A Study On The Influencing Factors Of High-Grade Pivot Shift Of Anterior Cruciate Ligament Injury And Its Effect On Short-Term Clinical Efficacy

Objective:To explore the risk factors of high-grade pivot shift in physical examination after anterior cruciate ligament injury and the effect of high-grade pivot shift before surgery on the short-term clinical outcome after anterior cruciate ligament reconstruction.Methods:Data of patients undergoing anterior cruciate ligament reconstruction for anterior cruciate ligament injury in our hospital from January 2021 to July 2021 were prospectively collected,According to the grading results of Pivot-shift test under preoperative anesthesia,they were divided into low-grade pivot shift group and high-grade pivot shift group.A total of 33 patients were enrolled in the low-grade pivot shift group and 38 patients were enrolled in the high-grade pivot shift group.Firstly,univariate logistic regression analysis was used to compare the age,gender,interval from injury to operation,abnormal medial/lateral Posterior-inferior tibial slope before operation,injury of anterolateral ligament and injury of medial/lateral meniscus under intraoperative microscope between low-grade pivot shift group and high-grade pivot shift group.Then,Odds Ratios(OR)and 95%Confidence Interval(CI)of these variables were calculated using multivariate Logistic regression analysis,and finally to determine the risk factors for high-grade pivot shift in physical examination after anterior cruciate ligament injury.Both groups underwent conventional arthroscopic single-bundle anterior cruciate ligament reconstruction.Visual analogue score was used to evaluate the pain degree after anterior cruciate ligament reconstruction in both groups.Lysholm score and IKDC score were used to evaluate knee function after anterior cruciate ligament reconstruction in both groups.Results:Of the 71 consecutive cases in this study,38 were in the high-grade pivot shift.Univariate Logistic regression analysis showed that there were significant differences between the low-grade pivot shift group and the high-grade pivot shift group in abnormal lateral Posterior-inferior tibial slope(P<0.001),anterolateral ligament injury(P=0.009)and intraoperative microscope lateral meniscus injury(P<0.001).Multivariate Logistic regression analysis further confirmed the abnormal lateral Posterior-inferior tibial slope(OR=22.017;95%CI: 1.884-257.239)and the condition of anterolateral ligament injury(OR=8.456;95%CI: 1.153-62.045)and lateral meniscus injury(OR=44.262;95%CI: 6.665-293.948)was a risk factor for high-grade pivot shift on physical examination after anterior cruciate ligament injury.The comparison results of short-term postoperative VAS score,Lysholm score and IKDC score between the two groups showed that the VAS score of the low-grade pivot shift group was lower than that of the high-grade pivot shift group at six weeks,three months and six months postoperatively,with statistically significant differences;Lysholm score and IKDC score at three and six months after operation were significantly higher in the low-grade pivot shift group than in the high-grade pivot shift group,and the difference was statistically significant.Conclusion:Increased lateral Posterior-inferior tibial slope,abnormal anterolateral ligament and lateral meniscus injury are risk factors for high-grade pivot shift in physical examination after anterior cruciate ligament injury,Furthermore,preoperative high-grade pivot shift was associated with higher pain scores and poorer functional scores after anterior cruciate ligament reconstruction.Therefore,the correction of excessive lateral Posterior-inferior tibial slope and repair of anterolateral ligament and lateral meniscus are important surgical options for eliminating pivot shift phenomenon,In addition,low-grade pivot shift was associated with lower postoperative pain scores and higher functional scores.