The pivot shift phenomenon: Results and description of a modified clinical test for anterior cruciate ligament insufficiency Bernard R. Bach, JR, MD , Russell F. Warren, MD , … The Lateral Pivot-Shift Test for Anterior Cruciate Ligament Rupture. Conclusion: Several methodologies have been identified and developed to quantify pivot shift test. Baxter R. Pocket guide to musculoskeletal assessment, second edition. The description of the pivot shift test and its modifications is for the most part based on clinical observations. This test  is one of the three major tests for assessing anterior cruciate injury or laxity, the other two being the anterior drawer and Lachman test.However, unlike the other two, it tests for instability, an important determinant as to how the knee will function. 膝ACL不全膝における pivot shift 現象の in vivo 4 次元動作解析磁気センサーを用いた3徒手検査手技の比較 横田 正司 , 北村 信人 , 遠山 晴一 , 長宗 高樹 , 黒坂 昌弘 , 安田 和則 JOSKAS 36(1), 48-49, 2011-03-25 1. The anterior cruciate ligament (ACL) joins the area intercondylaris anterior with the medial aspect of the lateral condyle. The opposite hand grasps the lateral portion of the leg at the level of the superior tibiofibular joint, increasing the force of internal rotation. This test is performed in 3 steps: Step 1: With the patient in the supine position, place one hand on their lower thigh with the thumb positioned behind the fibular head and grip the foot with the other hand. A positive reverse pivot shift test is found in 35% of normal knees, so it is very important to compare this test to the contralateral knee. With this test, the examiner applies an internal rotation and With an acute injured knee with moderate to severe damage of the posteromedial and posterolateral structures, including a complete anterior cruciate rupture, we find a grade III pivot shift. In a grade II knee is a more obvious anterior instability, due to a non- functioning ACL. The test is negative when the tibia is held in a position of definite lateral rotation. The tibia can follow its path to maximal anterior laxity. 1173185. The patient lies prone with the hip flexed and the knee extended. Van der Plas CG., Opstelten W., Devillé WLJM., et al. The mean sensitivity and specificity are respectively 0.32 and 0.98.  This highlights the clinical relevance of the test. This test is performed with the patient lying in the supine position with the hip passively flexed to 30 degrees and it is important to abduct the hip to relax the iliotibial tract and allow the tibia to rotate. Fysische diagnostiek - de waarde van enkele gebruikelijke tests voor het aantonen van een voorstekruisbandruptuur: meta-analyse. The pivot shift test has been quantified by means of 25 parameters, but most of the studies focused on anterior-posterior translations, internal-external rotation and acceleration in anterior-posterior direction. 2009 July 29. If a patient is deficient in one or more of these key supporting structures, they may be predisposed to PLRI. Is the pivot shift test a reliable test?The Pivot Shift test attempts to reproduce the rotary and transalatory instability in an ACL deficient knee. However, unlike the other two, it tests for instability, an important determinant as to how the knee will function. Because of the similarity of MacIntosh's and Galway's tests and the fact that they co-presented the first work on the pivot shift, most clinicians attribute the pivot-shift test to them both. Der Pivot-Shift-Test ist eine klinische Untersuchung des Kniegelenks. This involves secondary limitation in the posteromedial and posterolateral corners togheter with the purely lateral and medial structures. Bewegingsleer, de onderste extremiteit deel 2. Onderste extemiteit: Botten, banden en gewrichten. The pivot shift test is utilized for assessment of rotatory instability in the anterior cruciate ligament (ACL) deficient knee.There are multiple reports of the pivot shift maneuver, and there is a lack of consensus among clinicians as to a standardized maneuver. The standardized pivot-shift test was quantified in terms of the side-to-side difference in laxity both preoperatively and postoperatively with the patient under anesthesia. F.A. The structures that could be compromised if this test is positive are the ACL, LCL, posterolateral capsule, arcuate complex and ITB.  This is due to the successive use of the three positions of the tibial rotation. Grading the pivot shift, objective tests with implications for treatment. It prevents the tibia from moving ventrally.The posterior cruciate ligament (PCL) joins the area intercondylaris posterior with the lateral apect of the medial femurcondyle. , (For more information about the accuracy of certain test, in case of an acute knee injury, such as the pivot shift and the lachman test: http://www.aafp.org/afp/2005/0315/p1169.html#afp20050315p1169-t1), “A number of variations of the basic pivot shift test also have been described (Hugston et al.