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Quantifying “the Look” of the Pivot Shift

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Rotatory Knee Instability

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Abstract

The pivot-shift test is the most specific physical exam to detect the ACL insufficiency and the only manual test capable to predict the knee function and the development of osteoarthrosis after an ACL reconstruction. However, the lack of a standardized maneuver for the pivot-shift test makes the interpretation subjective and dependent on examiner’s experience.

Attempts to objectively measure the pivot-shift phenomenon have been made throughout the years. Quantifiable parameters of the pivot shift, such as the acceleration of the tibial reduction and the amount of lateral knee compartment translation, have been correlated to “the feeling” and to “the look” of the pivot shift, respectively.

The image analysis system was developed to quantify “the look” of the pivot shift, i.e., the anterior translation of the lateral tibial plateau during the pivot-shift phenomenon. This method consists in the analysis of video images, frame by frame, of the pivot-shift test taken from the lateral aspect of the knee using an ordinary digital camera.

In order to simplify the frame-by-frame processing of the video images and to obtain immediate quantitative results of the pivot-shift test, the image analysis system evolved to an iPad technology. From this application, automatic results of the pivot shift are collected in a graph curve, translation (millimeters) over time (seconds).

Both image analysis system and iPad technology consist in a simple, reliable, and accessible tool to measure “the look” of the pivot shift.

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Authors and Affiliations

  1. Department of Biomechanics, Medicine and Rehabilitation of Locomotor System - Ribeirao Preto Medical School, São Paulo University, Pittsburgh, PA, USA

    Paulo H. Araujo MD, PhD & Maurício Kfuri Jr MD, PhD

  2. Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA

    Paulo H. Araujo MD, PhD

  3. Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA

    Bruno Ohashi MD

Authors
  1. Paulo H. Araujo MD, PhD
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  2. Bruno Ohashi MD
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  3. Maurício Kfuri Jr MD, PhD
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Correspondence to Paulo H. Araujo MD, PhD .

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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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Araujo, P.H., Ohashi, B., Kfuri, M. (2017). Quantifying “the Look” of the Pivot Shift. 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_24

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  • DOI: https://doi.org/10.1007/978-3-319-32070-0_24

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-32069-4

  • Online ISBN: 978-3-319-32070-0

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