Reverse Pivot-Shift Test | Posterolateral Rotatory Instability Assessment
The posterior lateral corner abbreviated as PLC is a complex area, which involves many structures, of which the lateral collateral ligament, the popliteus tendon, and the popliteofibular ligament are said to be the most important stabilizers.
PLC injuries often happen due to direct blows to the anterior medial knee, hyperextension, or non-contact varus stress injuries, and often occur together with ACL or PCL tears, with only 28% of PLC tears in isolation.
Rubinstein et al. (1994) evaluated the Reverse Pivot Shift for its validity to detect Posterior Cruciate Ligament tears and found a low sensitivity of 26% and a high specificity of 95%. This test, therefore, has a moderate clinical value to confirm PCL tears but is not useful to rule them out.
No studies have evaluated this test to detect a lesion of the posterior lateral corner yet.
To perform the Reverse Pivot Shift test have your patient in supine lying position with the knee flexed to 90°. Then bring the tibia Into external rotation with your ipsilateral hand. Place your contralateral hand on the proximal lateral tibia to apply valgus stress and apply an axial load through the tibia with your distal arm or with the iliac crest.
In a patient with posterior lateral rotary instability, this position will sublux the lateral tibial plateau posteriorly. Then passively extend the patient’s leg while keeping the external rotation, valgus force, and axial load.
At around 30° of knee flexion, the iliotibial band changes from a flexion vector to an extension vector and will therefore pull the tibia anteriorly which reduces the rotary subluxation.
This test is thus positive if a clunk Is heard when the tibia reduces at around 30 degrees of flexion. Be aware though that the awake patient might not permit this maneuver and this test can be considered positive in case of apprehension.
21 OF THE MOST USEFUL ORTHOPAEDIC TESTS IN CLINICAL PRACTICE
Other orthopedic tests to assess the posterolateral corner are:
What customers have to say about the Assessment E-Book
The Assessment E-Book This book helped me in my studying for my exam and in assessing my first patients. Awesome! Also for beginners!
The Assessment E-Book It’s an amazing Compilation! Congrats to all the work you have put in there. You’ll propably find all the test’s you’ve been looking for with propper explaination and source to doublecheck for you self. definetly a must have for every student, but it will also help an experienced practioner. Im looking forward to the lifelong updates on the topics.
Great work, guys
The Assessment E-Book A must-have for all physiotherapists, osteopaths and manual therapists. The authors conducted an extensive research on assessment tests in manual therapy. I find it very easy to read. The more I read the more I learn. Thank you!
The Assessment E-Book This book is great! It is very structured and detailed. It works extremely well on my Macbook and iPad.
The Assessment E-Book The best way to spend 80euros. Totally worth it. The amount of work you put behind this must have been absolutely huge. Every physical or physiotherapist should own it.
Congrats guys you’ve done an incredible job.
I’ve learnd a lot of new things and my approach to therapy in general have totally changed.
In one word: amazing. Keep going guys ! Best wishes from france.
The technical storage or access is strictly necessary for the legitimate purpose of enabling the use of a specific service explicitly requested by the subscriber or user, or for the sole purpose of carrying out the transmission of a communication over an electronic communications network.
The technical storage or access is necessary for the legitimate purpose of storing preferences that are not requested by the subscriber or user.
The technical storage or access that is used exclusively for statistical purposes.The technical storage or access that is used exclusively for anonymous statistical purposes. Without a subpoena, voluntary compliance on the part of your Internet Service Provider, or additional records from a third party, information stored or retrieved for this purpose alone cannot usually be used to identify you.
The technical storage or access is required to create user profiles to send advertising, or to track the user on a website or across several websites for similar marketing purposes.