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Navigating the Pivot-Shift Test

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Rotatory Knee Instability

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Abstract

The main objective of computer-assisted surgery (CAS), which can be used for several different procedures, is to improve surgical outcomes by providing real-time intraoperative information and feedback to the surgeon. One of the most widespread CAS systems is represented by the intraoperative navigation system that is considered the gold standard for knee laxity quantitative evaluation. The main disadvantage of this technique is the invasiveness of the procedure.

ACL injuries are clinically evaluated mainly using manual tests, among these the Lachman and pivot-shift (PS) tests are the most widely used. In particular, the pivot-shift test is the most specific maneuver for the detection of dynamic laxity, and its result is correlated with reduced sports activity and complete or partial ACL tear. While several methodologies have been developed to quantify pivot-shift test results, the literature reports a variety of parameters which aim to quantitatively describe the test. In particular, the analyses are focused on the lateral tibial compartment, which has been demonstrated to be the one mainly affected by the pivot-shift phenomenon. Navigation systems may allow the pivot-shift phenomenon to be decomposed into many different parameters, potentially allowing for a better understanding of knee kinematics.

Highly precise quantification of the pivot-shift phenomenon may enable a better and more individualized approach for patients. To this end it is also important to allow a preoperative-to-postoperative and injured-to-contralateral joint comparison.

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Authors and Affiliations

  1. Laboratorio di Biomeccanica e Innovazione Tecnologica, Istituto Ortopedico Rizzoli, Bologna, BO, Italy

    Stefano Zaffagnini, Cecilia Signorelli, Alberto Grassi, Federico Raggi, Tommaso Roberti di Sarsina, Tommaso Bonanzinga & Nicola Lopomo

  2. Clinica Ortopedica e Traumatologica II, Istituto Ortopedico Rizzoli, Bologna, BO, Italy

    Stefano Zaffagnini, Alberto Grassi, Federico Raggi, Tommaso Roberti di Sarsina & Tommaso Bonanzinga

  3. Servicio Traumatologia y Ortopedia, Hospital Las Higueras, Talcahuano, Chile

    Francisco Urrizola

  4. Dipartimento di Ingegneria dell’Informazione, Università degli Studi di Brescia, Brescia, BS, Italy

    Nicola Lopomo

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  1. Stefano Zaffagnini
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  2. Cecilia Signorelli
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Correspondence to Stefano Zaffagnini .

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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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Zaffagnini, S. et al. (2017). Navigating 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_20

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  • DOI: https://doi.org/10.1007/978-3-319-32070-0_20

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