{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T17:04:06Z","timestamp":1785344646798,"version":"3.55.0"},"reference-count":7,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2026,4,25]],"date-time":"2026-04-25T00:00:00Z","timestamp":1777075200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,4,25]],"date-time":"2026-04-25T00:00:00Z","timestamp":1777075200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["arthroscopyjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Arthroscopy"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    Consensus indications for adding a lateral extra\u2010articular procedure (LEAP) to an anterior cruciate ligament (ACL) reconstruction include use of hamstring autograft, hypermobility, revision surgery, and high\u2010grade rotatory laxity (grade 3 pivot shift). Most of these indications are related to patient characteristics or surgical factors and can be determined preoperatively. However, pivot shift grading is somewhat subjective and often relies on examination under anesthesia in the operating room. There is a paucity of objective and radiological markers of high\u2010grade rotational instability. Recent literature has found that increased internal rotational tibial subluxation (ITRS) and axial internal tibial rotation (ITR\n                    <jats:sub>a<\/jats:sub>\n                    ) on knee magnetic resonance imaging are associated with high\u2010grade rotational instability. ITRS greater than 5.5\u2009mm and ITR\n                    <jats:sub>a<\/jats:sub>\n                    greater than 8.1\u00b0 were associated with grade 2 and grade 3 pivot shift with the ITRS cutoff of 5.5\u2009mm showing excellent specificity (86.5%) for high grade pivot shift. These measurements offer an objective marker of rotatory instability that we should factor into our preoperative decision\u2010making on when to add LEAP to ACL reconstruction.\n                  <\/jats:p>","DOI":"10.1002\/arj.70197","type":"journal-article","created":{"date-parts":[[2026,4,25]],"date-time":"2026-04-25T07:06:13Z","timestamp":1777100773000},"page":"1394-1396","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["<i>Editorial Commentary<\/i>\n                    : Look Out for Internal Rotational Tibial Subluxation on Magnetic Resonance Imaging as an Indicator of High\u2010Grade Rotatory Instability in Anterior Cruciate Ligament\u2010Deficient Knees"],"prefix":"10.1002","volume":"42","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2502-057X","authenticated-orcid":false,"given":"Vishal","family":"Saxena","sequence":"first","affiliation":[{"name":"Temple University Hospital  Philadelphia Pennsylvania U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,4,25]]},"reference":[{"key":"e_1_2_3_2_1","doi-asserted-by":"publisher","DOI":"10.1177\/0363546519896333"},{"key":"e_1_2_3_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2022.11.032"},{"key":"e_1_2_3_4_1","doi-asserted-by":"publisher","DOI":"10.1177\/03635465221128828"},{"key":"e_1_2_3_5_1","doi-asserted-by":"publisher","DOI":"10.1177\/0363546516686057"},{"key":"e_1_2_3_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/BPO.0000000000002236"},{"key":"e_1_2_3_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2025.06.011"},{"key":"e_1_2_3_8_1","doi-asserted-by":"crossref","first-page":"1382","DOI":"10.1002\/arj.70196","article-title":"More than 5.5\u2009mm of internal rotational tibial subluxation measured on magnetic resonance imaging predicts high\u2010grade pivot shift under anesthesia in patients with primary anterior cruciate ligament injury","volume":"42","author":"Bai W","year":"2026","journal-title":"Arthroscopy."}],"container-title":["Arthroscopy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/arthroscopyjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/arj.70197","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/arthroscopyjournals.onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/arj.70197","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/arthroscopyjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/arj.70197","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T16:57:18Z","timestamp":1785344238000},"score":1,"resource":{"primary":{"URL":"https:\/\/arthroscopyjournals.onlinelibrary.wiley.com\/doi\/10.1002\/arj.70197"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,25]]},"references-count":7,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2026,8]]}},"alternative-id":["10.1002\/arj.70197"],"URL":"https:\/\/doi.org\/10.1002\/arj.70197","archive":["Portico"],"relation":{},"ISSN":["0749-8063","1526-3231"],"issn-type":[{"value":"0749-8063","type":"print"},{"value":"1526-3231","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,25]]},"assertion":[{"value":"2026-04-25","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}