No difference in postoperative rotational laxity after ACL reconstruction in patients with and without anterolateral capsule injury: quantitative evaluation of the pivot-shift test at 1-year follow-up

  • Yuji Hiroshima
  • Yuichi HoshinoEmail author
  • Nobuaki Miyaji
  • Toshikazu Tanaka
  • Daisuke Araki
  • Noriyuki Kanzaki
  • Takehiko Matsushita
  • Ryosuke Kuroda



To compare rotational laxity in anterior cruciate ligament (ACL)-reconstructed knees retrospectively with and without concomitant anterolateral capsule (ALC) injury confirmed by magnetic resonance imaging (MRI) prior to ACL reconstruction.


Sixty-two ACL-reconstructed knees (26 men, 36 women; median age 20 (range 13–59)) were included. Pivot-shift test was performed before ACL reconstruction and 1 year postoperatively under anesthesia with both clinical grading and quantitative measurement simultaneously. Clinical grading was determined according to the International Knee Documentation Committee (IKDC) criteria (none, glide, clunk, or gross), and an electromagnetic measurement system was used to provide tibial acceleration as a quantitative parameter. The resence of concomitant ALC injury was confirmed retrospectively by MRI. The pivot-shift test was compared between ACL-reconstructed knees with and without ALC injury test for clinical grading and the independent t test for quantitative evaluation.


ALC injury was identified in 26 of 62 (42%) knees. Before ACL reconstruction, there was no difference in the pivot-shift test results between the ACL-deficient knees with and without ALC injury in IKDC grading (n.s.) or tibial acceleration (1.1 ± 0.7 m/s2 and 1.4 ± 1.1 m/s2, respectively, n.s.). At 1 year postoperatively, no difference was observed between groups (IKDC, p = 0.90; tibial acceleration, 0.6 ± 0.3 m/s2 and 0.8 ± 0.6 m/s2, n.s.).


Concomitant ALC injury at the time of ACL injury had no effect on the rotational laxity of the knee in the postoperative course after ACL reconstruction. Therefore, additional treatment for ALC injury may not be warranted.

Level of evidence



Anterior cruciate ligament ACL reconstruction Anterolateral capsule Pivot-shift test Quantitative measurement MRI Electromagnetic measurement system 


Author contributions

YH designed the study and wrote the initial draft of the manuscript. YH, NM, TT, DA, and TM contributed to analysis and interpretation of data, and assisted in the preparation of the manuscript. YH, NM, TT, DA, KN, TM and RK contributed to data collection and interpretation, and critically reviewed the manuscript. All authors approved the final version of the manuscript and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Compliance with ethical standards


This study was supported by JSPS KAKENHI Grant Number JP16K10902.

Conflict of interest

All authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee (the Institutional Review Board of Kobe University (ID No. B190055) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.


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Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2019

Authors and Affiliations

  1. 1.Department of Orthopaedic Surgery, Graduate School of MedicineKobe UniversityKobeJapan

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