Pivot shift test

Last revised by Henry Knipe on 8 Jan 2019

Citation, DOI, disclosures and article data

Citation:

Bell D, Knipe H, Pivot shift test. Reference article, Radiopaedia.org (Accessed on 19 Apr 2024) https://doi.org/10.53347/rID-65382

DOI:

https://doi.org/10.53347/rID-65382

Permalink:

https://radiopaedia.org/articles/65382

rID:

65382

Article created:

7 Jan 2019, Daniel J Bell ◉

Disclosures:

At the time the article was created Daniel J Bell had no recorded disclosures.

View Daniel J Bell's current disclosures

Last revised:

8 Jan 2019, Henry Knipe ◉ ◈

Disclosures:

At the time the article was last revised Henry Knipe had no recorded disclosures.

View Henry Knipe's current disclosures

Revisions:

2 times, by 2 contributors - see full revision history and disclosures

Systems:

Musculoskeletal, Trauma

Sections:

Signs

Tags:

cases, refs, sports, sports injuries, sports medicine

The pivot shift test forms part of the orthopedic examination of a post-traumatic knee. A positive test shows high specificity for injury of the anterior cruciate ligament.

Procedure

The pivot shift test is performed on a supine patient.

At the start the subject's knee is permitted to droop into complete extension and simultaneously the clinician exerts both internal rotation and valgus forces, such that the tibia subluxes forwards.

Then the clinician flexes the knee, but continues to exert the internal rotatory and valgus forces.

If the tibia abruptly shifts forwards with relation to the femur into the normal anatomical position then the pivot shift test is positive. This shift usually happens at ~20-30° of tibial flexion.

Interpretation

A positive test has been demonstrated to be highly specific for abnormal laxity of the anterior cruciate ligament (ACL). Its specificity remains high for injury in the patient who has had reconstruction of their ACL.