title: Experimental Execution of the Simulated Pivot-Shift Test: A Systematic Review of Techniques.
abstract: OBJECTIVE
  To conduct a systematic review to identify and summarize the various techniques that have been used to simulate the pivot-shift test in vitro.
  
  
  METHODS
  Medline, Embase, and the Cochrane Library were screened for studies involving the simulated pivot-shift test in human cadaveric knees published between 1946 and May 2014. Study parameters including sample size, study location, simulated pivot-shift technique, loads applied, knee flexion angles at which simulated pivot shift was tested, and kinematic evaluation tools were extracted and analyzed.
  
  
  RESULTS
  Forty-eight studies reporting simulated pivot-shift testing on 627 cadaveric knees fulfilled the criteria. Reviewer inter-rater agreement for study selection showed a κ score of 0.960 (full-text review). Twenty-seven studies described the use of internal rotation torque, with a mean of 5.3 Nm (range, 1 to 18 Nm). Forty-seven studies described the use of valgus torque, with a mean of 8.8 Nm (range, 1 to 25 Nm). Four studies described the use of iliotibial tract tension, ranging from 10 to 88 N. Regarding static simulated pivot-shift test techniques, 100% of the studies performed testing at 30° of knee flexion, and the most tested range of motion in the continuous tests was 0° to 90°. Anterior tibial translation was the most analyzed parameter during the simulated pivot-shift test, being used in 45 studies. In 22% of the studies, a robotic system was used to simulate the pivot-shift test. Robotic systems were shown to have better control of the loading system and higher tracking system accuracy.
  
  
  CONCLUSIONS
  This study provides a reference for investigators who desire to apply simulated pivot shift in their in vitro studies. It is recommended to simulate the pivot-shift test using a 10-Nm valgus torque and 5-Nm internal rotation torque. Knee flexion of 30° is mandatory for testing.
  
  
  METHODS
  Level IV, systematic review of basic science studies.
authors: Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A.; Orthopaedic Robotics Laboratory, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A.; Department of Orthopaedic Surgery, University Hospital of Canoas, Canoas, Rio Grande Do Sul, Brazil.
authors: Fabio V
authors: FV
authors: Arilla
authors: Division of Orthopaedic Surgery, McMaster University Medical Center, Hamilton, Ontario, Canada.
authors: Marco
authors: M
authors: Yeung
authors: Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A.; Orthopaedic Robotics Laboratory, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A.
authors: Kevin
authors: K
authors: Bell
authors: Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A.; Orthopaedic Robotics Laboratory, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A.
authors: Ata A
authors: AA
authors: Rahnemai-Azar
authors: Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A.; Orthopaedic Robotics Laboratory, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A.
authors: Benjamin B
authors: BB
authors: Rothrauff
authors: Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A.
authors: Freddie H
authors: FH
authors: Fu
authors: Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A.; Orthopaedic Robotics Laboratory, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A.
authors: Richard E
authors: RE
authors: Debski
authors: Division of Orthopaedic Surgery, McMaster University Medical Center, Hamilton, Ontario, Canada.
authors: Olufemi R
authors: OR
authors: Ayeni
authors: Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A.; Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A.; Orthopaedic Robotics Laboratory, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A.. Electronic address: musahlv@upmc.edu.
authors: Volker
authors: V
authors: Musahl
mesh_terms: D016118:Anterior Cruciate Ligament / Q000503:physiopathology*; D001696:Biomechanical Phenomena; D002102:Cadaver; D006801:Humans; D007719:Knee Joint / Q000503:physiopathology*; D008954:Models, Biological; D010808:Physical Examination / Q000379:methods*; D012371:Robotics; D012399:Rotation; D019415:Torque