Correlation between quantitative pivot shift and generalized joint laxity: a prospective multicenter study of ACL ruptures

Knee Surg Sports Traumatol Arthrosc. 2018 Aug;26(8):2362-2370. doi: 10.1007/s00167-017-4785-2. Epub 2017 Nov 17.


Purpose: To investigate whether an increased magnitude of quantitative rotatory knee laxity is associated with a greater level of generalized joint laxity in ACL-injured and contralateral knees.

Methods: A total of 103 patients were enrolled across four international centers to undergo anatomic ACL reconstruction. Rotatory knee laxity was evaluated preoperatively, both in the awake state and under anesthesia, using the standardized pivot shift test. Two devices were used to quantify rotatory knee laxity; an inertial sensor, measuring the joint acceleration, and an image analysis system, measuring the lateral compartment translation of the tibia. The presence of generalized joint laxity was determined using the Beighton Hypermobility Score. The correlation between the level of generalized joint laxity and the magnitude of rotatory knee laxity was calculated for both the involved knee and the non-involved knee. Further, patients were dichotomized into low (0-4) or high (5-9) Beighton Score groups. Alpha was set at < 0.05.

Results: Ninety-six patients had complete datasets, 83 and 13 in the low and high Beighton Score groups respectively. In anesthetized patients, there was a significant correlation between the degree of Beighton Score and quantitative pivot shift when analyzing the non-involved knee using the image analysis system (r = 0.235, p < 0.05). When analyzing the same knee, multivariate analysis adjusted for meniscal injury, age and gender revealed an increased odds ratio for patients with increased lateral compartment translation to be part of the high Beighton Score group (OR 1.86, 95% CI 1.10-3.17, p < 0.05). No other correlation was significant. When analyzing the dichotomized subgroups, no significant correlations could be established.

Conclusion: The findings in this study suggest that there is a weak correlation between generalized joint laxity and the contralateral healthy knee, indicating increased rotatory knee laxity in these patients. Generalized joint laxity does not appear to correlate with rotatory knee laxity in ACL-injured knees.

Level of evidence: Prospective cohort study; level of evidence, 2.

Keywords: Anterior cruciate ligament reconstruction; Beighton Score; Generalized joint hypermobility; Generalized joint laxity; Image analysis system; Inertial sensor; Pivot shift test; Rotatory knee laxity.

Publication types

  • Multicenter Study
  • Observational Study

MeSH terms

  • Adolescent
  • Adult
  • Anterior Cruciate Ligament / physiopathology
  • Anterior Cruciate Ligament Injuries / physiopathology*
  • Biomechanical Phenomena
  • Child
  • Female
  • Humans
  • Joint Instability / physiopathology*
  • Knee Joint / physiopathology*
  • Male
  • Physical Examination / instrumentation
  • Prospective Studies
  • Range of Motion, Articular
  • Rotation
  • Rupture / surgery
  • Tibia / surgery
  • Young Adult