title: The pivot shift test is of limited clinical relevance in the arthritic anterior cruciate ligament-deficient knee.
abstract: The pivot shift test is used to assess the integrity of the anterior cruciate ligament (ACL). This test has been shown to be highly sensitive in detecting instability in knees with complete ACL rupture. However, in the presence of osteoarthritis, the rotation and subluxation required for the pivot shift to be effective can be limited and therefore is likely to impact upon the reliability of this test. We performed the pivot shift test on 50 patients, under general anesthesia, prior to total knee replacement and then recorded the integrity of the ACL intraoperatively. This allowed us to assess the accuracy of this test in the presence of significant osteoarthritis. Of the 50 knees tested, none had a positive pivot shift test preoperatively; however, 14% of the knees included in the study had a completely ruptured ACL. This gives a sensitivity of 0% and a specificity of 1% for the pivot shift test for ACL ruptures in the presence of established osteoarthritis. We conclude that the pivot shift test may not be a reliable test for ACL function in the presence of symptomatic arthritis of the knee.
authors.affiliation: South West Thames Orthopaedic Rotation Worthing and Southlands NHS Trust, Worthing Hospital, Worthing, West Sussex, United Kingdom.
authors.forename: Matthew
authors.initials: M
authors.lastname: Dodd
authors.forename: Alexander
authors.initials: A
authors.lastname: Trompeter
authors.forename: Tim
authors.initials: T
authors.lastname: Harrison
authors.forename: Simon
authors.initials: S
authors.lastname: Palmer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016118:Anterior Cruciate Ligament / Q000473:pathology* / Q000601:surgery; D000070598:Anterior Cruciate Ligament Injuries; D019645:Arthroplasty, Replacement, Knee / Q000379:methods; D001696:Biomechanical Phenomena; D005260:Female; D006801:Humans; D007593:Joint Instability; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000175:diagnosis / Q000601:surgery; D010808:Physical Examination / Q000295:instrumentation / Q000379:methods; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015203:Reproducibility of Results; D012421:Rupture; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D016896:Treatment Outcome