Pivot shift test
For: ACL rupture
A tear of the anterior cruciate ligament, which stops the shin sliding forwards and rotating on the thigh bone. Usually from a twisting or pivoting injury.
Best used to rule inLikelihood ratios as published by the review from its pooled statistical model, so they differ slightly from ratios of the rounded sensitivity and specificity.
What the numbers mean
- Positive result: a strong rule-in: a positive result makes the diagnosis much more likely.
- Negative result: a small shift: a negative result nudges the diagnosis down, but does not exclude it.
Source
Sokal PA, Norris R, Maddox TW, Oldershaw RA. The diagnostic accuracy of clinical tests for anterior cruciate ligament tears are comparable but the Lachman test has been previously overestimated: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc. 2022;30:3287–3303. Journal article (DOI) · meta-analysis
Figures as they will appear in Rule It In, Rule It Out (Trokos, forthcoming). If a newer or better study changes them, this page changes with the book. Figures last updated from the book on 2 October 2026.
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