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The Envelope of Laxity of the Pivot Shift Test

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Rotatory Knee Instability

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Abstract

The pivot shift is a dynamic test of knee laxity which correlates with subjective sensations of knee instability. As the knee flexes from full extension, the tibia subluxes, both in anterior translation and internal rotation, so that the lateral femoral condyle moves ‘downhill’ to the posterior edge of the tibial plateau under the influence of the compressive joint load. With further knee flexion, the tension in the iliotibial tract eventually overcomes the load which has maintained the subluxation and then the tibia is suddenly reduced to its anatomical articulation. Thus, the envelope of laxity of the pivot shift shows a pattern of simultaneous gradual pathological anterior translation and internal rotation, occurring over approximately 35° of knee flexion, followed by a relatively sudden reduction, which is a falling back posteriorly and externally to the anatomical position. It is desirable to measure both tibial translations and rotations to understand each injured knee, because differing patterns of injury may explain the wide range of tibiofemoral movements, such as the relative amount of tibial translation versus rotation, that have been reported during the pivot shift.

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Authors and Affiliations

  1. Mechanical Engineering Department, Biomechanics Group, Imperial College London, London, SW7 2AZ, UK

    Breck Lord & Andrew A. Amis

  2. Department of Surgery and Cancer, Musculoskeletal Surgery Group, Imperial College London School of Medicine, London, W6 8RF, UK

    Andrew A. Amis

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  1. Breck Lord
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Correspondence to Andrew A. Amis .

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Editors and Affiliations

  1. UPMC Center for Sports Medicine, Pittsburgh, Pennsylvania, USA

    Volker Musahl

  2. Sahlgrenska Academy, University of Gothenburg, Mölndal, Sweden

    Jón Karlsson

  3. Orthopaedic Surgery, Kobe University School of Medicine, Kobe, Japan

    Ryosuke Kuroda

  4. Istituto Ortopedico Rizzoli, University of Bologna, Bologna, Italy

    Stefano Zaffagnini

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Lord, B., Amis, A.A. (2017). The Envelope of Laxity of the Pivot Shift Test. In: Musahl, V., Karlsson, J., Kuroda, R., Zaffagnini, S. (eds) Rotatory Knee Instability. Springer, Cham. https://doi.org/10.1007/978-3-319-32070-0_18

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  • DOI: https://doi.org/10.1007/978-3-319-32070-0_18

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