McMaster University

McMaster University

Experimental Execution of the Simulated Pivot-Shift Test

We are pleased to share with you a recent publication in the Journal of Arthroscopy. This publication is entitled "Experimental Execution of the Simulated Pivot-Shift Test: A Systematic Review of Techniques."

Please find the abstract below and to access the full-version of the article click here.


Arilla FV, Yeung M, Bell K, Rahnemai-Azar AA, Rothrauff BB, Fu FH, Debski RE, Ayeni OR, Musahl V. Experimental Execution of the Simulated Pivot-Shift Test: A Systematic Review of Techniques. Arthroscopy. 2015 Aug 27. pii: S0749-8063(15)00538-1. doi: 10.1016/j.arthro.2015.06.027. [Epub ahead of print]

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.

Valid XHTML 1.0 Transitional Level Double-A conformance, W3C WAI Web Content Accessibility Guidelines 2.0