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Pivot Shift Test

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Other Names

  • Pivot Shift Test

Purpose

The pivot shift test. (1) Internal rotation applied by examiners' left hand (top). (2) Valgus stress applied by examiners' right hand (middle). (3) Knee flexion (applied by left hand) with release of the rotational stress and reduction of the tibial plateau (bottom)[1]

Description

  • The patient is in the supine position
  • Examiner holds the patient’s lower leg
  • Start with the knee in extension and flexion of the hip to 20-30°
  • Bring the tibia into the internal rotation with one hand and begin placing valgus stress on the knee using the other hand.
  • While holding this position, the knee should now be flexed
  • Positive test
    • Stress
    • Instability
    • Subluxation
    • Clunk
  • Note, this test is challenging in the acutely injured knee
    • Encouraged to use other diagnostic tests in this setting.

Pathology


Evidence

  • Meta-analysis of studies looking at value of special tests[2]
    • Sensitivity: 24% (95% CI, 21–27)
    • Specificity: 98% (95% CI, 96–99)

See Also


References

  1. Ohashi, Bruno, et al. "Partial anterior cruciate ligament ruptures: knee laxity measurements and pivot shift." Sports Injuries: Prevention, Diagnosis, Treatment and Rehabilitation; Springer: Berlin/Heidelberg, Germany (2015): 1245-1258.
  2. Benjaminse, Anne, Alli Gokeler, and Cees P. van der Schans. "Clinical diagnosis of an anterior cruciate ligament rupture: a meta-analysis." Journal of orthopaedic & sports physical therapy 36.5 (2006): 267-288.
Created by:
John Kiel on 19 November 2020 08:04:45
Authors:
Last edited:
27 April 2023 08:49:50
Category: