The pivot shift test is a test to assess the integrity of both the anterior cruciate ligament and and also the other key structures that contribute to the knee's stability.

pivot shift test

The patient lies face up with the head supported. The examiner stands to the side of the knee, grasping the the ankle in one hand with the heel of the other hand behind the fibula head, with the hip flexed to 30 degrees and maintaining 20 degrees of internal tibial rotation. It is important to abduct the hip a bit to relax the iliotibial band.

The examiner slowly flexes the knee, while slowly increasing internal rotation and adding a valgus force. The test is positive when the tibia suddenly subluxes.


Pivot shift and the anterolateral ligament

Although the test was originally conceived to identify anterior cruciate ligament laxity, there is a strong correlation between the more severe gradings on the pivot shift test and grade II and II injuries of the anterolateral ligament.



The pivot shift. Lane CG, Warren R and Pearle AD. J Am Acad Orthop Surg. 2008 Dec;16(12):679-88.

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