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
-
Published:2021-04-01
Issue:4
Volume:9
Page:232596712110000
-
ISSN:2325-9671
-
Container-title:Orthopaedic Journal of Sports Medicine
-
language:en
-
Short-container-title:Orthopaedic Journal of Sports Medicine
Author:
Batty Lachlan M.1, Firth Andrew1, Moatshe Gilbert1, Bryant Dianne M.1, Heard Mark1, McCormack Robert G.1, Rezansoff Alex1, Peterson Devin C.1, Bardana Davide1, MacDonald Peter B.1, Verdonk Peter C.M.1, Spalding Tim1, Getgood Alan M.J.1, Willits Kevin1, Birmingham Trevor1, Hewison Chris1, Wanlin Stacey1, Firth Andrew1, Pinto Ryan1, Martindale Ashley1, O’Neill Lindsey1, Jennings Morgan1, Daniluk Michal1, Boyer Dory1, Zomar Mauri1, Moon Karyn1, Pritchett Raely1, Payne Krystan1, Fan Brenda1, Mohan Bindu1, Buchko Gregory M.1, Hiemstra Laurie A.1, Kerslake Sarah1, Tynedal Jeremy1, Stranges Greg1, Mcrae Sheila1, Gullett LeeAnne1, Brown Holly1, Legary Alexandra1, Longo Alison1, Christian Mat1, Ferguson Celeste1, Mohtadi Nick1, Barber Rhamona1, Chan Denise1, Campbell Caitlin1, Garven Alexandra1, Pulsifer Karen1, Mayer Michelle1, Simunovic Nicole1, Duong Andrew1, Robinson David1, Levy David1, Skelly Matt1, Shanmugaraj Ajaykumar1, Howells Fiona1, Tough Murray1, Thompson Pete1, Metcalfe Andrew1, Asplin Laura1, Dube Alisen1, Clarkson Louise1, Brown Jaclyn1, Bolsover Alison1, Bradshaw Carolyn1, Belgrove Larissa1, Millan Francis1, Turner Sylvia1, Verdugo Sarah1, Lowe Janet1, Dunne Debra1, McGowan Kerri1, Suddens Charlie-Marie1, Declercq Geert1, Vuylsteke Kristien1, Van Haver Mieke1,
Affiliation:
1. Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
Abstract
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; P = .002), male sex (OR, 2.30; 95% CI, 1.28-4.13; P = .005), presence of a posterior third medial (OR, 2.55; 95% CI, 1.11-5.84; P = .03) or lateral (OR, 1.76; 95% CI, 1.01-3.08; P = .048) meniscal injury, tibial slope >9° (OR, 2.35; 95% CI, 1.09-5.07; P = .03), and chronicity >6 months (OR, 1.70; 95% CI, 1.00-2.88; P = .049). The presence of knee hyperextension improved the diagnostic utility of the Beighton score as a predictor of a high-grade pivot shift. Tibial slope <9° was associated with only a high-grade pivot in the presence of a posterior third medial meniscal injury. Patients with a high-grade pivot shift had higher baseline 4-Item Pain Intensity Measure scores than did those without a high-grade pivot shift (mean ± SD, 11 ± 13 vs 8 ± 14; P = .04); however, there was no difference between groups in baseline International Knee Documentation Committee, ACL Quality of Life, Knee injury and Osteoarthritis Outcome Score, or Knee injury and Osteoarthritis Outcome Score subscale scores. 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.
Funder
international society of arthroscopy, knee surgery and orthopaedic sports medicine
Publisher
SAGE Publications
Subject
Orthopedics and Sports Medicine
Cited by
17 articles.
订阅此论文施引文献
订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献
|
|