Pivot Shift Test
The Pivot Shift test is an orthopaedic test of the knee joint to assess stability. Often used when there is a history of ‘gives way’ at the knee, usually due anterior cruciate ligament (ACL) sprain or rupture.
- Patient supine with leg straight
- Examiner flexes patient’s knee approximately 50° and applies force
- With the other hand the examiner attempts to maintain a medial rotational force at the knee with the thumb behind the fibular head and internally rotating the fibula, tibia, and ankle
- The examiner, while maintaining the internal rotatory and valgus force, proceeds to flex the patient’s knee to 45°.
Repeatable “clunk” or the patient feels like the knee is “giving way”: Anterolateral rotational instability, anterior cruciate ligament sprain, lateral collateral ligament sprain, iliotibial band lesion, posterior capsule damage.
Synonym: McIntosh Pivot Shift
Patients with knee instability often have a history of knee joint injury and/or repetitive stress activities.