Background: Various technologies have been developed to quantify the pivot shift, as it is regarded as a key indicator of anterolateral rotatory laxity of the knee. Purpose: To determine the usefulness of a commercially available triaxial accelerometer (Kinematic Rapid Assessment [KiRA]) in numerically quantifying the pivot shift in patients under anesthesia with an anterior cruciate ligament (ACL)–deficient knee. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: Both knees of 50 patients (26 male [mean age, 30.4 years], 24 female [mean age, 26.6 years]) under anesthesia were assessed immediately before unilateral ACL reconstruction by an orthopaedic fellow and 1 of 3 experienced knee surgeons. The pivot-shift grade and 2 KiRA outputs (range of acceleration and slope of acceleration change) were compared. Results: The surgeon and fellow recorded the same pivot-shift grade for 45 of 50 patients (90%). Data from the 5 patients with no agreement and 1 patient with extreme outlying data were excluded from subsequent analysis. Using the KiRA range and slope data, the surgeon identified the injured knee in 74% and 76% of patients, respectively, while the fellow’s rate of injured knee identification was 74% and 80%, respectively. A correlation could be found only between pivot-shift grade and surgeon-derived range data ( ρ = 0.40; P & .01) but not slope data or any fellow-derived outputs. Using the surgeon-derived range data, there was a significant difference between a grade 3 pivot (&5 m/s ~(2)) and a grade 1 or 2 pivot (&5 m/s ~(2)) ( P = .01). Conclusion: Although a correlation between KiRA output data and pivot-shift grade was found when the device was used by an experienced surgeon, there was no correlation when used by a well-trained but less experienced orthopaedic fellow. Furthermore, the KiRA output data identified the ACL-deficient knee correctly in only 74% of patients. Although a threshold acceleration range value could be identified, above which the value was associated with a grade 3 pivot shift, this was dependent on the examiner, and distinction between other grades could not be made.
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机译：背景：已经开发了各种技术来量化枢轴偏移，因为它被认为是膝关节的前外侧旋转松弛的关键指标。目的：确定市售三轴加速度计的有用性（运动快速评估[基拉]）在数量上量化麻醉患者的枢转偏移与前十字韧带（ACL）的膝关节的枢转。研究设计：队列研究（诊断）;证据水平，3.方法：膝关节均为50名患者（26名男性[平均年龄，30.4岁]，24例女性[平均年龄，26.6岁]立即进行麻醉前，由整形外科研究员重建和1 3个经验丰富的膝盖外科医生。比较枢轴级别和2个基拉输出（加速度和加速度变化的范围）。结果：外科医生和同伴记录了50名患者中45名（90％）的相同枢转级别。从随后的分析中排除了来自5名没有协议和1例患者的5名患者的数据被排除在后续分析之外。使用基拉范围和坡度数据，外科医生分别确定了74％和76％的患者的受伤膝关节，而受伤膝关节识别的率分别为74％和80％。只能在枢轴转换等级和外科医生衍生的范围数据之间找到相关性（ρ= 0.40; p＆ .01）但不是斜率数据或任何来自派生输出。使用外科医生衍生的范围数据，3级枢轴（＆ 5 m / s〜（2））之间存在显着差异，并且1或2级枢轴（＆ 5 m / s〜（2））（ p = .01）。结论：尽管当经验丰富的外科医生使用设备时发现基尔输出数据和枢轴换档等级的相关性，但是当经过良好训练但不太经历的骨科的家庭使用时，没有相关性。此外，基拉输出数据仅在74％的患者中正确识别了ACL缺陷的膝关节。尽管可以识别阈值加速范围值，但是在该阈值与3级枢转偏移相关的值，这取决于检查器，不能进行其他等级之间的区别。
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