Clinical analysis of the pivot shift tests: description of the pivot drawer test.

A clinical analysis of the pivot shift was performed by evaluating 100 patients with unilateral anterior cruciate ligament (ACL) insufficiency in an office setting. Each patient was examined in a random order using the Macintosh, Losee, Hughston, Slocum, pivot drawer, and flexion rotation drawer versions of the pivot shift test. Pathologic anterior tibial displacement was estimated with the Lachman test and quantitatively measured using the KT-1000 knee ligament arthrometer. Pivot shift was graded as 0 (absent), grade I (slight), grade II (definite subluxation), and grade III (subluxation and momentary locking). The presence or absence of any degree of pivot shift was correlated with the arthroscopic finding of a torn ACL. Results indicated the "drawer type" tests were significantly more sensitive than other versions of the pivot shift because they can be performed without causing significant pain and muscle spasm, and the limb position maximizes pathologic coupled motion. A correlation between increasing displacement estimated with the Lachman test and measured displacement with the KT-1000 arthrometer revealed that as pathologic displacement increases so does the grade of the Slocum, pivot drawer, and flexion rotation drawer tests. We recommend using the pivot drawer or flexion rotation drawer as a standard method for assessing the pivot shift phenomenon.