Pivot-shift test

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Lateral Pivot Shift Test for Anterolateral Knee Instability This test can be use to look at the anterolateral structures’ of the knee and look for sprains of the different structures’.

This test is performed with the patient lying supine with the hip passively flexed to 30 degrees. The examiner stands lateral to the patient. The lower leg and ankle is grasped maintaining 20 degrees of internal tibial rotation. The knee is allowed to sag into complete extension. The opposite hand grasps the lateral portion of the leg at the level of the superior tibiofibular joint, increasing the force of internal rotation.

While maintaining internal rotation, a valgus force is applied to the knee while it is slowly flexed. If the tibia’s position on the femur reduces as the knee is flexed in the range of 30 to 40 degrees. If there is an anterior subluxation felt during extension. These are all implications of a tear of the ACL, posterolateral capsule, arcuate ligament complex, or the IT band.

This is a hard test to do because meniscal involvement may limit range of motion and muscle guarding can produce a false-negative. This test is best performed by a physician when the patient is under anesthesia.

Reference Starkey, C., & Ryan, J. (2003). The Knee. Orthopedic & Athletic Injury Evaluation Handbook (pp.106). F.A. Davis Company