Quantifying the pivot shift test: A systematic review

Nicola Lopomo, Stefano Zaffagnini, Andrew A. Amis

Research output: Contribution to journalArticlepeer-review


Purpose: This study aims to identify and summarize the evidence on the biomechanical parameters and the corresponding technologies which have been used to quantify the pivot shift test during the clinical and functional assessment of anterior cruciate ligament (ACL) injury and surgical reconstruction. Methods: Searchstrategy Internet search of indexed scientific articles on the PubMed database, Web of Science and references on published manuscripts. No year restriction was used. Selection criteria Articles included were written only in English and related to search terms: "pivot shift" AND (OR "ACL"). The reviewers independently selected only those studies that included at least one quantitative parameter for the analysis of the pivot shift test, including both in vitro and in vivo analyses performed on human joint. Those studies that analysed only clinical grading were excluded from the analysis. Analysis After evaluating the methodological quality of the articles, the parameters found were summarized. Results: Six hundred and eight studies met the inclusion criteria, and finally, 68 unique studies were available for the systematic review. Quantitative results were heterogeneous. The pivot shift test has been quantified by means of 25 parameters, but most of the studies focused on anterior-posterior translations, internal-external rotation and acceleration in anterior-posterior direction. Conclusion: Several methodologies have been identified and developed to quantify pivot shift test. However, clinical professionals are still lacking a 'gold standard' method for the quantification of knee joint dynamic laxity. A widespread adoption of a standardized pivot shift manoeuvre and measurement method to allow objective comparison of the results of ACL reconstructions is therefore desirable. Further development of measurement methods is indeed required to achieve this goal in a routine clinical scenario. Level of Evidence: Systematic review of-at least-level II studies, Level II.

Original languageEnglish
Pages (from-to)767-783
Number of pages17
JournalKnee Surgery, Sports Traumatology, Arthroscopy
Issue number4
Publication statusPublished - 2013


  • Anterior cruciate ligament
  • Pivot shift
  • Systematic review

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Surgery


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