The Hip: Preservation, Replacement and Revision Tracking Pixel
Duke Orthopaedics
presents
Wheeless' Textbook of Orthopaedics

Reverse Pivot Shift Test



- Discussion:
    - this sign is positive in pts with acute or chronic posterolateral instability of the knee;
    - knee begins in flexion while an external rotation and valgus stress are applied;
           - supine
           - valgus stress
           - foot in ER
           - bring knee from 90 deg flexion to full extension
           - feel for palpable “shift” of  lateral tibial plateau as it moves anteriorly from a posteriorly subluxed position
    - lateral tibial plateau shifts from position of posterior subluxation to a position of reduction as the flexed knee isextended under valgus 
           stress and w/ foot in external rotation; (w/ the true pivot shift the tibia is internally rotated);
           - clunk is appreciatted as the knee is extended;
    - plateau subluxates again as knee is flexed in the opposite manner;
    - since it describes shift of lateral tibial plateau in opposite direction from true joint shift, its called reverse pivot shift;
    - significantly positive reverse pivot shift suggest that PCL, arcuate complex, and the LCL are all torn;
    - in the position of tibial inernal rotation, the sign disappears



Observations on rotatory instability of the lateral compartment of the knee:  Experimental studies on the functional anatomy and pathomechanism of the true and reversed pivot shift sign.



Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Tuesday, May 1, 2012 4:23 pm