Pivot shift test

Definition/Description The pivot shift is a dynamic but passive test of knee stability, carried out by the examiner without any activity of the patient. It shows a dysregulation between rolling and gliding in the kneejoint. The patient lies in supine.

Pivotshift is not straightforward to perform. For many with instability, the reproduction of instability is unpleasant and ‘visceral’. Accordingly, having experienced it once, the patient is unlikely to relax enough for a second or confirmatory test. This is probably why the sensitivity of the three major knee exams is increased with general anesthesia.

Place the heel of one hand behind the fibular head of the patient. Use the other hand to grasp the tibia, while palpating the medial joint line. While maintaining a valgus force and internal rotation of the tibia throughout the test, slowly flex the patient’s knee (note: the test starts by putting the tibia in the abnormal position!).

A pivot shift test The examination is then carried out in each of three positions of rotation. A positive test may result in a gentle slide (Grade 1), or in a more severe jerk (Grade 2), or clunk (Grade 3). The grade of the pivot shift has been shown to correlate with patient-reported functional instability and clinical outcomes.

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.

Pivot Shift Test – Orthopedic Examination of the Knee The Pivot Shift Test is commonly used in orthopedic examinations to test for anterior cruciate ligament (ACL) and posterior capsule integrity. It is one of the most well-known and accurate tests when testing the stability of the knee.