Association of Ligamentous Laxity, Male Sex, Chronicity, Meniscal Injury, and Posterior Tibial Slope With a High-Grade Preoperative Pivot Shift: A Post Hoc Analysis of the STABILITY Study.

BACKGROUND

A spectrum of anterolateral rotatory laxity exists in anterior cruciate ligament (ACL)-injured knees. Understanding of the factors contributing to a high-grade pivot shift continues to be refined.

PURPOSE

To investigate factors associated with a high-grade preoperative pivot shift and to evaluate the relationship between this condition and baseline patient-reported outcome measures (PROMs).

STUDY DESIGN

Cross-sectional study; Level of evidence, 3.

METHODS

A post hoc analysis was performed of 618 patients with ACL deficiency deemed high risk for reinjury. A binary logistic regression model was developed, with high-grade pivot shift as the dependent variable. Age, sex, Beighton score, chronicity of the ACL injury, posterior third medial or lateral meniscal injury, and tibial slope were selected as independent variables. The importance of knee hyperextension as a component of the Beighton score was assessed using receiver operator characteristic curves. Baseline PROMs were compared between patients with and without a high-grade pivot.

RESULTS

Six factors were associated with a high-grade pivot shift: Beighton score (each additional point; odds ratio [OR], 1.17; 95% CI, 1.06-1.30;

CONCLUSION

Ligamentous laxity, male sex, posterior third medial or lateral meniscal injury, increased posterior tibial slope, and chronicity were associated with a high-grade pivot shift in this population deemed high risk for repeat ACL injury. The effect of tibial slope may be accentuated by the presence of meniscal injury, supporting the need for meniscal preservation. Baseline PROMs were similar between patients with and without a high-grade pivot shift.

Informations de copyright

© The Author(s) 2021.

Déclaration de conflit d'intérêts

One or more of the authors has declared the following potential conflict of interest or source of funding: This study was funded by an ISAKOS/OREF grant (2014; International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine/Orthopaedic Research and Education Foundation). R.G.M. has received speaking fees from Bioventus, Pendopharm, Sanofi, and Smith & Nephew. T.S. has received consulting fees from Conmed and speaking fees from Conmed, Joint Operations, and Smith & Nephew. P.C.M.V. has received consulting fees from Conmed and speaking fees from Conmed and Smith & Nephew. A.M.J.G. has received consulting fees from Olympus, Ossur, and Smith & Nephew and royalties from Graymont and Smith & Nephew. L.A.H. has received consulting fees and speaking fees from Conmed. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.