Pivot Shift Test

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The pivot shift test

The pivot-shift test , also known as the twist-slip test or the subluxation test, is one of the clinically performed examinations for suspected injury of the anterior cruciate ligament (ACL) in the knee joint . Not to be confused with the so-called reversed pivot-shift test, which is used for the clinical diagnosis of an injury to the posterior cruciate ligament (PCL) .


The main task of the anterior cruciate ligament is to prevent the tibial head from sliding in front of the thigh roll ( dislocation ). It also works against overstretching the knee joint and stabilizes the rotational movement (rotation) of the lower leg in flexion .

A rupture of the anterolateral ligament (part of the outer ligament) is discussed as a further cause for a positive pivot-shift test .


The test consists of a provoked subluxation of the tibia inwards, that is, the examiner pushes the lower leg towards the knee with one hand while the patient is lying down and simultaneously performs an internal rotation. With the other hand, he bends the knee and puts it under valgus stress, that is, he brings it into a knock-kneed position.

In the starting position of the pivot shift test, the knee is subluxed. The anterior cruciate ligament is no longer able to prevent the tibial head from moving in front of the condyles. If you bend the knee joint under valgus stress, internal rotation and axial pressure, the joint snaps back into the normal position of the two joint surfaces with a flexion of approx. 20–30 °. This is due to the pull of the iliotibial band , which pulls the shinbone dorsally when flexed 20 to 30 degrees. This snap can be felt and in some situations also audible. The pivot shift test is thus positive and damage to the anterior cruciate ligament can be assumed. It should also be noted that the test in the acute stage (immediately after the injury) is usually perceived as painful and is therefore rarely carried out by many doctors. It has the advantage over the less painful Lachman test that it is used to assess the joint stability of the posterolateral joint structures and thus for further operation planning.

See also

Individual evidence

  1. M. Engelhardt (Ed.): Sports injuries: diagnosis, management and accompanying measures . Chapter 2, Springer 2006, ISBN 9783437240904
  2. Deutsches Ärzteblatt: Surgeons describe new tape on the knee joint from December 6, 2013; last accessed on December 11, 2013
  3. Horst-P. Schwerdtner, Fernand Schallier: Traumatological diagnostics of the knee joint . In: German Journal for Osteopathy , Issue 01 Volume 1, January 2003