Pivot-shift test

Lateral Pivot Shift Test for Anterolateral Knee Instability. This test can be used to evaluate the anterolateral structures of the knee for sprains.[1]

This test is performed with the patient lying in the supine position with the hip passively flexed to 30 degrees. The examiner stands lateral to the patient. The lower leg and ankle is grasped maintaining 20 degrees of internal tibial rotation. The knee is allowed to sag into complete extension. The opposite hand grasps the lateral portion of the leg at the level of the superior tibiofibular joint, increasing the force of internal rotation.

While maintaining internal rotation, a valgus force is applied to the knee while it is slowly flexed. If the tibia’s position on the femur reduces as the knee is flexed in the range of 30 to 40 degrees or if there is an anterior subluxation felt during extension the test is positive for a tear of the ACL, posterolateral capsule, arcuate ligament complex, or the IT band.

This is a hard test to do because meniscal involvement, such as with bucket handle tears of the medial meniscus,[2] may limit range of motion and muscle guarding to produce a false-negative.


  • Starkey, C., & Ryan, J. (2003). The Knee. Orthopedic & Athletic Injury Evaluation Handbook (pp. 106). F.A. Davis Company

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