Reverse Pivot Shift Test (Jakob) Special Test
Orthopedic Physical Examination & Clinical Assessment Guide
What is it used for?
- Diagnosing Posterolateral Rotatory Instability (PLRI).
How to Perform
- Position: Patient supine, knee flexed to 90°.
- Action: Externally rotate the tibia and apply a Valgus stress.
- Movement: Slowly extend the knee.
Interpretation of Results
- Positive Test: At ~20-30° of flexion, the posteriorly subluxated tibia reduces (shifts forward) with a clunk.
Diagnostic Accuracy
- Sensitivity: 26%
- Specificity: 95%
Clinical Context & Limitations
The Reverse Pivot Shift Test (Jakob) should be considered as one component of a comprehensive musculoskeletal assessment. No single special test has perfect diagnostic accuracy; thus, clinical decision-making should integrate test results with patient-reported symptoms, mechanism of injury, functional impairment, and relevant imaging.
Clinicians should be aware of potential false-positive results in patients with pain sensitisation, muscle guarding, or poor relaxation. For the Knee region, combining the Reverse Pivot Shift Test (Jakob) with complementary examination tests significantly improves overall diagnostic confidence.
References
- Magee, D. J. (2021). Orthopedic Physical Assessment.
