Knee ACL & PCL Evidence: confirmed

Pivot Shift Test Special Test

Orthopedic Physical Examination & Clinical Assessment Guide

Pivot Shift Test Orthopedic Special Test

What is it used for?

  • Diagnosing Anterolateral Rotatory Instability (ACL + lateral capsule injury).
  • Replicates the “giving way” sensation.

How to Perform

  • Position: Patient lies supine with the hip slightly flexed and abducted (30°).
  • Action: Examiner holds the heel (internal rotation) and applies a Valgus force at the knee.
  • Movement: Slowly flex the knee from full extension.

Interpretation of Results

  • Positive Test: At ~20-40° of flexion, the subluxated tibia suddenly reduces (shifts back) with a palpable “clunk”.

Diagnostic Accuracy

  • Sensitivity: 24% (Awake), 81% (Under Anesthesia)
  • Specificity: 98%

References

  • Magee, D. J. (2021). Orthopedic Physical Assessment.
  • Miller, M. D. (2020). Miller's Review of Orthopaedics.