What is the Pivot Shift Test used for?

Diagnosing Anterolateral Rotatory Instability (ACL + lateral capsule injury).Replicates the “giving way” sensation.

How do you perform the Pivot Shift Test?

Position: Patient lies supine with the hip slightly flexed and abducted (30°). Action: Examiner holds the heel (internal rotation) and applies a Valgus force at the knee.Movement: Slowly flex the knee from full extension.

What is a positive result for the Pivot Shift Test?

Positive Test: At ~20-40° of flexion, the subluxated tibia suddenly reduces (shifts back) with a palpable “clunk”.

What is the diagnostic accuracy of the Pivot Shift Test?

Sensitivity: 24% (Awake), 81% (Under Anesthesia)Specificity: 98%

Pivot Shift Test – Knee Special Test

What is it used for?

Diagnosing Anterolateral Rotatory Instability (ACL + lateral capsule injury).
Replicates the “giving way” sensation.

How to Perform

Position: Patient lies supine with the hip slightly flexed and abducted (30°).
Action: Examiner holds the heel (internal rotation) and applies a Valgus force at the knee.
Movement: Slowly flex the knee from full extension.

Interpretation of Results

Positive Test: At ~20-40° of flexion, the subluxated tibia suddenly reduces (shifts back) with a palpable “clunk”.

Diagnostic Accuracy

Sensitivity: 24% (Awake), 81% (Under Anesthesia)
Specificity: 98%

Clinical Context & Limitations

The Pivot Shift Test 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 Pivot Shift Test with complementary examination tests significantly improves overall diagnostic confidence.