The pivot shift test is used to assess which condition?

The pivot shift test is used to assess which condition?

• A. Meniscal tear
• B. ACL deficiency with dynamic instability
• C. Patellar instability
• D. Hip joint pathology

Answer: (B)

Rotary instability from ACL deficiency is what the pivot shift test reveals. The ACL normally limits anterior tibial translation and helps control knee rotation. When the ACL is torn, the tibia can subluxate forward with the knee near extension while the tibia is internally rotated and subjected to valgus stress. As you move the knee into flexion, roughly around 20–30 degrees, the tibia reduces back under the femur, often with a palpable or audible clunk. This dynamic “give” is the hallmark of an ACL injury with anterolateral rotatory instability. This test is not a reliable indicator of a meniscal tear, which is better assessed with maneuvers like the McMurray or Thessaly tests; nor is it used to evaluate patellar instability or hip pathology, which are approached with different exam maneuvers specific to those structures.

Rotary instability from ACL deficiency is what the pivot shift test reveals. The ACL normally limits anterior tibial translation and helps control knee rotation. When the ACL is torn, the tibia can subluxate forward with the knee near extension while the tibia is internally rotated and subjected to valgus stress. As you move the knee into flexion, roughly around 20–30 degrees, the tibia reduces back under the femur, often with a palpable or audible clunk. This dynamic “give” is the hallmark of an ACL injury with anterolateral rotatory instability.

This test is not a reliable indicator of a meniscal tear, which is better assessed with maneuvers like the McMurray or Thessaly tests; nor is it used to evaluate patellar instability or hip pathology, which are approached with different exam maneuvers specific to those structures.