Anterior cruciate ligament injuries in children with open physes: evolving strategies of treatment.

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Abstract

[Indexed for MEDLINE] 16. Front Med (Lausanne). 2026 May 7;13:1813111. doi: 10.3389/fmed.2026.1813111. eCollection 2026. Risk factors for high-grade pivot shift in patients with anterior cruciate ligament tears combined with lateral meniscus posterior root tears: a systematic review and meta-analysis. Zhang P(1)(2), Wang X(2), Shi X(2), Yuan Y(2), Xie D(2)(3), Du F(2)(4), Wang Y(2)(4), Zhang M(2)(4), Tan H(2), Cao G(2). Author information: (1)Hunan University of Chinese Medicine, Changsha, China. (2)Department of Knee Surgery, Luoyang Orthopedic Hospital of Henan Province, Orthopedic Hospital of Henan Province, Luoyang, Henan, China. (3)Fujian University of Traditional Chinese Medicine, Fuzhou, China. (4)School of Orthopedics and Traumatology, Henan University of Chinese Medicine, Zhengzhou, China. OBJECTIVE: High-grade pivot shift is the most common complication in patients with anterior cruciate ligament (ACL) tears combined with lateral meniscus posterior root tears (LMPRT), and it significantly impairs quality of life. Risk factors for high-grade pivot shift in this patient population have not been fully investigated. This meta-analysis aims to evaluate the incidence and risk factors of high-grade pivot shift in these patients to provide evidence-based guidance for clinical treatment. METHODS: We searched for observational studies investigating high-grade pivot shift in patients with ACL tears combined with LMPRT in PubMed, Embase, Cochrane Library, Web of Science, CNKI, Wanfang, VIP, and SinoMed from the inception of each database through November 2025, using a combination of MeSH terms and free-text keywords. Basic study characteristics, incidence of high-grade pivot shift, and relevant risk factors were extracted from included studies. Methodological quality and risk of bias were assessed, and meta-analysis of incidence rates and risk factors was performed using Stata 18.0 software. RESULTS: A total of twenty studies involving 8,102 patients were included. High-grade pivot shift was identified in 46% of patients with isolated ACL tears (95% CI: 0.26, 0.65) and in 72% of those with ACL tears combined with LMPRT (95% CI: 0.54, 0.89). Nineteen of the included studies were rated as high quality. Younger age (MD = -0.13, 95% CI: -0.19 to -0.06), elevated KT-SSD (MD = 0.77, 95%CI: 0.28-1.26; OR = 5.13, 95%CI: 3.01-8.74), increased anterior tibial translation (MD = 0.90, 95%CI: 0.23 to 1.58), joint laxity (OR = 1.78, 95%CI: 1.03-3.08), severe meniscal extrusion (MD = 1.51, 95%CI: 0.52-2.49), increased lateral tibial slope (MD = 0.15, 95%CI: 0.03-0.26), and complete meniscal tear (OR = 5.01, 95%CI: 2.89-8.66) were independent risk factors for high-grade pivot shift in patients with ACL tear combined with LMPRT. CONCLUSION: Younger age, elevated KT-SSD values, increased anterior tibial translation, joint laxity, severe meniscal extrusion, increased lateral tibial slope, and complete meniscal tear are independent risk factors for high-grade pivot shift in patients with ACL tear combined with LMPRT. Patients with these high-risk factors require enhanced follow-up and timely intervention to reduce the incidence of high-grade pivot shift and improve patients' quality of life. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/home, identifier CRD420251269936. Copyright © 2026 Zhang, Wang, Shi, Yuan, Xie, Du, Wang, Zhang, Tan and Cao. DOI: 10.3389/fmed.2026.1813111 PMCID: PMC13190479