HOME HELP CONTACT US SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:
Sign In to gain access to subscriptions and/or personal tools.

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Request Permissions Request Reprints Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Lucie, R. S. Articles by Messner, D. G. Search for Related Content PubMed Articles by Lucie, R. S. Articles by Messner, D. G.

The acute pivot shift: Clinical correlation

Jerome D. Wiedel, MD

University of Colorado Health Sciences Center, Denver, Colorado

Duane G. Messner, MD

University of Colorado Health Sciences Center, Denver, Colorado, Lakewood Orthopaedic Clinic, Lakewood, Colorado

The pivot shift test and its various modifications has been well described for evaluation of chronic antero lateral rotatory insufficiency of the knee. Fifty knees with acute traumatic hemarthrosis were examined un der general anesthesia to assess the reliability of the pivot shift in the acute injury. The pivot shift test as described by Galway and Maclntosh was employed. No patients with a history of previous knee injuries were included. Arthrotomy or arthroscopy was per formed following the examination in all cases. There were 38 knees with positive shifts, 35 with complete anterior cruciate tears, and 3 with significant partial tears or attenuation of the ligament. The 12 knees with negative shift demonstrated five normal anterior cru ciates, five partial tears and two complete tears of the anterior cruciate. Both of the complete tears were associated with complete medial collateral ligament tears and were clinically apparent by drawer and Lach man tests. A positive pivot shift in this study was very accurate for significant anterior cruciate tears. A nega tive pivot shift ruled out complete anterior cruciate ligament tears but did not preclude the presence of a partial tear. Partial tears associated with a negative pivot shift retained ligament competence.

We conclude that: (1) the pivot shift is a direct test of cruciate competence; (2) the pivot shift is present acutely in a very high percentage of cases and does not necessarily develop over time; (3) the pivot shift exam performed under general anesthesia is a very reliable test for significant tears of the anterior cruciate; and (4) the arthroscope remains a useful tool in the evaluation of acute traumatic hemarthrosis, but is not always necessary in establishing competence of the anterior cruciate ligament.

This article has been cited by other articles:

				J. H. Lubowitz, B. J. Bernardini, and J. B. Reid III Current Concepts Review: Comprehensive Physical Examination for Instability of the Knee Am. J. Sports Med., March 1, 2008; 36(3): 577 - 594. [Abstract] [Full Text] [PDF]

				M. S. George, W. R. Dunn, and K. P. Spindler Current Concepts Review: Revision Anterior Cruciate Ligament Reconstruction Am. J. Sports Med., December 1, 2006; 34(12): 2026 - 2037. [Abstract] [Full Text] [PDF]

				M. S. Kocher, J. R. Steadman, K. K. Briggs, W. I. Sterett, and R. J. Hawkins Relationships Between Objective Assessment of Ligament Stability and Subjective Assessment of Symptoms and Function After Anterior Cruciate Ligament Reconstruction Am. J. Sports Med., April 1, 2004; 32(3): 629 - 634. [Abstract] [Full Text] [PDF]

				E. Davis Clinical examination of the knee following trauma: an evidence-based perspective Trauma, July 1, 2002; 4(3): 135 - 145. [Abstract] [PDF]

				B. R. Bach JR, G. T. Jones, F. A. Sweet, and C. A. Hager Arthroscopy-assisted Anterior Cruciate Ligament Reconstruction Using Patellar Tendon Substitution: Two- to Four-year Follow-up Results Am. J. Sports Med., December 1, 1994; 22(6): 758 - 767. [Abstract] [PDF]

				K. D. Shelbourne and P. A. Nitz The O'Donoghue triad revisited: Combined knee injuries involving anterior cruciate and medial collateral ligament tears Am. J. Sports Med., September 1, 1991; 19(5): 474 - 477. [Abstract] [PDF]

				F. R. Noyes, E. S. Grood, J. F. Cummings, and R. R. Wroble An analysis of the pivot shift phenomenon: The knee motions and subluxations induced by different examiners Am. J. Sports Med., March 1, 1991; 19(2): 148 - 155. [Abstract] [PDF]

				R. J. Hawkins, G. W. Misamore, and T. R. Merritt Followup of the acute nonoperated isolated anterior cruciate ligament tear Am. J. Sports Med., June 1, 1986; 14(3): 205 - 210. [Abstract] [PDF]