Objectifying the Pivot Shift Test

Background: The pivot shift test is an important clinical maneuver used to assess rotational instability in the knee, particularly in cases of anterior cruciate ligament (ACL) injuries. Despite its widespread use, the subjective nature and variability of the test among physicians can lead to inconsistent results and misdiagnoses. This inconsistency highlights the need for objective measurement tools to enhance the reliability of the pivot shift test. This study addresses these challenges by investigating various methods for quantifying the pivot shift maneuver, aiming to improve diagnostic accuracy and clinical outcomes. Methods: The authors conducted a comprehensive review of the existing literature on the pivot shift test, focusing on traditional and new objective measurement techniques between ۲۰۰۹ and ۲۰۲۱. They examined various tools such as inertial sensors, electromagnetic systems, and imaging analysis methods that provide quantitative data during the pivot shift maneuver. This review also discusses how to integrate these technologies into clinical practice to standardize the test and reduce examiner bias. Furthermore, the authors emphasized the importance of conducting tests under anesthesia to minimize muscular protection, which can affect outcomes. Results: The review found that objective measurement tools significantly improve the reliability of the pivot shift test. For example, the use of accelerometers during the maneuver allows for precise quantification of knee laxity and rotational instability. The study indicated that performing the pivot shift test under anesthesia resulted in higher accelerometer values compared to tests without anesthesia, suggesting a more accurate assessment of knee instability. Additionally, it was noted that anatomical factors beyond the ACL, such as tibial slope and meniscal integrity, play crucial roles in knee stability. The study concluded that combining objective measurement systems could lead to better identification of patients at risk for residual instability after surgery and ultimately enhance treatment strategies. Conclusion: Objectifying the pivot shift test represents a significant advancement in orthopedic diagnosis for ACL injuries. By integrating objective measurement tools into clinical practice, surgeons can achieve more consistent and reliable assessments of knee stability. This approach not only enhances diagnostic accuracy but also aids in developing surgical interventions and rehabilitation protocols for patients with ACL injuries.

کلیدواژه ها:

Pivot Shift Test ، Anterior Cruciate Ligament (ACL) ، Knee Instability ، Objective Measurement ، Inertial Sensors