pivot shift test

Last reviewed 01/2018

Pivot Shift Test

• pivot shift test:
• assesses degree of incapacitating dysfunction in knee with anterior crucitate ligament (ACL) deficiency and secondary restraint deficiency
• reproduces event that occurs when knee gives way becuase of loss of ACL
  • there is a forward subluxation of tibia during sudden change in direction
• test may also be used to judge the success of ACL reconstruction
  
  
• various methods of eliciting pivot-shift phenomenon have been described
  
  
• during test, patient is supine and examiner holds patient's leg with both hands
  
  
• is important to abduct the hip to relax the IT band allow the tibia to rotate
  
  
• knee is held at approx 20 degrees of flexion and in neutral rotation
  
  
• patient relaxes his or her muscles, which allows femur to drop backward (if the ACL is torn)
  
  
• knee is then placed in full extension with aplication of valgus stress and internal rotation stress;
  • knee extension: posterior capsule holds reduction
    
    
• slowly flex the knee while valgus and internal rotation is maintained;
  • knee flexion: at 40 degrees: iliotibial band provides reduction
    
    
• load is then placed on knee joint by application of axial or valgus force (or both) while tibia is kept in a neutral rotation
  
  
• if test is positive, a subluxation (lateral > medial) will occur at 20 to 40 deg of flexion, indicating ACL deficiency
  
  
• rotation can be added to accentuate or diminish subluxation
  
  
• isolated tear of the ACL will produce only small subluxation;
  • greater subluxation occurs when the lateral capsular complex or semimembranosus corner is also deficient
    
    
• test can also be be performed from flexion to extension;
  • tibia is placed in external rotation and as the knee is extended ensure that the tibia can rotate - allowing subluxation to occur at between 10-20 degrees
    
    
    
• this is a difficult test because meniscal involvement, such as with bucket handle tears of the medial meniscus, may limit range of motion and muscle guarding to produce a false-negative

Click here for video of Pivotal Shift Test