Lateral Pivot Shift Test for Anterolateral Knee Instability. This test can be used to evaluate the anterolateral structures of the knee

Knee

The knee joint joins the thigh with the leg and consists of two articulations: one between the fibula and tibia, and one between the femur and patella. It is the largest joint in the human body and is very complicated. The knee is a mobile trocho-ginglymus , which permits flexion and extension as...

 for sprains.

This test is performed with the patient lying in the supine position

Supine position

The supine position is a position of the body: lying down with the face up, as opposed to the prone position, which is face down, sometimes with the hands behind the head or neck. When used in surgical procedures, it allows access to the peritoneal, thoracic and pericardial regions; as well as the...

 with the hip passively flexed to 30 degrees. The examiner stands lateral to the patient. The lower leg and ankle

Ankle

The ankle joint is formed where the foot and the leg meet. The ankle, or talocrural joint, is a synovial hinge joint that connects the distal ends of the tibia and fibula in the lower limb with the proximal end of the talus bone in the foot...

 is grasped maintaining 20 degrees of internal tibial

Tibial

Tibial can refer to:* Tibia bone* Tibial nerve* Anterior tibial artery* Posterior tibial artery* Anterior tibial vein* Posterior tibial vein...

rotation. The knee is allowed to sag into complete extension. The opposite hand grasps the lateral portion of the leg at the level of the superior tibiofibular joint, increasing the force of internal rotation.

While maintaining internal rotation, a valgus force is applied to the knee while it is slowly flexed. If the tibia’s position on the femur

Femur

The femur , or thigh bone, is the most proximal bone of the leg in tetrapod vertebrates capable of walking or jumping, such as most land mammals, birds, many reptiles such as lizards, and amphibians such as frogs. In vertebrates with four legs such as dogs and horses, the femur is found only in...

 reduces as the knee is flexed in the range of 30 to 40 degrees or if there is an anterior subluxation felt during extension the test is positive for a tear of the ACL, posterolateral capsule, arcuate ligament

Arcuate ligament

The term arcuate ligament refers to an arc-shaped ligament. Specifically, it can refer to a variety of ligaments in the human body:* Arcuate ligaments of the diaphragm** Median arcuate ligament** Medial arcuate ligament** Lateral arcuate ligament...

 complex, or the IT band.

This is a hard test to do because meniscal involvement, such as with bucket handle tears of the medial meniscus, may limit range of motion and muscle guarding to produce a false-negative. This test is best performed by a physician when the patient is under anesthesia

Anesthesia

Anesthesia, or anaesthesia , traditionally meant the condition of having sensation blocked or temporarily taken away...

.