Pivot Shift Test
Other Names
- Pivot Shift Test
- Lateral Pivot Shift Test of the Knee
- Test of MacIntosh
- Lateral Pivot Shift Test
- MacIntosh Pivot Shift Test
- ACL Pivot Shift Test
- Pivot Shift Maneuver
- Pivot Shift Examination
- Pivot Shift Phenomenon
- Dynamic Pivot Shift Test
- Jakob Pivot Shift Test
- Slocum Pivot Shift Test
- Anterolateral Rotatory Instability Test
Purpose
- To evaluate the integrity of the Anterior Cruciate Ligament in patients with knee pain
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
- ACL Injury
- Anterolateral rotatory instability of the knee
Evidence
- Meta-analysis of studies looking at value of special tests[3]
- Sensitivity: 24% (95% CI, 21–27)
- Specificity: 98% (95% CI, 96–99)
- Blanke et al[4]
- Sensitivity: 46%
- Specificity: 96%
- PPV: 92%
- NPV: 64%
- LR+: 11.5
- LR-: 0.56
See Also
References
- ↑ Salzler, Matt, et al. "State-of-the-art anterior cruciate ligament tears: a primer for primary care physicians." The Physician And Sportsmedicine 43.2 (2015): 169-177.
- ↑ 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.
- ↑ 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.
- ↑ Blanke, Fabian, et al. "The forced active buckling sign: a new clinical test for the diagnosis of ACL insufficiency." The journal of knee surgery 33.01 (2020): 042-047.
Created by:
John Kiel on 19 November 2020 08:04:45
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Last edited:
7 May 2026 17:38:17
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