The reverse pivot shift test helps to diagnose acute or chronic posterolateral instability of the knee. A significantly positive reverse pivot shift test suggests that the PCL, the LCL, the arcuate complex, and the popliteal fibular ligament are all torn.
How do you perform the Reverse Pivot Shift test?
The reverse pivot shift test begins with the patient supine with the knee in 90° of flexion. Valgus stress is then applied to the knee with an external rotation force. Bring the knee from 90° of flexion to full extension. The tibia reduces from a posterior subluxed position at about 20° of flexion. A shift and reduction of the lateral tibial plateau can be felt as it moves anteriorly from a posteriorly subluxed position. A “clunk” occurs as the knee is extended. This is called reverse pivot shift because shift of the lateral tibial plateau occurs in the opposite direction of the true pivot shift (seen in ACL tears). If the tibia is posterolaterally subluxed the iliotibial band will reduce the knee as the IT band transitions from a flexor to extensor of the knee. It is very important to compare this test to the contralateral knee.
The Pivot Shift Test will indicate an ACL tear. The Reverse Pivot Shift test indicates posterolateral instability of the knee. A posterolateral corner injury includes the LCL, popliteal fibular ligament, arcuate complex, and the lateral capsule.
