Knee Orthopaedic Test: Pivot Shift

orthopaedic tests May 28, 2023

The Pivot Shift Test is a physical examination test used to assess the stability of the knee joint, specifically for evaluating the presence of an anterior cruciate ligament (ACL) tear.


  • Position the patient lying supine on an examination table with the knee being tested fully extended (straight).


  1. Examine the knee joint for any visible deformities, swelling, or tenderness.
  2. Palpate (feel) the knee joint to identify any areas of tenderness or abnormal structures.
  3. Assess the range of motion (ROM) of the knee joint by gently flexing and extending the knee.
  4. With one hand, grasp the patient's ankle and the other hand on the lateral aspect of the patient's knee joint, just above the joint line.
  5. Apply a valgus stress (inward pressure) to the knee while simultaneously internally rotating the tibia (lower leg) with a slight flexion at the hip and knee.
  6. While maintaining the valgus stress and internal rotation, slowly flex the knee joint.
  7. Observe and feel for any abnormal or excessive anterior translation (forward movement) of the tibia in relation to the femur as the knee is flexed.
  8. If a "clunk" or sudden shift is felt or seen during the test, it may indicate a positive Pivot Shift Test, suggesting an ACL tear.



  1. Magee, D. J. (2014). Orthopedic Physical Assessment (6th ed.). Saunders.
  2. Noyes, F. R., & Barber-Westin, S. D. (2012). The treatment of acute combined ruptures of the anterior cruciate and medial collateral ligaments of the knee. The American journal of sports medicine, 40(7), 1558-1564.
  3. van der List, J. P., & DiFelice, G. S. (2017). Range of motion and complications following primary repair versus reconstruction of the anterior cruciate ligament: a meta-analysis. Knee Surgery, Sports Traumatology, Arthroscopy, 25(2), 540-551.
  4. American Academy of Orthopaedic Surgeons. (2014). OrthoInfo: Pivot Shift Test of the Knee. Available at:

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