Pivot shift intraoperative quantitative assessment using a smartphone accelerometer in ACL deficient knees
Abstract Purpose The Pivot Shift (PS) test is a complex clinical sign that assesses the internal rotation and anterior tibial translation, which occurs abnormally in ACL deficient‐knees. Because of the high inter‐observer variability, different devices have been designed to characterize this complex...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2023-01-01
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| Series: | Journal of Experimental Orthopaedics |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s40634-023-00570-7 |
| _version_ | 1827324276653424640 |
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| author | Guillaume Soudé Jean‐Baptiste De Villeneuve Bargemon Raghbir Khakha Martine Pithioux Jean‐Noël Argenson Matthieu Ollivier Christophe Jacquet |
| author_facet | Guillaume Soudé Jean‐Baptiste De Villeneuve Bargemon Raghbir Khakha Martine Pithioux Jean‐Noël Argenson Matthieu Ollivier Christophe Jacquet |
| author_sort | Guillaume Soudé |
| collection | DOAJ |
| description | Abstract Purpose The Pivot Shift (PS) test is a complex clinical sign that assesses the internal rotation and anterior tibial translation, which occurs abnormally in ACL deficient‐knees. Because of the high inter‐observer variability, different devices have been designed to characterize this complex movement in quantitative variables. The objective of this pilot study is to validate the reproducibility of intraoperative quantitative assessment of the PS with a smartphone accelerometer. Methods Twelve ACL‐injured knees were included and compared with the contralateral uninjured side. The PS was measured by two independent observers utilizing a smartphone accelerometer and graded according to the IKDC classification. Measurements were taken preoperatively, intraoperatively and postoperatively. Intraoperative readings were taken during each stage of reconstruction or repair of meniscoligamentous lesions including meniscal lesions, ramp lesions, ACL reconstruction and lateral tenodesis. Reproducibility of the measurements were evaluated according to an intraclass correlation coefficient (ICC). Results The intra‐observer reliability was good for the first examiner and excellent for the second examiner, with the ICC 0.89 [0.67, 0.98] p < 0,001 and ICC 0.97 [0.91, 1.0] p < 0,001 respectively. The inter‐observer reliability was excellent between the two observers with the ICC 0.99 [0.97, 1.0] p < 0,001. The mean tibial acceleration measured 3.45 m.s2 (SD = 1.71) preoperatively on the injured knees and 1.03 m.s2 (SD = 0.36) on the healthy knees, demonstrating a significant difference following univariate analysis p < 0.001. Postoperatively, no significant difference was observed between healthy and reconstructed knees The magnitudes of tibial acceleration values were correlated with the PS IKDC grade. Conclusion The smartphone accelerometer is a reproducible device to quantitatively assess the internal rotation and anterior tibial translation during ACL reconstruction surgery. The measurements are influenced by the different surgical steps. Other larger cohort studies are needed to evaluate the specific impact of each step of the ACL reconstruction and meniscal repair on this measurement. An external validation using other technologies are needed to validate the reliability of this device to assess the PS test. Level of evidence Level IV, case series, pilot study. |
| first_indexed | 2024-03-08T04:57:48Z |
| format | Article |
| id | doaj.art-c3e8b2e4d21e44188bb8e535e7d1ad49 |
| institution | Directory Open Access Journal |
| issn | 2197-1153 |
| language | English |
| last_indexed | 2024-04-25T02:09:59Z |
| publishDate | 2023-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of Experimental Orthopaedics |
| spelling | doaj.art-c3e8b2e4d21e44188bb8e535e7d1ad492024-03-07T12:46:41ZengWileyJournal of Experimental Orthopaedics2197-11532023-01-01101n/an/a10.1186/s40634-023-00570-7Pivot shift intraoperative quantitative assessment using a smartphone accelerometer in ACL deficient kneesGuillaume Soudé0Jean‐Baptiste De Villeneuve Bargemon1Raghbir Khakha2Martine Pithioux3Jean‐Noël Argenson4Matthieu Ollivier5Christophe Jacquet6Aix‐Marseille UniversityCNRSISM UMR 728713288cedex 09MarseilleFranceDepartment of Orthopedic surgery and Traumatology St. Marguerite HospitalInstitute of movement and locomotion270 Boulevard Sainte Marguerite29 13274MarseilleBPFranceGuys and St Thomas HospitalsLondonUKAix‐Marseille UniversityCNRSISM UMR 728713288cedex 09MarseilleFranceAix‐Marseille UniversityCNRSISM UMR 728713288cedex 09MarseilleFranceAix‐Marseille UniversityCNRSISM UMR 728713288cedex 09MarseilleFranceAix‐Marseille UniversityCNRSISM UMR 728713288cedex 09MarseilleFranceAbstract Purpose The Pivot Shift (PS) test is a complex clinical sign that assesses the internal rotation and anterior tibial translation, which occurs abnormally in ACL deficient‐knees. Because of the high inter‐observer variability, different devices have been designed to characterize this complex movement in quantitative variables. The objective of this pilot study is to validate the reproducibility of intraoperative quantitative assessment of the PS with a smartphone accelerometer. Methods Twelve ACL‐injured knees were included and compared with the contralateral uninjured side. The PS was measured by two independent observers utilizing a smartphone accelerometer and graded according to the IKDC classification. Measurements were taken preoperatively, intraoperatively and postoperatively. Intraoperative readings were taken during each stage of reconstruction or repair of meniscoligamentous lesions including meniscal lesions, ramp lesions, ACL reconstruction and lateral tenodesis. Reproducibility of the measurements were evaluated according to an intraclass correlation coefficient (ICC). Results The intra‐observer reliability was good for the first examiner and excellent for the second examiner, with the ICC 0.89 [0.67, 0.98] p < 0,001 and ICC 0.97 [0.91, 1.0] p < 0,001 respectively. The inter‐observer reliability was excellent between the two observers with the ICC 0.99 [0.97, 1.0] p < 0,001. The mean tibial acceleration measured 3.45 m.s2 (SD = 1.71) preoperatively on the injured knees and 1.03 m.s2 (SD = 0.36) on the healthy knees, demonstrating a significant difference following univariate analysis p < 0.001. Postoperatively, no significant difference was observed between healthy and reconstructed knees The magnitudes of tibial acceleration values were correlated with the PS IKDC grade. Conclusion The smartphone accelerometer is a reproducible device to quantitatively assess the internal rotation and anterior tibial translation during ACL reconstruction surgery. The measurements are influenced by the different surgical steps. Other larger cohort studies are needed to evaluate the specific impact of each step of the ACL reconstruction and meniscal repair on this measurement. An external validation using other technologies are needed to validate the reliability of this device to assess the PS test. Level of evidence Level IV, case series, pilot study.https://doi.org/10.1186/s40634-023-00570-7PS testAnterior cruciate ligament repairTriaxial smartphone accelerometerKnee laxityMeniscus injuryProtocol study |
| spellingShingle | Guillaume Soudé Jean‐Baptiste De Villeneuve Bargemon Raghbir Khakha Martine Pithioux Jean‐Noël Argenson Matthieu Ollivier Christophe Jacquet Pivot shift intraoperative quantitative assessment using a smartphone accelerometer in ACL deficient knees Journal of Experimental Orthopaedics PS test Anterior cruciate ligament repair Triaxial smartphone accelerometer Knee laxity Meniscus injury Protocol study |
| title | Pivot shift intraoperative quantitative assessment using a smartphone accelerometer in ACL deficient knees |
| title_full | Pivot shift intraoperative quantitative assessment using a smartphone accelerometer in ACL deficient knees |
| title_fullStr | Pivot shift intraoperative quantitative assessment using a smartphone accelerometer in ACL deficient knees |
| title_full_unstemmed | Pivot shift intraoperative quantitative assessment using a smartphone accelerometer in ACL deficient knees |
| title_short | Pivot shift intraoperative quantitative assessment using a smartphone accelerometer in ACL deficient knees |
| title_sort | pivot shift intraoperative quantitative assessment using a smartphone accelerometer in acl deficient knees |
| topic | PS test Anterior cruciate ligament repair Triaxial smartphone accelerometer Knee laxity Meniscus injury Protocol study |
| url | https://doi.org/10.1186/s40634-023-00570-7 |
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