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Lateral Pivot Shift Test
The Lateral Pivot Shift test is used to detect the presence of anterolateral rotary instability of the knee in the presence of a rupture of the anterior cruciate ligament. This test is also called the Pivot Shift test and the McIntosh’s test.
This test is performed in 3 steps:
Step 1: With the patient in the supine position, place one hand on their lower thigh with the thumb positioned behind the fibular head and grip the foot with the other hand.
Lift the lower limb to position the hip to 30 degrees of flexion, 30 degrees of abduction, and some internal rotation.
Step 2: Flex the knee to 5 degrees and internally rotate the tibia by turning the foot and pushing the fibular head forward.
In the presence of an anterior cruciate ligament rupture, as internal rotation is applied to the tibia, the lateral tibial condyle displaces forward.
Step 3: Apply a valgus load to the knee by pulling the foot outward and pushing the lower thigh inward. Now, gradually flex the knee and observe for an abrupt realignment of the tibia with the femur at some point up to 40 degrees of flexion. The sudden relocation occurs as a result of the tension developed in the iliotibial band and is referred to as the ‘pivot shift’. This relocation confirms the presence of an anterior cruciate ligament rupture.
It should also be noted that anterolateral stability of the knee relies on additional structures including:
• Arcuate-popliteus complex
• Lateral collateral ligament
• Posterolateral capsule
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