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Reverse Pivot Shift Test

- Discussion:
    - this sign is positive in pts with acute or chronic posterolateral instability of the knee;
    - knee begins in flexion while an external rotation and valgus stress are applied;
           - supine
           - valgus stress
           - foot in ER
           - bring knee from 90 deg flexion to full extension
           - feel for palpable “shift” of  lateral tibial plateau as it moves anteriorly from a posteriorly subluxed position
    - lateral tibial plateau shifts from position of posterior subluxation to a position of reduction as the flexed knee isextended under valgus 
           stress and w/ foot in external rotation; (w/ the true pivot shift the tibia is internally rotated);
           - clunk is appreciatted as the knee is extended;
    - plateau subluxates again as knee is flexed in the opposite manner;
    - since it describes shift of lateral tibial plateau in opposite direction from true joint shift, its called reverse pivot shift;
    - significantly positive reverse pivot shift suggest that PCL, arcuate complex, and the LCL are all torn;
    - in the position of tibial inernal rotation, the sign disappears

Observations on rotatory instability of the lateral compartment of the knee:  Experimental studies on the functional anatomy and pathomechanism of the true and reversed pivot shift sign.

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