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Arthroscopy. 2015 Dec;31(12):2445-54.e2. doi: 10.1016/j.arthro.2015.06.027. Epub 2015 Aug 28.

Experimental Execution of the Simulated Pivot-Shift Test: A Systematic Review of Techniques.

Author information

1
Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A.; Orthopaedic Robotics Laboratory, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A.; Department of Orthopaedic Surgery, University Hospital of Canoas, Canoas, Rio Grande Do Sul, Brazil.
2
Division of Orthopaedic Surgery, McMaster University Medical Center, Hamilton, Ontario, Canada.
3
Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A.; Orthopaedic Robotics Laboratory, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A.
4
Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A.; Orthopaedic Robotics Laboratory, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A.
5
Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A.
6
Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A.; Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A.; Orthopaedic Robotics Laboratory, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A.. Electronic address: musahlv@upmc.edu.

Abstract

PURPOSE:

To conduct a systematic review to identify and summarize the various techniques that have been used to simulate the pivot-shift test in vitro.

METHODS:

Medline, Embase, and the Cochrane Library were screened for studies involving the simulated pivot-shift test in human cadaveric knees published between 1946 and May 2014. Study parameters including sample size, study location, simulated pivot-shift technique, loads applied, knee flexion angles at which simulated pivot shift was tested, and kinematic evaluation tools were extracted and analyzed.

RESULTS:

Forty-eight studies reporting simulated pivot-shift testing on 627 cadaveric knees fulfilled the criteria. Reviewer inter-rater agreement for study selection showed a κ score of 0.960 (full-text review). Twenty-seven studies described the use of internal rotation torque, with a mean of 5.3 Nm (range, 1 to 18 Nm). Forty-seven studies described the use of valgus torque, with a mean of 8.8 Nm (range, 1 to 25 Nm). Four studies described the use of iliotibial tract tension, ranging from 10 to 88 N. Regarding static simulated pivot-shift test techniques, 100% of the studies performed testing at 30° of knee flexion, and the most tested range of motion in the continuous tests was 0° to 90°. Anterior tibial translation was the most analyzed parameter during the simulated pivot-shift test, being used in 45 studies. In 22% of the studies, a robotic system was used to simulate the pivot-shift test. Robotic systems were shown to have better control of the loading system and higher tracking system accuracy.

CONCLUSIONS:

This study provides a reference for investigators who desire to apply simulated pivot shift in their in vitro studies. It is recommended to simulate the pivot-shift test using a 10-Nm valgus torque and 5-Nm internal rotation torque. Knee flexion of 30° is mandatory for testing.

LEVEL OF EVIDENCE:

Level IV, systematic review of basic science studies.

PMID:
26321110
DOI:
10.1016/j.arthro.2015.06.027
[Indexed for MEDLINE]

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