Pivot Shift
Original Editor - Beth Barrett
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Purpose
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The purpose of this test is to detect anterolateral rotary instability of the knee. Structures compromised if this test is positive could be the ACL, LCL, posterolateral capsule, arcuate complex and ITB.
Technique
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The patient lies supine with legs relaxed. The examiner grasps the heel of the involved leg with examiners opposite hand placed laterally on the proximal tibia just distal to the knee. The examiner then applies a valgus stress while internally rotating the tibia as the knee is moved into flexion from a fully extended position[1] A positive test is indicated by subluxation of the tibia while the femur externally rotations then reduction of the tibia at 30-40 degrees of flexion.
Evidence[edit | edit source]
The Pivot Shift test attempts to reproduce the rotary and transalatory instability in an ACL deficient knee[2] . The test is both sensitive (81.8%) and specific (98.4%) for diagnosing ACL tear.Although the test is clinically relevant and reproduces a functional movement of the knee joint, it is difficult to quantify. Recently a study was done using a navigation system to quantify measurements of knee laxity in individuals who underwent ACL reconstruction. The Pivot shift test was reliable with both patient self-assessment of laxity and with surgical performance[3] . This highlights the clinical relevance of the test.
Traditionally, the Lachman was used more often to measure knee laxity due to its quantifiability, however recent advances in technology have allowed for more objective and measurable observations of the motions involved in the pivot shift and may lead to the ability to make the test quanitifiable for research[4].
Recent Related Research (from Pubmed)[edit | edit source]
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References[edit | edit source]
- ↑ Baxter R. Pocket guide to musculoskeletal assessment, second edition. Elsevier Science 2003.
- ↑ Lane CG, Warren R, Pearl AD. The pivot shift. J Am Acad Orthop Surg. 2008 Dec;16(12):679-88.
- ↑ Lopomo N, Zaffagnini N, Bignozzi S, Visani A, Marcacci M. Pivot Shift Test: Analysis and Quantification of Knee Laxity Parameters using a Navigaion System. J Orthop Res. 2009 July 29.
- ↑ Katz JW, Fingeroth RJ. The Diagnostic Accuracy of Ruptures of the Anterior Cruciate Ligament comparing the Lachman Test, the Anterior Drawer Sign, and the Pivot Shift Test in Acute and Chronic Knee Injuries. Am J Sports Med. 1986 Jan-Feb;14(1): 88-91.
