J Knee Surg 2010; 23(3): 131-136
DOI: 10.1055/s-0030-1267473
ORIGINAL ARTICLE

© Thieme Medical Publishers

The Pivot Shift Test Is of Limited Clinical Relevance in the Arthritic Anterior Cruciate Ligament–Deficient Knee

Matthew Dodd1 , Alexander Trompeter1 , Tim Harrison2 , Simon Palmer3
  • 1South West Thames Orthopaedic Rotation, Worthing Hospital, Worthing, West Sussex, United Kingdom
  • 2North East Thames Orthopaedic Rotation, Worthing Hospital, Worthing, West Sussex, United Kingdom
  • 3Department of Trauma and Orthopaedics, Worthing and Southlands NHS Trust, Worthing Hospital, Worthing, West Sussex, United Kingdom
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Publikationsdatum:
26. Oktober 2010 (online)

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ABSTRACT

The pivot shift test is used to assess the integrity of the anterior cruciate ligament (ACL).This test has been shown to be highly sensitive in detecting instability in knees with complete ACL rupture. However, in the presence of osteoarthritis, the rotation and subluxation required for the pivot shift to be effective can be limited and therefore is likely to impact upon the reliability of this test. We performed the pivot shift test on 50 patients, under general anesthesia, prior to total knee replacement and then recorded the integrity of the ACL intraoperatively. This allowed us to assess the accuracy of this test in the presence of significant osteoarthritis. Of the 50 knees tested, none had a positive pivot shift test preoperatively; however, 14% of the knees included in the study had a completely ruptured ACL. This gives a sensitivity of 0% and a specificity of 1% for the pivot shift test for ACL ruptures in the presence of established osteoarthritis. We conclude that the pivot shift test may not be a reliable test for ACL function in the presence of symptomatic arthritis of the knee.

REFERENCES

Alexander TrompeterM.R.C.S. 

68 Highgate West Hill

London N6 6BU, United Kingdom

eMail: alex_trompeter@hotmail.com