The pivot shift: A global user guide

Volker Musahl, Yuichi Hoshino, Mattias Ahlden, Paulo Araujo, James J. Irrgang, Stefano Zaffagnini, Jon Karlsson, Freddie H. Fu

Research output: Contribution to journalArticle


Purpose: The use of several different maneuvers for the pivot shift test has resulted in inconsistent quantitative measurements. The purpose of this study was to describe, analyze, and group several surgeon-specific techniques for the pivot shift test and to propose a standardized pivot shift test. Methods: Twelve expert surgeons examined a whole lower cadaveric extremity with their preferred technique and assigned a clinical grade, I-III. Anterior tibial translation and acceleration were measured using an electromagnetic system. The test was repeated after watching an instructional video focused on a standardized pivot shift technique. Measurements were repeated and compared with the preferred technique. Results: The expert surgeons utilized valgus stress unanimously in addition to fixed internal rotation (n = 5), fixed external rotation (n = 1), a motion-allowing technique (n = 3), a dislocation-type maneuver (n = 2), and a fixed anterior drawer type of maneuver in extension (n = 1). Anterior tibial translation measured was on average 15.9 ± 3.7 mm. Average tibial acceleration was 3.3 ± 2.1 mm/s 2. Average clinical grading was 2.3 ± 0.5. There were no differences in average clinical grading when using high stress (2.5 ± 0.6) versus low stress (2.3 ± 0.5, n. s.), or using fixed rotation (2.2 ± 0.5) versus a motion-allowing technique (2.3 ± 0.6; n. s.). Conclusions: Clinical grading, tibial translation, and acceleration vary between examiners performing the pivot shift test. High forces and extremes of rotation are not necessary to produce a clinical detectable pivot shift. In the future, a standardized pivot shift test-which can be performed universally and utilizes only gentle forces allowing motion to occur-may be beneficial when assessing differences in outcome following ACL reconstruction.

Original languageEnglish
Pages (from-to)724-731
Number of pages8
JournalKnee Surgery, Sports Traumatology, Arthroscopy
Issue number4
Publication statusPublished - Apr 2012


  • Acceleration
  • ACL
  • Pivot shift
  • Standard technique

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Surgery

Fingerprint Dive into the research topics of 'The pivot shift: A global user guide'. Together they form a unique fingerprint.

  • Cite this

    Musahl, V., Hoshino, Y., Ahlden, M., Araujo, P., Irrgang, J. J., Zaffagnini, S., Karlsson, J., & Fu, F. H. (2012). The pivot shift: A global user guide. Knee Surgery, Sports Traumatology, Arthroscopy, 20(4), 724-731.