Reverse Pivot Shift Test
The reverse pivot shift test helps to diagnose acute or
chronic posterolateral instability of the knee. A significantly positive
reverse pivot shift test suggests that the PCL, the LCL, the arcuate complex,
and the popliteal fibular ligament are all torn. The reverse pivot shift test
begins with the patient supine with the knee in 900 flexion. Valgus
stress is then applied to the knee with an external rotation force. Bring the
knee from 90o of flexion to full extension. The tibia reduces from a
posterior subluxed position at about 20o of flexion. A shift and
reduction of the lateral tibial plateau can be felt as it moves anteriorly from
a posteriorly subluxed position. This is called the reverse pivot shift because
shift of the lateral tibial plateau occurs in the opposite direction of the
true pivot shift (seen in ACL tears). If the tibia is posterolaterally
subluxed, the iliotibial band will reduce the knee as the IT band transitions
from a flexor to extensor of the knee. It is very important to compare this
test to the contralateral knee. The pivot shift test indicates an ACL tear. The
reverse pivot shift test indicates posterolateral instability of the knee.
Posterolateral corner injury includes the LCL, popliteal fibular ligament,
arcuate complex, and the lateral capsule.
