Lateral Pivot-Shift Test to Assess Anterior Cruciate Ligament (ACL) ruptures

The Lateral Pivot-Shift Test has a sensitivity of 24% and a specificity of 98% according to a meta-analysis of Benjaminse et al. (2006). It makes use of the dynamic subluxation phenomenon that occurs during 20-40° of knee flexion during gait with a torn ACL.

As with other tests for the ACL, protective muscle contraction in an acute situation might lead to a false-negative test, which is why we recommend having your patient relax as much as possible and possibly repeat the test a couple of times.

To perform the test, have your patient in a supine lying position with his hip both flexed and abducted to 30° in slight medial rotation. Then grab the patient’s leg at the calcaneus and bring the tibia into internal rotation. Some authors also describe added axial compression. With your other hand, you want to give a valgus force from behind the fibula. This subluxates the tibia anteriorly from the femur in extension. Then slowly bring your patient’s knee into flexion.

This test is positive if the tibia is reduced or jogs backward at around 30-40° of flexion due to tightening of the iliotibial band. This can produce a clunk sound and often the patient describes this as a recognizable “giving way” feeling.

Other common tests to assess ACL injuries:

• Lachman Test 
• Lelli Test / Lever Sign
• Anterior Drawer Test

21 OF THE MOST USEFUL ORTHOPAEDIC TESTS IN CLINICAL PRACTICE

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References

Benjaminse A, Gokeler A, van der Schans CP. Clinical diagnosis of an anterior cruciate ligament rupture: a meta-analysis. Journal of Orthopaedic & Sports Physical Therapy. 2006 May;36(5):267-88.

van Eck, C. F., van den Bekerom, M. P., Fu, F. H., Poolman, R. W., & Kerkhoffs, G. M. (2013). Methods to diagnose acute anterior cruciate ligament rupture: a meta-analysis of physical examinations with and without anaesthesia. Knee Surgery, Sports Traumatology, Arthroscopy, 21(8), 1895-1903.

Huang, W., Zhang, Y., Yao, Z., & Ma, L. (2016). Clinical examination of anterior cruciate ligament rupture: a systematic review and meta-analysis. Acta Orthop Traumatol Turc, 50(1), 22-31.

Peeler, J., Leiter, J., & MacDonald, P. (2010). Accuracy and reliability of anterior cruciate ligament clinical examination in a multidisciplinary sports medicine setting. Clinical journal of sport medicine, 20(2), 80-85.