Triaxial accelerometer evaluation is correlated with IKDC grade of pivot shift

Knee Surg Sports Traumatol Arthrosc. 2020 Feb;28(2):381-388. doi: 10.1007/s00167-019-05563-7. Epub 2019 Jun 14.


Purpose: The purpose of this study was to evaluate the correlation between tibial acceleration parameters measured by the KiRA device and the clinical grade of pivot shift. The secondary objective was to report the risk factors for pre-operative high-grade pivot shift.

Methods: Two-hundred and ninety-five ACL deficient patients were examined under anesthesia. The pivot shift tests were performed twice by an expert surgeon. Clinical grading was performed using the International Knee Documentation Committee (IKDC) scale and tibial acceleration data was recorded using a triaxial accelerometer system (KiRA). The difference in the tibial acceleration range between injured and contralateral limbs was used in the analysis. Correlation coefficients were calculated using linear regression. Multivariate logistic regression was used to identify risk factors for high grade pivot shift.

Results: The clinical grade of pivot shift and the side-to-side difference in delta tibial acceleration determined by KiRA were significantly correlated (r = 0.57; 95% CI 0.513-0.658, p < 0.0001). The only risk factor identified to have a significant association with high grade pivot shift was an antero-posterior side to side laxity difference > 6 mm (OR = 2.070; 95% CI (1.259-3.405), p = 0.0042).

Conclusion: Side-to-side difference in tibial acceleration range, as measured by KiRA, is correlated with the IKDC pivot shift grade in anaesthetized patients. Side-to-side A-P laxity difference greater than 6 mm is reported as a newly defined risk factor for high grade pivot shift in the ACL injured knee.

Diagnostic study: Level II.

Keywords: Anterior cruciate ligament; Antero-posterior laxity; Pivot shift grade; Quantitative pivot shift.

MeSH terms

  • Acceleration
  • Accelerometry / instrumentation*
  • Adult
  • Anesthesia, General
  • Anterior Cruciate Ligament Injuries / diagnosis*
  • Anterior Cruciate Ligament Injuries / physiopathology*
  • Anterior Cruciate Ligament Injuries / surgery
  • Female
  • Humans
  • Joint Instability / physiopathology
  • Joint Instability / surgery
  • Logistic Models
  • Male
  • Physical Examination
  • Tibia / physiopathology*
  • Young Adult