Pivot Shift Test: An Evidence-Based Outcome Tool

Abstract

Restoration of rotational stability is a critical step in the success of anterior cruciate ligament (ACL) reconstruction surgery. Objective evaluation of rotational control after ACL reconstruction surgery requires reliable, precise, and specific measurement tools. The manual pivot shift test remains the most common and valid technique used in daily clinical routine and incorporates two components: anterior translation of the lateral tibial plateau and internal rotation of the tibia relative to the femur.

The evidence in the literature concerning the pivot shift test can be classified as follows: patient satisfaction, subjective symptoms and functional outcomes, and development of osteoarthritis (OA). A significant association has been found with (1) positive pivot shift test and patient dissatisfaction; (2) positive pivot shift test and partial and full giving way, difficulty cutting, difficulty twisting, activity limitation, lower knee function, limitations in sports participation, and lower Lysholm score; (3) negative pivot shift test and better functional subjective outcome score; (4) grade of pivot shift test and level of patient “disabilities”; (5) pivot shift test result and final functional outcome; and(6) positive pivot shift test at 2 years after surgery and subchondral bone scintigraphic uptake at 5–9 years of follow-up.

However, the lack of accuracy of the pivot shift test has pushed research to use adjunct technological support to increase its reproducibility. Standardization of the physical exam technique combined with lateral compartment translation measurements using computer-analyzed skin sensors is undergoing evaluation. This would allow for a simpler, more reproducible, accurate, and precise measurement without relying on the examiner’s impression of displacement.