Pivot shift test

The pivot shift test assesses the presence of an anterior cruciate ligament injury.
(A) The 45 degrees of the flexed knee is reduced with external tibial rotation.
(B) Knee is allowed to extend with strong valgus pressure. A positive test is a definite "thud" as the tibia becomes subluxated and internally rotates between 20 and 10 degrees.
(C) Complete extension reduces the knee as the posterior capsule tightens.This test may be more sensitive than the anterior drawer or Lachman test but is difficult to perform in the acutely injured athlete because of guarding and apprehension.