Reliability of the quantitative measurement of the pivot shift test using an inertial sensor
ESSKA Academy. Yasuma S. May 12, 2018; 218169
Sanshiro Yasuma
Sanshiro Yasuma
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Objectives: One of the common methodologies for evaluation of the pivot shift test is the pivot shift grading as defined by International Knee Documentation Committee (IKDC). However, as they depend entirely on the tester's subjectivity, the results tends to be inconsistent among examiners. Recently, novel technology for quantitative evaluation of the pivot shift test using an inertial sensor has been validated by several researchers. The purpose of this study was to determine the intra- and inter-rater reliability of the quantitative measurement of the pivot shift test using an inertial sensor.

Methods: A total of 40 patients undergoing double bundle anterior cruciate ligament (ACL) reconstruction using hamstrings tendon autograft were enrolled in this study. Knee rotational instability of all patients were evaluated quantitatively by 2 specific orthpaedists (tester A and B) using an inertial sensor.
First, an inertial sensor was fixed on the tibial tuberosity with an exclusive strap under anesthesia, and the pivot shift test was performed repeatedly by both tester A and B to calculate acceleration and external rotational (ER) angular velocity during the maneuver. Subsequently, the mean value of these parameters for the 3 times pivot shift test was calculated. Patients were tested on both ACL-injured knee and contra-lateral knee preoperatively, and also tested intra-operatively on the involved knee after ACL grafts were temporally fixed. Knee stability was measured for the following 3 states: were measured (1) contra-lateral intact knee < intact >, (2) preoperative ACL-injured knee < ACLD >, and (3) ACL-reconstructed knee < ACLR >. For statistical analysis, the test-retest reliability for the 3 times pivot shift test repetitions performed by tester A and B was assessed by calculating the intra-rater intraclass correlation coefficients (ICC) derived from one-way ANOVA. Furthermore, inter-rater ICC was evaluated to assess the inter-rater reliability of these tests using the methodology of two-way mixed effects ANOVA.

Results: Acceleration for the intact, ACLD and ACLR for tester A was 4.2±0.8 (m/s²), 22.0±10.8 and 4.3±1.1 respectively, while it was 5.5±1.4, 12.7±6.3, and 4.2±1.1 respectively for tester B. The intra-rater ICC for acceleration for tester A and B was 0.97 and 0.95 respectively, while the inter-rater ICC was 0.82. ER angular velocity for intact, ACLD and ACLR for tester A was 117.3±30.0 (deg/s), 298.3±97.3, and 153.4±51.6 respectively, while it was 69.7±18.5, 160.8±66.2, and 61.6±12.4 respectively for tester B . The intra-rater ICC for ER angular velocity for tester A and B was 0.97 and 0.94 respectively while the inter-rater ICC was 0.82.

Conclusions: Regarding acceleration and ER angular velocity, both intra-rater and inter-rater reliability was excellent in this study according to Landis and Koch's reliability standards. These results suggest that an inertial sensor can provide an accurate quantitative measurement of rotational instability quantitatively.

anterior cruciate ligament, inertial sensor, pivot shift test
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