Pivot Shift Test

Indications

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.

Procedure

  1. Patient supine with leg straight
  2. Examiner flexes patient’s knee approximately 50° and applies force
  3. 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
  4. The examiner, while maintaining the internal rotatory and valgus force, proceeds to flex the patient’s knee to 45°.

Pivot Shift test for knee - testing anterior cruciate ligament (ACL)

Pivot Shift Test - anterior cruciate ligament (ACL) test

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

Interpretation

Positive Pivot Shift Test

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.

Clinical Notes

Synonym: McIntosh Pivot Shift

Patients with knee instability often have a history of knee joint injury and/or repetitive stress activities.