This site is intended for healthcare professionals

Go to /sign-in page

You can view 5 more pages before signing in

Go to /pro/cpd-dashboard page

This page is worth 0.05 CPD credits. CPD dashboard

Go to /account/subscription-details page

This page is worth 0.05 CPD credits. Upgrade to Pro

Pivot shift test

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

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


Create an account to add page annotations

Annotations allow you to add information to this page that would be handy to have on hand during a consultation. E.g. a website or number. This information will always show when you visit this page.

The content herein is provided for informational purposes and does not replace the need to apply professional clinical judgement when diagnosing or treating any medical condition. A licensed medical practitioner should be consulted for diagnosis and treatment of any and all medical conditions.

Connect

Copyright 2024 Oxbridge Solutions Limited, a subsidiary of OmniaMed Communications Limited. All rights reserved. Any distribution or duplication of the information contained herein is strictly prohibited. Oxbridge Solutions receives funding from advertising but maintains editorial independence.