What question did this study set out to answer?

To identify preoperative factors that predict high-grade pivot shift under anesthesia in patients with ACL injury.

April 27, 2026Arthroscopy The Journal of Arthroscopic and Related Surgery0 citations

More Than 5.5 mm of Internal Rotational Tibial Subluxation Measured on Magnetic Resonance Imaging Predicts High‐Grade Pivot Shift Under Anesthesia in Patients With Primary Anterior Cruciate Ligament Injury

WBWenbin BaiPeking University ZZZhiyu ZhangPeking University CCChenxi CaoPeking University

Key Points

To identify preoperative factors that predict high-grade pivot shift under anesthesia in patients with ACL injury.
Retrospective review of consecutive patients undergoing primary ACL reconstruction from January 2022 to July 2024.
Comparative analysis of patient characteristics and MRI measurements of tibiofemoral position between different pivot shift groups.
Multivariable logistic regression and ROC analyses were used to identify predictors and optimal cutoff values.
The optimal cutoff for internal rotational tibial subluxation (IRTS) predicting high-grade pivot shift was identified as 5.5 mm (AUC = 0.756).
Key predictors included increased IRTS (OR = 1.433) and longer time from injury to surgery (OR = 1.737).
Other significant predictors were Beighton score ≥ 4 (OR = 2.979), posterior horn meniscus injury (OR = 3.587), and increased lateral femoral condyle ratio (OR = 1.183).

Abstract

Purpose To identify preoperative predictors for high‐grade pivot shift under anesthesia in patients with primary anterior cruciate ligament (ACL) injury, with a particular focus on investigating the association between altered rotational tibiofemoral position measured on magnetic resonance imaging (MRI) and high‐grade pivot shift. Methods Consecutive patients who underwent primary ACL reconstruction (ACLR) performed by the same senior surgeon between January 2022 and July 2024 were retrospectively reviewed. Patient characteristics, along with MRI measurements of anatomic features and tibiofemoral positions, were compared between the two groups. Multivariable logistic regression analysis was performed to identify predictors of high‐grade pivot shift. Receiver operating characteristic (ROC) analyses were conducted to determine the optimal cutoff values for the identified predictors. Results A total of 52 patients with grade II or III pivot shift under anesthesia were included in this study, along with 156 age‐ and sex‐matched controls exhibiting grade 0 or I pivot shift. ROC analysis indicated that the optimal cutoff value for internal rotational tibial subluxation (IRTS) to predict high‐grade pivot shift was 5.5 mm (area under the curve AUC = 0.756). The multivariable prediction (AUC = 0.861) identified increased IRTS (odds ratio OR = 1.433), longer time from injury to surgery (OR = 1.737), Beighton score ≥ 4 (OR = 2.979), injury to the posterior horn of the lateral meniscus (OR = 3.587), and increased lateral femoral condyle ratio (LFCR; OR = 1.183) as significant predictors of high‐grade pivot shift. Conclusions Increased IRTS (threshold of 5.5 mm) showed notable diagnostic performance in predicting high‐grade pivot shift. Additionally, longer time from injury to surgery, Beighton score ≥ 4, injury to the posterior horn of the lateral meniscus, and increased LFCR were also identified as significant predictors of high‐grade pivot shift. Level of Evidence Level III, retrospective comparative case series.

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Cite This Study

Bai et al. (Fri,) studied this question.

synapsesocial.com/papers/69eefdb5fede9185760d47c4 https://doi.org/https://doi.org/10.1002/arj.70196

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