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Knee Surgery, Sports Traumatology, Arthroscopy

Erschienen in:

12.01.2023 | KNEE

Posterior tibial plateau impaction fractures are not associated with increased knee instability: a quantitative pivot shift analysis

verfasst von: Brian M. Godshaw, Jonathan D. Hughes, Gian Andrea Lucidi, Joshua Setliff, Mikael Sansone, Jon Karlsson, Volker Musahl

Erschienen in: Knee Surgery, Sports Traumatology, Arthroscopy | Ausgabe 7/2023

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Abstract

Purpose

This study aimed to evaluate posterolateral tibial plateau impaction fractures and how they contribute to rotatory knee laxity using quantitative pivot shift analysis. It was hypothesised that neither the presence of nor the degree of involvement of the plateau would affect rotatory knee laxity in the ACL-deficient knee.

Methods

A retrospective review of prospectively collected data on 284 patients with complete anterior cruciate ligament (ACL) injuries was conducted. Posterolateral tibial plateau impaction fractures were identified on preoperative MRI. The patients were divided into two cohorts: “fractures” or “no fractures”. The cohort with fractures was further categorised based on fracture morphology: “extra-articular”, “articular-impaction”, or “displaced-articular fragment”. All data were collected during examination under anaesthesia performed immediately prior to ACL reconstruction. This included a standard pivot shift test graded by the examiner and quantitative data including anterior tibial translation (mm) via Rolimeter, quantitative pivot shift (QPS) examination (mm) via PIVOT tablet technology, and acceleration (m/sec²) during the pivot shift test via accelerometer. Quantitative examinations were compared with the contralateral knee.

Results

There were 112 patients with posterolateral tibial plateau impaction fractures (112/284, 39%). Of these, 71/112 (63%) were “extra-articular”, 28/112 (25%) “articular-impaction”, and 13/112 (12%) “displaced-articular”. Regarding the two groups with or without fractures, there was no difference in subjective pivot shift (2 ± 0 vs 2 ± 0, respectively, n.s.), QPS (2.4 ± 1.6 mm vs 2.7 ± 2.2 mm, respectively, n.s.), anterior tibial translation measurements (6 ± 3 mm vs 5 ± 3 mm, respectively, n.s.), or acceleration of the knee during the pivot (1.7 ± 2.3 m/s² vs 1.8 ± 3.1 m/s², respectively, n.s.). When the fractures were further subdivided, subgroup analysis revealed no significant differences noted in any of the measured examinations between the fracture subtypes.

Conclusion

This study showed that the posterolateral tibial plateau impaction fractures are commonly encountered in the setting of ACL tears; however, contrary to previous reports, they do not significantly increase rotatory knee laxity. This suggests that this type of concomitant injury may not need to be addressed at the time of ACL reconstruction.

Level of evidence

Level III.

Arilla FV, Rahnemai-Azar AA, Yacuzzi C, Guenther D, Engel BS, Fu FH et al (2016) Correlation between a 2D simple image analysis method and 3D bony motion during the pivot shift test. Knee 23:1059–1063CrossRefPubMed

Balasch H, Schiller M, Friebel H, Hoffmann F (1999) Evaluation of anterior knee joint instability with the Rolimeter. A test in comparison with manual assessment and measuring with the KT-1000 arthrometer. Knee Surg Sports Traumatol Arthrosc 7:204–208CrossRefPubMed

Bernholt DL, DePhillipo NN, Grantham WJ, Crawford MD, Aman ZS, Kennedy MI et al (2020) Morphologic variants of posterolateral tibial plateau impaction fractures in the setting of primary anterior cruciate ligament tear. Am J Sports Med 48:318–325CrossRefPubMed

Bernholt DL, Dornan GJ, DePhillipo NN, Aman ZS, Kennedy MI, LaPrade RF (2020) High-grade posterolateral tibial plateau impaction fractures in the setting of a primary anterior cruciate ligament tear are correlated with an increased preoperative pivot shift and inferior postoperative outcomes after anterior cruciate ligament reconstruction. Am J Sports Med 48:2185–2194CrossRefPubMed

Bojicic KM, Beaulieu ML, Imaizumi Krieger DY, Ashton-Miller JA, Wojtys EM (2017) Association between lateral posterior tibial slope, body mass index, and ACL injury risk. Orthop J Sports Med 5:2325967116688664CrossRefPubMedPubMedCentral

Cui W, Nakagawa Y, Katagiri H, Otabe K, Ohara T, Shioda M et al (2021) Knee laxity, lateral meniscus tear and distal femur morphology influence pivot shift test grade in ACL injury patients. Knee Surg Sports Traumatol Arthrosc 29:633–640CrossRefPubMed

Galway HR, MacIntosh DL (1980) The lateral pivot shift: a symptom and sign of anterior cruciate ligament insufficiency. Clin Orthop Relat Res 147:45–50CrossRef

Getgood AMJ, Bryant DM, Litchfield R, Heard M, McCormack RG, Rezansoff A et al (2020) Lateral extra-articular tenodesis reduces failure of hamstring tendon autograft anterior cruciate ligament reconstruction: 2-year outcomes from the STABILITY study randomized clinical trial. Am J Sports Med 48:285–297CrossRefPubMed

Hoshino Y, Araujo P, Ahlden M, Moore CG, Kuroda R, Zaffagnini S et al (2012) Standardized pivot shift test improves measurement accuracy. Knee Surg Sports Traumatol Arthrosc 20:732–736CrossRefPubMed

10.

Hoshino Y, Araujo P, Ahldén M, Samuelsson K, Muller B, Hofbauer M et al (2013) Quantitative evaluation of the pivot shift by image analysis using the iPad. Knee Surg Sports Traumatol Arthrosc 21:975–980CrossRefPubMed

11.

Hoshino Y, Hiroshima Y, Miyaji N, Nagai K, Araki D, Kanzaki N et al (2020) Unrepaired lateral meniscus tears lead to remaining pivot-shift in ACL-reconstructed knees. Knee Surg Sports Traumatol Arthrosc 28:3504–3510CrossRefPubMed

12.

Jonsson H, Riklund-Ahlström K, Lind J (2004) Positive pivot shift after ACL reconstruction predicts later osteoarthrosis: 63 patients followed 5–9 years after surgery. Acta Orthop Scand 75:594–599CrossRefPubMed

13.

Kanakamedala AC, Burnham JM, Pfeiffer TR, Herbst E, Kowalczuk M, Popchak A et al (2018) Lateral femoral notch depth is not associated with increased rotatory instability in ACL-injured knees: a quantitative pivot shift analysis. Knee Surg Sports Traumatol Arthrosc 26:1399–1405CrossRefPubMed

14.

Kaplan N, Wickiewicz TL, Warren RF (1990) Primary surgical treatment of anterior cruciate ligament ruptures. A long-term follow-up study. Am J Sports Med 18:354–358CrossRefPubMed

15.

Kaplan PA, Walker CW, Kilcoyne RF, Brown DE, Tusek D, Dussault RG (1992) Occult fracture patterns of the knee associated with anterior cruciate ligament tears: assessment with MR imaging. Radiology 183:835–838CrossRefPubMed

16.

Katakura M, Nakamura K, Watanabe T, Horie M, Nakamura T, Katagiri H et al (2020) Risk factors for residual anterolateral rotational instability after double bundle anterior cruciate ligament reconstruction: evaluation by quantitative assessment of the pivot shift phenomenon using triaxial accelerometer. Knee 27:95–101CrossRefPubMed

17.

Leitze Z, Losee RE, Jokl P, Johnson TR, Feagin JA (2005) Implications of the pivot shift in the ACL-deficient knee. Clin Orthop Relat Res. https://doi.org/10.1097/01.blo.0000160026.14363.22CrossRefPubMed

18.

Li JS, Hosseini A, Cancre L, Ryan N, Rubash HE, Li G (2013) Kinematic characteristics of the tibiofemoral joint during a step-up activity. Gait Posture 38:712–716CrossRefPubMedPubMedCentral

19.

Lopomo N, Signorelli C, Bonanzinga T, Marcheggiani Muccioli GM, Visani A, Zaffagnini S (2012) Quantitative assessment of pivot-shift using inertial sensors. Knee Surg Sports Traumatol Arthrosc 20:713–717CrossRefPubMed

20.

Lopomo N, Signorelli C, Rahnemai-Azar AA, Raggi F, Hoshino Y, Samuelsson K et al (2017) Analysis of the influence of anaesthesia on the clinical and quantitative assessment of the pivot shift: a multicenter international study. Knee Surg Sports Traumatol Arthrosc 25:3004–3011CrossRefPubMed

21.

Lopomo N, Zaffagnini S, Signorelli C, Bignozzi S, Giordano G, Marcheggiani Muccioli GM et al (2012) An original clinical methodology for non-invasive assessment of pivot-shift test. Comput Methods Biomech Biomed Engin 15:1323–1328CrossRefPubMed

22.

Lucidi GA, Grassi A, Di Paolo S, Agostinone P, Neri MP, Macchiarola L et al (2021) The lateral femoral notch sign is correlated with increased rotatory laxity after anterior cruciate ligament injury: pivot shift quantification with a surgical navigation system. Am J Sports Med 49:649–655CrossRefPubMed

23.

Luo CF, Sun H, Zhang B, Zeng BF (2010) Three-column fixation for complex tibial plateau fractures. J Orthop Trauma 24:683–692CrossRefPubMed

24.

Melugin HP, Johnson NR, Wu IT, Levy BA, Stuart MJ, Krych AJ (2018) Is treatment of segond fracture necessary with combined anterior cruciate ligament reconstruction? Am J Sports Med 46:832–838CrossRefPubMed

25.

Menzdorf L, Drenck T, Akoto R, Hartel M, Krause M, Guttowski D et al (2020) Clinical results after surgical treatment of posterolateral tibial plateau fractures (“apple bite fracture”) in combination with ACL injuries. Eur J Trauma Emerg Surg 46:1239–1248CrossRefPubMed

26.

Moore TM (1981) Fracture–dislocation of the knee. Clin Orthop Relat Res 156:128–140CrossRef

27.

Muller B, Hofbauer M, Rahnemai-Azar AA, Wolf M, Araki D, Hoshino Y et al (2016) Development of computer tablet software for clinical quantification of lateral knee compartment translation during the pivot shift test. Comput Methods Biomech Biomed Engin 19:217–228CrossRefPubMed

28.

Musahl V, Ayeni OR, Citak M, Irrgang JJ, Pearle AD, Wickiewicz TL (2010) The influence of bony morphology on the magnitude of the pivot shift. Knee Surg Sports Traumatol Arthrosc 18:1232–1238CrossRefPubMed

29.

Musahl V, Griffith C, Irrgang JJ, Hoshino Y, Kuroda R, Lopomo N et al (2016) Validation of quantitative measures of rotatory knee laxity. Am J Sports Med 44:2393–2398CrossRefPubMed

30.

Nakamura K, Koga H, Sekiya I, Watanabe T, Mochizuki T, Horie M et al (2017) Evaluation of pivot shift phenomenon while awake and under anaesthesia by different manoeuvres using triaxial accelerometer. Knee Surg Sports Traumatol Arthrosc 25:2377–2383CrossRefPubMed

31.

Nishida K, Matsushita T, Hoshino Y, Araki D, Matsumoto T, Niikura T et al (2020) The influences of chronicity and meniscal injuries on pivot shift in anterior cruciate ligament-deficient knees: quantitative evaluation using an electromagnetic measurement system. Arthroscopy 36:1398–1406CrossRefPubMed

32.

Pfeiffer TR, Burnham JM, Kanakamedala AC, Hughes JD, Zlotnicki J, Popchak A et al (2019) Distal femur morphology affects rotatory knee instability in patients with anterior cruciate ligament ruptures. Knee Surg Sports Traumatol Arthrosc 27:1514–1519CrossRefPubMed

33.

Prins M (2006) The Lachman test is the most sensitive and the pivot shift the most specific test for the diagnosis of ACL rupture. Aust J Physiother 52:66CrossRefPubMed

34.

Rahnemai-Azar AA, Abebe ES, Johnson P, Labrum J, Fu FH, Irrgang JJ et al (2017) Increased lateral tibial slope predicts high-grade rotatory knee laxity pre-operatively in ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 25:1170–1176CrossRefPubMed

35.

Schatzker J, McBroom R, Bruce D (1979) The tibial plateau fracture. The Toronto experience 1968–1975. Clin Orthop Relat Res 138:94–104

36.

Shybut TB, Vega CE, Haddad J, Alexander JW, Gold JE, Noble PC et al (2015) Effect of lateral meniscal root tear on the stability of the anterior cruciate ligament-deficient knee. Am J Sports Med 43:905–911CrossRefPubMed

37.

Tanaka M, Vyas D, Moloney G, Bedi A, Pearle AD, Musahl V (2012) What does it take to have a high-grade pivot shift? Knee Surg Sports Traumatol Arthrosc 20:737–742CrossRefPubMed

38.

Vaudreuil NJ, Rothrauff BB, de Sa D, Musahl V (2019) The pivot shift: current experimental methodology and clinical utility for anterior cruciate ligament rupture and associated injury. Curr Rev Musculoskelet Med 12:41–49CrossRefPubMedPubMedCentral

39.

Werner BC, Gwathmey FW, Higgins ST, Hart JM, Miller MD (2014) Ultra-low velocity knee dislocations: patient characteristics, complications, and outcomes. Am J Sports Med 42:358–363CrossRefPubMed

40.

Yao L, Lee JK (1988) Occult intraosseous fracture: detection with MR imaging. Radiology 167:749–751CrossRefPubMed

41.

Zaffagnini S, Signorelli C, Grassi A, Yue H, Raggi F, Urrizola F et al (2016) Assessment of the pivot shift using inertial sensors. Curr Rev Musculoskelet Med 9:160–163CrossRefPubMedPubMedCentral

Titel: Posterior tibial plateau impaction fractures are not associated with increased knee instability: a quantitative pivot shift analysis
verfasst von: Brian M. Godshaw
Jonathan D. Hughes
Gian Andrea Lucidi
Joshua Setliff
Mikael Sansone
Jon Karlsson
Volker Musahl
Publikationsdatum: 12.01.2023
Verlag: Springer Berlin Heidelberg
Erschienen in: Knee Surgery, Sports Traumatology, Arthroscopy / Ausgabe 7/2023
Print ISSN: 0942-2056
Elektronische ISSN: 1433-7347
DOI: https://doi.org/10.1007/s00167-023-07312-3

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Posterior tibial plateau impaction fractures are not associated with increased knee instability: a quantitative pivot shift analysis