Reverse Pivot Shift Test

Purpose: The Reverse Pivot Shift Test is used to assess the integrity of the PCL or posterior cruciate ligament of the knee.

reverse pivot shift test

How to Perform Reverse Pivot Shift Test

Position of Patient: The patient should be relaxed in a supine position with the hip and knee placed in 80-90 degrees of flexion.

Performance: The examiner will support the patient’s leg and rotate the tibia into external rotation rotation.  Maintain this external rotation and apply a valgus force to the knee; posterior subluxation of the tibia may occur in this position if the patient’s PCL is compromised. The examiner continues the test by extending the knee, maintaining a valgus and external rotation force to the tibia.

How to Interpret Reverse Pivot Shift Test

Positive Finding: This test is considered positive if the tibia is subluxed posteriorly at the starting position when the knee is flexed but reduces back into place anteriorly while extending the knee through a small range, usually around 30 degrees of flexion.  A ‘clunk’ may be felt by the examiner and the patient as the knee is moved into extension, however, this is usually very uncomfortable for the patient and may result in guarding or apprehension. 

Test Accuracy / Reliability / Evidence:

Reverse Pivot Shift Test Sensitivity and Specificity
Sensitivity = 0.26
Specificity = 0.95

Research Source: https://www.ncbi.nlm.nih.gov/pubmed/7943523  Rubenstein RA, Shelbourne KD, JR MC, CD VM, Rettig AC. The accuracy of the clinical examination in the setting of posterior cruciate ligament injuries. Am J Sports Med. 1994;22(4):550–557.

Reverse Pivot Shift Test Video

The Reverse Pivot Shift Test is used to assess the integrity of the PCL or posterior cruciate ligament of the knee.

The patient should be relaxed in a supine position with the hip and knee placed in 80-90 degrees of flexion.

The examiner will support the patient’s leg and rotate the tibia into external rotation rotation.  Maintain this external rotation and apply a valgus force to the knee; posterior subluxation of the tibia may occur in this position if the patient’s PCL is compromised. The examiner continues the test by extending the knee, maintaining a valgus and external rotation force to the tibia.

This test is considered positive if the tibia is subluxed posteriorly at the starting position when the knee is flexed but reduces back into place anteriorly while extending the knee through a small range, usually around 30 degrees of flexion.  A ‘clunk’ may be felt by the examiner and the patient as the knee is moved into extension, however, this is usually very uncomfortable for the patient and may result in guarding or apprehension. 

Next Special Test: Posterior Sag Sign