Pivot Shift Test

pivot shift test

Purpose:  The Pivot Shift Test is used to assess the integrity of the ACL as well as the overall stability of the knee. It is one of three major tests for detecting an ACL injury along with the Lachman test and the anterior drawer test. 

How to Perform Pivot Shift Test

Position of Patient: The patient should be relaxed in a supine position with the hip placed in 20 to 30 degrees of flexion and full knee extension. 

Performance: The examiner will support the patient’s leg and rotate the tibia into internal rotation.  Maintain this internal rotation and apply a valgus force to the knee while flexing the knee to full flexion. 

How to Interpret Pivot Shift Test

Positive Finding: This test is considered positive for instability of the ACL if the tibia is subluxed anteriorly at the starting position when the knee is extended but reduces back into place while flexing the knee through a small range.  A ‘clunk’ may be felt by the examiner and the patient as the knee is moved into flexion, replicating the sensation felt by the patient when the injury occurred.

Test Accuracy / Reliability / Evidence:

Pivot Shift Test Sensitivity and Specificity

Sensitivity = 0.28
Specificity = 0.81
+LR = 1.47
-LR = 0.89

Research Source: Van Eck CF, van den Bekerom MPJ, Fu FH, et al: Methods to diagnose acute anterior cruciate ligament rupture: a meta-analysis of physical examinations with and without anaesthesia. Knee Surg Sports Traumatol Arthrosc 2013; 21: pp. 1895-1903

Further Tests for ACL tears: Lachman Test