The influence of applied internal and external rotation on the pivot shift phenomenon.

PURPOSE: The pivot shift test is performed in different techniques and the rotation of the tibia seems to have a significant impact on the amount of the pivot shift phenomenon. It has been hypothesised that external rotation will increase the phenomenon due to less tension at the iliotibial band in knee extension. METHODS: Twenty-four patients with unilateral anterior cruciate ligament insufficiency were included prospectively. The pivot shift test was performed bilaterally in internal and external tibial rotation under general anaesthesia. Knee motion was captured using a femoral and a tibial inertial sensor. The difference between positive and negative peak values in Euclidean norm of acceleration was calculated to evaluate the amount of the pivot shift phenomenon. RESULTS: The pivot shift phenomenon was significantly increased in patients with ACL insufficiency when the test was performed in external [mean 5.2 ms- 2 (95% CI 4.3-6.0)] compared to internal tibial rotation [mean 4.4 ms- 2 (95% CI 3.5-5.4)] (p = 0.002). In healthy, contralateral knees did not show any difference between external [mean 4.0 ms- 2 (95% CI 3.3-4.7)] and internal tibial rotation [mean 4.0 ms- 2 (95% CI 3.4-4.6)] (ns). CONCLUSIONS: The pivot shift phenomenon was increased with external rotation in ACL-insufficient knees, and therefore, one should perform the pivot shift test, rather, in external rotation to easily evoke the, sometimes difficult to detect, pivot shift phenomenon. LEVEL OF EVIDENCE: I (diagnostic study).

[Reliability of the novel gait analysis system RehaWatch]. / Reliabilitätsstudie zum Ganganalysesystem RehaWatch.

Quantitative gait analysis plays an important role in neurological and orthopedic rehabilitation regarding the evaluation of rehabilitation progress. However, most of the currently available gait analysis systems share the disadvantage of being expensive, time-consuming, and complex. A promising alternative is the portable gait analysis system RehaWatch. It is based on inertial sensors that allow the quantitative measurement of the important kinemetric variables acceleration and angular velocity. The associated software analyzes the sensor signals and calculates temporal (e.g., stride duration, gait phases) and spatial (e.g., stride length, foot angle) parameters on this basis. The aim of this study was to investigate the intraobserver reliability of RehaWatch. A total of 44 healthy subjects (age: 27.7±4.2 years) were included in the study. Each participant underwent three measurements (walking distance: 20 m) for each of the three sessions with a time interval of 48 h in-between. Variance analysis (General Linear Model) revealed no significant differences between gait parameters at different measuring points. ICCs (Average Measure Intraclass Correlations) were between 0.691 and 0.959. In addition to the results of the variance and correlation analysis the Bland-Altman plots suggest high reliability.