Pivot Shift Test

 Pivot Shift Test

What is Pivot Shift Test?

Pivot Shift Test is a special test used to diagnose the rotatory instability related to injury of anterior cruciate ligament ACL of the knee.

This test was first described by Galway et al.1 in 1972 and has been described since by a number of authors.

See Also: Anterior Cruciate Ligament Injury

How do you do a Pivot Shift Test?

What does a positive Pivot Shift Test mean?

Sensitivity & Specificity

In a meta-analysis 2 that looked at 28 studies to assess the accuracy of clinical tests for diagnosing ACL ruptures, Benjaminse et al. found the pivot shift test to be very specific both in acute as well as in chronic conditions, and recommended that both the Lachman and pivot shift tests be performed in all cases of suspected ACL injury:

Notes

According to Jakob, a genuine pivot shift phenomenon can partially disappear, despite anterior cruciate ligament insufficiency, under the following conditions:

  1. When a complete tear of the medial collateral ligament is present, the valgus opening prevents force concentration in the lateral compartment. Subluxation cannot occur under these circumstances.
  2. When the iliotibial tract is traumatically divided, only the subluxation will be observed, not the abrupt reduction.
  3. A bucket-handle tear of the medial or lateral meniscus can prevent anterior translation or reduction of the tibia.
  4. Increasing osteoarthritis in the lateral compartment with osteophytes can create a concave contour along the once convex lateral tibial plateau.

Jakob Graded Pivot Shift Test

Gradation of the pivot shift test allowing for translation and rotation of the tibia.

The procedure is identical to the pivot shift test except that here instability of the knee is assessed with the lower leg not only in internal rotation but also in neutral and external rotation.

Pivot shift grade I:

Pivot shift grade II:

Pivot shift grade III:

Reference

  1. Galway HR, MacIntosh DL. The lateral pivot shift: a symptom and sign of anterior cruciate ligament insufficiency. Clin Orthop Relat Res. 1980 Mar-Apr;(147):45-50. PMID: 7371314.
  2. Benjaminse A, Gokeler A, van der Schans CP. Clinical diagnosis of an anterior cruciate ligament rupture: a meta-analysis. J Orthop Sports Phys Ther. 2006 May;36(5):267-88. doi: 10.2519/jospt.2006.2011. PMID: 16715828.
  3. Clinical Tests for the Musculoskeletal System 3rd Edition.
  4. Dutton’s Orthopaedic Examination, Evaluation, And Intervention 3rd Edition.

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