - David Sundemo
- Investigation performed at IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Kristian Samuelsson
- Investigation performed at IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Volker Musahl
- Investigation performed at IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Jon Karlsson
- Investigation performed at IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Andrew Sheean
- Investigation performed at IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Jeremy M Burnham
- Investigation performed at IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Jayson Lian
- Investigation performed at IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Clair Smith
- Investigation performed at IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Adam Popchak
- Investigation performed at IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Elmar Herbst
- Investigation performed at IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Thomas Pfeiffer
- Investigation performed at IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Paulo Araujo
- Investigation performed at IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Alicia Oostdyk
- Investigation performed at IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Daniel Guenther
- Investigation performed at IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Bruno Ohashi
- Investigation performed at IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - James J Irrgang
- Investigation performed at IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Freddie H Fu
- Investigation performed at IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Kouki Nagamune
- Investigation performed at IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Masahiro Kurosaka
- Investigation performed at IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | | | - Nicola Lopomo
- Investigation performed at IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Federico Raggi
- Investigation performed at IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Eleonor Svantesson
- Investigation performed at IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | | | - Haukur Bjoernsson
- Investigation performed at IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Mattias Ahlden
- Investigation performed at IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Neel Desai
- Investigation performed at IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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10
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Anatomic double bundle ACL reconstruction outperforms any types of single bundle ACL reconstructions in controlling dynamic rotational laxity. Knee Surg Sports Traumatol Arthrosc 2018; 26:1414-1419. [PMID: 29138915 DOI: 10.1007/s00167-017-4781-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 10/30/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE To compare the different types of ACL reconstructions in terms of knee dynamic laxity evaluated by acceleration. METHODS Sixteen fresh frozen cadaveric knees were used. Pivot shift test was manually performed while monitoring the tibial acceleration by use of a triaxial accelerometer. The test was repeated before and after the ACL resection and reconstruction. Three types of ACL reconstruction were tested: (1) Anatomic Single-Bundle reconstruction (n = 8), the graft was placed at the center of the ACL footprint for the both femoral and tibial sides (tunnel diameter: 8mm); (2) Conventional Single-Bundle reconstruction (n = 8), the graft was placed from the tibial PL footprint to femoral high AM position (tunnel diameter: 8mm) and (3) Anatomic Double-Bundle reconstruction (n = 8). The acceleration in each of three x-y-z directions and the overall magnitude of acceleration was calculated to evaluate dynamic rotational laxity and compared between different ACL reconstructions. RESULTS The overall magnitude of acceleration was significantly different between ACL intact and deficient knees (p < 0.0001). The acceleration was reduced by the DB ACL reconstruction to the intact level (n.s.), but the two SB ACL reconstruction failed to achieve the intact level of the acceleration (p = 0.0002non-anatomic SB, p < 0.0001 anatomic SB). CONCLUSION The anatomic DB reconstruction better restores dynamic rotational laxity when compared to the SB ACL reconstructions no matter if the tunnel placement was anatomic. The anatomic DB reconstruction better restores dynamic rotational laxity when compared to both anatomic and non-anatomic SB ACL reconstruction. For this reason anatomic DB ACL reconstruction is recommended for cases where rotational laxity is an issue.
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Marcheggiani Muccioli GM, Signorelli C, Grassi A, Sarsina TRD, Raggi F, Carbone G, Macchiarola L, Vaccari V, Zaffagnini S. In-vivo pivot-shift test measured with inertial sensors correlates with the IKDC grade. J ISAKOS 2018. [DOI: 10.1136/jisakos-2017-000167] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Sundemo D, Blom A, Hoshino Y, Kuroda R, Lopomo NF, Zaffagnini S, Musahl V, Irrgang JJ, Karlsson J, Samuelsson K. Correlation between quantitative pivot shift and generalized joint laxity: a prospective multicenter study of ACL ruptures. Knee Surg Sports Traumatol Arthrosc 2018; 26:2362-2370. [PMID: 29150746 PMCID: PMC6061776 DOI: 10.1007/s00167-017-4785-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 10/30/2017] [Indexed: 12/16/2022]
Abstract
PURPOSE To investigate whether an increased magnitude of quantitative rotatory knee laxity is associated with a greater level of generalized joint laxity in ACL-injured and contralateral knees. METHODS A total of 103 patients were enrolled across four international centers to undergo anatomic ACL reconstruction. Rotatory knee laxity was evaluated preoperatively, both in the awake state and under anesthesia, using the standardized pivot shift test. Two devices were used to quantify rotatory knee laxity; an inertial sensor, measuring the joint acceleration, and an image analysis system, measuring the lateral compartment translation of the tibia. The presence of generalized joint laxity was determined using the Beighton Hypermobility Score. The correlation between the level of generalized joint laxity and the magnitude of rotatory knee laxity was calculated for both the involved knee and the non-involved knee. Further, patients were dichotomized into low (0-4) or high (5-9) Beighton Score groups. Alpha was set at < 0.05. RESULTS Ninety-six patients had complete datasets, 83 and 13 in the low and high Beighton Score groups respectively. In anesthetized patients, there was a significant correlation between the degree of Beighton Score and quantitative pivot shift when analyzing the non-involved knee using the image analysis system (r = 0.235, p < 0.05). When analyzing the same knee, multivariate analysis adjusted for meniscal injury, age and gender revealed an increased odds ratio for patients with increased lateral compartment translation to be part of the high Beighton Score group (OR 1.86, 95% CI 1.10-3.17, p < 0.05). No other correlation was significant. When analyzing the dichotomized subgroups, no significant correlations could be established. CONCLUSION The findings in this study suggest that there is a weak correlation between generalized joint laxity and the contralateral healthy knee, indicating increased rotatory knee laxity in these patients. Generalized joint laxity does not appear to correlate with rotatory knee laxity in ACL-injured knees. LEVEL OF EVIDENCE Prospective cohort study; level of evidence, 2.
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Affiliation(s)
- David Sundemo
- Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Anna Blom
- Närhälsan Torslanda Rehabilitation Center, Torslanda, Sweden
| | - Yuichi Hoshino
- Department of Orthopaedic Surgery, Kobe University, Kobe, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University, Kobe, Japan
| | - Nicola Francesco Lopomo
- Dipartimento di Ingengeria dell’Informazione, Università degli Studi di Brescia, Brescia, Italy ,Laboratorio di Biomeccanica e Innovazione Tecnologica, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Stefano Zaffagnini
- Laboratorio di Biomeccanica e Innovazione Tecnologica, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Volker Musahl
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA USA
| | - James J. Irrgang
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA USA
| | - Jón Karlsson
- Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden ,Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Kristian Samuelsson
- Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden ,Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden
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Kitamura N, Yasuda K, Yokota M, Goto K, Wada S, Onodera J, Kondo E. The Effect of Intraoperative Graft Coverage With Preserved Remnant Tissue on the Results of the Pivot-Shift Test After Anatomic Double-Bundle Anterior Cruciate Ligament Reconstruction: Quantitative Evaluations With an Electromagnetic Sensor System. Am J Sports Med 2017; 45:2217-2225. [PMID: 28541797 DOI: 10.1177/0363546517706702] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Remnant tissue preservation may be important in improving graft healing after anterior cruciate ligament (ACL) reconstruction, but it has yet to be established whether remnant tissue preservation improves the control of pivot-shift laxity. HYPOTHESIS The amount of ACL graft coverage with preserved remnant tissue improves the control of pivot-shift laxity, as qualitatively determined with an electromagnetic device. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS The 3-dimensional kinematics were evaluated intraoperatively using an electromagnetic sensor system in 38 patients at the time of anatomic double-bundle ACL reconstruction with remnant tissue preservation and again at a minimum of 12 months postoperatively. The magnitude of the peak coupled anterior tibial translation (pCAT) and the maximal acceleration of posterior translation (APT) during the pivot-shift test were evaluated. The degree of graft coverage by remnant tissue was determined arthroscopically at the end of surgery, which was evaluated quantitatively using a scoring system (0-9 points). The relationship between the values during the pivot-shift test and preoperative and intraoperative factors were assessed. RESULTS The mean (±SD) side-to-side difference of the pCAT (ΔpCAT) was significantly ( P < .0001) improved from 14.0 ± 5.0 mm to 2.6 ± 1.1 mm. Also, the mean side-to-side difference of the APT (ΔAPT) was significantly ( P < .0001) improved from 525.6 ± 99.7 mm/s2 to 32.9 ± 23.6 mm/s2. The mean initial graft coverage score was 5.3 ± 2.6. The correlation analysis demonstrated that the degree of initial graft coverage was significantly correlated with the ΔpCAT ( r = -0.517, P = .0007) and ΔAPT ( r = -0.532, P = .0005). The status of the reconstructed graft at second-look arthroscopic surgery showed no significant correlations with the degree of initial graft coverage or the results of the pivot-shift test. CONCLUSION The present study demonstrated that the preservation of ACL remnant tissue in anatomic double-bundle ACL reconstruction appears to improve the control of pivot-shift laxity at a minimum of 12 months postoperatively, as measured by an electromagnetic device. This improvement was significantly affected by the degree of intraoperative graft coverage with preserved remnant tissue.
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Affiliation(s)
- Nobuto Kitamura
- Department of Sports Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Kazunori Yasuda
- Department of Sports Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Masashi Yokota
- Department of Sports Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Keiko Goto
- Department of Sports Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Susumu Wada
- Department of Sports Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Jun Onodera
- Department of Sports Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Eiji Kondo
- Department of Advanced Therapeutic Research for Sports Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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Abstract
Wearable sensors, in particular inertial measurement units (IMUs) allow the objective, valid, discriminative and responsive assessment of physical function during functional tests such as gait, stair climbing or sit-to-stand. Applied to various body segments, precise capture of time-to-task achievement, spatiotemporal gait and kinematic parameters of demanding tests or specific to an affected limb are the most used measures. In activity monitoring (AM), accelerometry has mainly been used to derive energy expenditure or general health related parameters such as total step counts. In orthopaedics and the elderly, counting specific events such as stairs or high intensity activities were clinimetrically most powerful; as were qualitative parameters at the ‘micro-level’ of activity such as step frequency or sit-stand duration. Low cost and ease of use allow routine clinical application but with many options for sensors, algorithms, test and parameter definitions, choice and comparability remain difficult, calling for consensus or standardisation.
Cite this article: Grimm B, Bolink S. Evaluating physical function and activity in the elderly patient using wearable motion sensors. EFORT Open Rev 2016;1:112–120. DOI: 10.1302/2058-5241.1.160022.
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Affiliation(s)
- Bernd Grimm
- AHORSE Research Foundation, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Stijn Bolink
- AHORSE Research Foundation, Zuyderland Medical Center, Heerlen, The Netherlands
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Grassi A, Lopomo NF, Rao AM, Abuharfiel AN, Zaffagnini S. No proof for the best instrumented device to grade the pivot shift test: a systematic review. J ISAKOS 2016. [DOI: 10.1136/jisakos-2015-000047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Sundemo D, Alentorn-Geli E, Hoshino Y, Musahl V, Karlsson J, Samuelsson K. Objective measures on knee instability: dynamic tests: a review of devices for assessment of dynamic knee laxity through utilization of the pivot shift test. Curr Rev Musculoskelet Med 2016; 9:148-59. [PMID: 26984465 DOI: 10.1007/s12178-016-9338-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Current reconstructive methods used after anterior cruciate ligament (ACL) injury do not entirely restore native knee kinematics. Evaluation of dynamic knee laxity is important to accurately diagnose ACL deficiency, to evaluate reconstructive techniques, and to construct treatment algorithms for patients with ACL injury. The purpose of this study is to present recent progress in evaluation of dynamic knee laxity through utilization of the pivot shift test. A thorough electronic search was performed and relevant studies were assessed. Certain dynamic knee laxity measurement methods have been present for over 10 years (Navigation system, Electromagnetic sensor system) while other methods (Inertial sensor, Image analysis system) have been introduced recently. Methods to evaluate dynamic knee laxity through the pivot shift test are already potent. However, further refinement is warranted. In addition, to correctly quantify the pivot shift test, the involved forces need to be controlled through either standardization or mechanization of the pivot shift test.
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Affiliation(s)
- David Sundemo
- Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden.
| | | | - Yuichi Hoshino
- Department of Orthopaedic Surgery, Kobe Kaisei Hospital, Kobe, Japan
| | - Volker Musahl
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jón Karlsson
- Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden.,Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Kristian Samuelsson
- Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden.,Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden
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Rahnemai-Azar AA, Naendrup JH, Soni A, Olsen A, Zlotnicki J, Musahl V. Knee instability scores for ACL reconstruction. Curr Rev Musculoskelet Med 2016; 9:170-7. [PMID: 26980119 PMCID: PMC4896882 DOI: 10.1007/s12178-016-9339-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Despite abundant biological, biomechanical, and clinical research, return to sport after anterior cruciate ligament (ACL) injury remains a significant challenge. Residual rotatory knee laxity has been identified as one of the factors responsible for poor functional outcome. To improve and standardize the assessment of knee instability, a variety of instability scoring systems is available. Recently, devices to objectively quantify static and dynamic clinical exams have been developed to complement traditional subjective grading systems. These devices enable an improved evaluation of knee instability and possible associated injuries. This additional information may promote the development of new treatment algorithms and allow for individualized treatment. In this review, the different subjective laxity scores as well as complementary objective measuring systems are discussed, along with an introduction of injury to an individualized treatment algorithm.
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Affiliation(s)
- Ata A Rahnemai-Azar
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, Pittsburgh, PA, 15213, USA
- Orthopaedic Robotics Laboratory, Center for Bioengineering, University of Pittsburgh, 300 Technology Drive, Pittsburgh, PA, 15219, USA
| | - Jan-Hendrik Naendrup
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, Pittsburgh, PA, 15213, USA
- Orthopaedic Robotics Laboratory, Center for Bioengineering, University of Pittsburgh, 300 Technology Drive, Pittsburgh, PA, 15219, USA
| | - Ashish Soni
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, Pittsburgh, PA, 15213, USA
| | - Adam Olsen
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, Pittsburgh, PA, 15213, USA
| | - Jason Zlotnicki
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, Pittsburgh, PA, 15213, USA
- Orthopaedic Robotics Laboratory, Center for Bioengineering, University of Pittsburgh, 300 Technology Drive, Pittsburgh, PA, 15219, USA
| | - Volker Musahl
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, Pittsburgh, PA, 15213, USA.
- Orthopaedic Robotics Laboratory, Center for Bioengineering, University of Pittsburgh, 300 Technology Drive, Pittsburgh, PA, 15219, USA.
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