Evidence-based medicine for rotary knee instability

Abstract

The pivot shift test is used to evaluate the knee for anterior cruciate ligament (ACL) laxity. More specifically, the pivot shift evaluates the presence of rotary knee instability, which leads to the feeling of “giving way�? that patients often complain about. Evidence from the literature also shows that the pivot shift test correlates with long-term subjective patient outcomes. However, the pivot shift also has shortcomings such as a lack of a standardized maneuver and a low sensitivity without anesthesia. Due to its relevance to patients’ outcomes, we recommend using the pivot shift in conjunction with other physical examination tests, especially postoperatively, to evaluate knee stability.