Pivot Shift Syndrome of the Knee: diagnosis and treatment strategies

Background: The knee shift syndrome is a clinical phenomenon related to anterior cruciate ligament (ACL) injuries, characterized by a specific pattern of instability during movement. This syndrome manifests as a sensation of 'giving way' of the knee, especially during activities that involve sudden rotation or directional changes. Understanding the mechanism of axial shift is crucial for diagnosing ACL deficiencies and developing effective treatment strategies. The axial shift test serves as a key assessment tool for evaluating this instability, yet its pathophysiology and implications for treatment remain complex and not fully understood. Methods: This article reviews the existing literature on the axial shift syndrome between ۲۰۱۰-۲۰۲۳, focusing on its historical development, diagnostic criteria, and treatment options. It includes a combination of various studies examining the biomechanics of the axial shift phenomenon and its clinical significance. The review evaluates the effectiveness of the axial shift test in diagnosing ACL injuries. Additionally, it explores surgical and non-surgical treatment options for managing ACL injuries and associated symptoms. Results: Findings indicate that the axial shift syndrome is primarily associated with ACL insufficiency, leading to abnormal translation and rotation of the tibia during knee flexion. The axial shift test is recognized as one of the most sensitive clinical assessments for diagnosing ACL injuries, often revealing instability correlated with symptoms reported by the patient. Studies show that patients with positive axial shift tests often experience significant functional limitations, including difficulties in sports and daily activities. This review highlights that while surgical interventions, such as ACL reconstruction, can restore stability, rehabilitation protocols should be tailored to effectively address residual instability. Non-surgical treatments, including physical therapy focused on strengthening surrounding muscles and improving proprioception, are also vital components of management. The article emphasizes the need for further research to clarify the underlying mechanisms of the axial shift syndrome and to develop standard protocols for its assessment and treatment. Conclusion: The axial shift syndrome represents a significant challenge in the management of knee injuries, particularly those related to ACL deficiencies. The axial shift test remains a cornerstone of diagnosis. However, understanding its implications requires a comprehensive approach that encompasses both surgical and non-surgical strategies. Effective management depends on accurate diagnosis and personalized rehabilitation programs that address both mechanical stability and functional recovery. As research in this field continues to evolve, there is potential for improving outcomes for patients affected by this syndrome.

کلیدواژه ها:

Pivot Shift Syndrome ، Anterior Cruciate Ligament ، Knee Instability ، Pivot Shift Test ، ACL Reconstruction