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Hip and knee
Published in Ian Mann, Alastair Noyce, The Finalist’s Guide to Passing the OSCE, 2021
MacIntosh test/pivot shift test (rotary instability/anterior subluxation of the lateral tibial condyle) – Extend the knee, internally rotate the leg and apply a valgus force to the knee. Next, flex the knee and feel for a jerk consistent with anterior cruciate damage.
Examination of Knee Joint in a Child
Published in Nirmal Raj Gopinathan, Clinical Orthopedic Examination of a Child, 2021
The test is performed in supine position. The hip is slightly abducted and flexed. The examiner supports the ankle with one hand and distal thigh with the other. Ensure that the limb is in slight internal rotation while it is being lifted off the table and in an extended position. Subsequently, the knee is flexed, and simultaneous valgus stress is applied with pressure over the upper aspect of the leg. In an ACL-deficient knee, the lateral tibial plateau is posteriorly subluxated over the femur at the initiation of the test (knee flexion 0° to >30°), and subsequently, with an increase in flexion to 30° or beyond, the displaced lateral tibial plateau reduces suddenly, producing a palpable and sometimes audible clunk, indicating a positive pivot shift test. The best site to observe this reduction is at the tubercle of Gerdy. The pivot shift test will be inaccurate if knee extension is not possible because of pain, swelling, or displaced meniscal tear.
Ligament Reconstruction with Reference to the Anterior Cruciate Ligament of the Knee
Published in Verna Wright, Eric L. Radin, Mechanics of Human Joints, 2020
Matsumoto (28), working in our department, concluded from in vitro experiments that the rupture of the ACL is a necessary but not sufficient condition for the pivot shift phenomenon to occur. The geometry of the lateral compartment plays an important role. If the lateral tibial plateau is flat or does not have a pronounced convexity, the same degree of internal rotation of the tibia occurs under the forces imposed during the test. The rotation is gradual, however, and so the sudden subluxation of the lateral tibial plateau does not occur. Such a knee may be considered to have a negative pivot shift test, regardless of a large amount of tibial rotation, simply because it did not exhibit the sudden subluxation associated with the test.
The presence of high-grade pivot shift test preoperatively is associated with inferior functional outcomes
Published in The Physician and Sportsmedicine, 2022
Ravi Gupta, Anil Kapoor, Akash Singhal, Bharath Mali Patil, Parth Bansal
Anterior cruciate ligament (ACL) is the primary restrain to anterior translation of the tibia on the femur and is responsible for the rotational stability of the knee. Lachman and pivot shift tests are performed to assess an ACL tear [1]. Pivot shift test is a more specific test for the diagnosis of ACL tear [2]. It is a dynamic test and assess anterolateral rotatory instability of the knee. International Knee Documentation Committee Classification (IKDC) graded this test on four-point scale: grade 0 (none), grade 1 (glide), grade 2 (clunk), and grade 3 (gross) [3]. There are a number of other factors that can influence the magnitude of pivot shift test such as duration of injury, meniscus tear, tibial slope, anterolateral capsule, and iliotibial band [4–12]. The effect of side of meniscus tear (medial or lateral) on pivot shift has been studied previously; however, there is no clear consensus till now [13,14].
Superior rotational stability and lower re-ruptures rate after combined anterolateral and anterior cruciate ligament reconstruction compared to isolated anterior cruciate ligament reconstruction: a 2-year prospective randomized clinical trial
Published in The Physician and Sportsmedicine, 2023
Ștefan Mogos, Dinu Antonescu, Ioan-Cristian Stoica, Riccardo D’Ambrosi
The pivot shift test assesses for anterolateral rotatory instability of the knee. It is a very useful test to determine if the patient will have a symptomatic ACL tear or not. With this test, the examiner applies an internal rotation and valgus force to the extended knee, and if there is an ACL tear, the tibia will usually sublux anterolaterally on the femur [28].
How weakness of the tensor fascia lata and gluteus maximus may contribute to ACL injury: A new theory
Published in Physiotherapy Theory and Practice, 2020
Michael T. Cibulka, Jack Bennett
Anterolateral instability of the knee joint produces two important clinical phenomena – the pivot shift sign and, its reverse test, the positive jerk test (Hughston, Andrews, Cross, and Moschi, 1976; Matsumoto, 1990), that lend further support to our hypothesis. A deficient ACL is responsible for causing the tibia to sublux anteriorly creating anterolateral rotatory instability (Hughston, Andrews, Cross, and Moschi, 1976; Jakob, Hassler, and Staeubli, 1981; Matsumoto, 1990). The pivot shift sign produces an increase in tibial IR with a sudden reduction in an ACL-deficient knee (Matsumoto, 1990). The pivot shift test is created by the change in position of the ITB relative to the knee joint axis, which moves more posterior as the knee flexes (Matsumoto, 1990). The jerk test occurs when the ACL is ruptured and the tibia is unconstrained during the movement of knee flexion to extension and the tibia suddenly subluxes anteriorly, while the pivot shift is the subluxation of the tibial during knee movement of knee extension to flexion (Hughston, Andrews, Cross, and Moschi, 1976). Both the pivot shift sign and jerk test are dependent upon the normal tension in the ITB (Jakob, Hassler, and Staeubli, 1981), and hence also from tension proximally by the contraction of the TFL/Gmax muscles. Suero et al. (2013) showed that a greater magnitude of tibial translation occurs when the effect of the ITB is removed. In a recent study of ACL-deficient knees, when comparing anesthetized versus awake patients, those that were anesthetized had a greater anterior tibial translation (pivot shift) than those that were awake (Matsushita et al, 2013), suggesting that a dynamic contraction, possibly coming from the TFL/Gmax muscles, stabilizing the tibia preventing an unstable jerk or pivot shift phenomenon. The increase in instability that develops in ACL-deficient knees after the ITB removed is further evidence of the importance of the stabilizing effect of the ITB in controlling tibial motion. Other studies also emphasize the fact that relaxation or damage to the ITB increases anterior tibial translation (Bach, Warren, and Wickiewicz, 1988; Galway and MacIntosh, 1980; Terry, Hughston, and Norwood, 1986; Terry, Norwood, Hughston, and Caldwell, 1993). Thus, the ITB complex appears to be important in stabilizing the ACL-deficient knee in those with anterolateral rotatory instability. How much do the TFL and Gmax muscles each contribute to ITB tension distally is an interesting but currently unanswerable question?