Implications of the pivot shift in the ACL-deficient knee.

Published

Journal Article

The Losee repair controls rotational subluxation of the lateral femoral condyle, or pivot shift, but does not reliably eliminate Lachman laxity. Despite this surgical limitation, many patients who were operated on continued to do high-demand activities at the last followup. We hypothesized that Lachman findings alone did not predict poor surgical outcome or progression to osteoarthritis. We report on 87 patients evaluated at an average of 9 years (range, 5-21 years) postoperatively. Prospectively collected examinations and radiographic, subjective, and objective outcome measures were recorded and statistically evaluated. The presence of a postoperative pivot shift or residual varus laxity correlated with poor patient subjective evaluations and poor scoring outcomes. Lachman laxity with an absent pivot shift had no correlation with the outcome measures or onset of radiographic progression to osteoarthritis. Meniscectomy, additional knee surgery, increased valgus or varus laxity, and time from injury until the final radiograph positively correlated with the onset of osteoarthritis. Elimination of the pivot shift was necessary to achieve successful relief of symptoms and functional outcome. In the absence of a pivot shift, Lachman laxity was not solely predictive of poor outcomes.Prognostic study, Level II-1 (retrospective study). See the Guidelines for Authors for a complete description of levels of evidence.

Full Text

Duke Authors

Cited Authors

  • Leitze, Z; Losee, RE; Jokl, P; Johnson, TR; Feagin, JA

Published Date

  • July 2005

Published In

Start / End Page

  • 229 - 236

PubMed ID

  • 15995446

Pubmed Central ID

  • 15995446

Electronic International Standard Serial Number (EISSN)

  • 1528-1132

International Standard Serial Number (ISSN)

  • 0009-921X

Language

  • eng