Anatomical and morphological features associated with high grade pivot shift / 中华骨科杂志

ABSTRACT

The pivot shift test is the most specific physical examination to assess the rotatory laxity of knee joint following anterior cruciate ligament injury.It is also one of the most important physical examinations to assess the stability and recovery of the knee joint after anterior cruciate ligament reconstruction.The following anterior lateral structures of knee joint contribute to the grade of the pivot shift,including the lateral meniscus,anterolateral capsule,iliotibial band and the morphology of tibial plateau.Lateral meniscus is a secondary stabilizer to rotatory loads in the anterior cruciate ligament deficient knee.Anterolateral capsule controls anterior tibial translation and internal rotation.Iliotibial band is an important secondary restraint to anterior tibial translation and internal rotation at high flexion angles.Posteroinferior slope of the tibial plateau results in increased anterior tibial translation during pivot shift.The size of the lateral tibial plateau is also associated with the grade of poivt shift.The integrity destruction of the anterolateral soft tissue in the anterior cruciate ligament deficient knee leads to higher grade of poivt shift.The morphological features of the tibial plateau can also affect the stability of the knee joint.However,there is still a paucity of knowledge about the anatomical and morphological features responsible for a high grade pivot shift.Higher grade pivot shift indicates the injury of anterolateral structures and the abnormality of tibial plateau.In order to restore the integrity of anterolateral soft tissue,the injury of lateral meniscus and iliotibial band should be repaired via anterior cruciate ligament reconstruction surgery with an addition of a lateral extraarticular reconstruction when the anterior cruciate ligament deficiency combined with injuries to anterolateral capsule.