Abstract
With recent advances in our understanding of the diagnosis, pathoanatomy, and pathomechanics of ligamentous knee injuries, the pivot shift sign continues to be an important clinical and conceptual entity. Though it was observed some 50 years ago, the sign is most commonly associated with the names of Macintosh and Galway and their excellent description published in 1972 (Galway et al. 1972). The pivot shift was a source of controversy in the early 1970s, and 4 years passed before the sign and its importance became generally acknowledged. This was a time in which our knowledge of the biomechanics of the knee was expanded through the work of O’Donoghue, Slocum, Hughston, Kennedy, Trillat, and others. In the present chapter we shall explore the history, clinical presentation, and pathology of the pivot shift phenomenon, and we shall propose recommendations for treatment.
This is a preview of subscription content, log in via an institution.
Buying options
Tax calculation will be finalised at checkout
Purchases are for personal use only
Learn about institutional subscriptionsPreview
Unable to display preview. Download preview PDF.
References
Andrews JR, Sanders RA, Morin B (1985) Surgical treatment of anterolateral rotatory instability. Am J Sports Med 73: 112–119
Arnold JA, Coker TP, Heaton LM et al. (1979) Natural history of anterior cruciate tears. Am J Sports Med 7: 305–313
Bach BR, Warren RF, Wickiewicz TL (1988) The pivot shift phenomenon: results and description of a modified test for anterior crucial ligament in sufficiency. Am J Sports Med 16/6: 571–576
Bousquet G, Rhenter JL (1982) Illustré du genou. Mure, Le Coteau
Felsenreich F (1934) Klinik der Kreuzbandverletzungen. Arch Klin Chir 179: 375–408
Galway HR, Macintosh DL (1980) The lateral pivot shift. A symptom and sign of anterior cruciate ligament instability. Clin Orthop 147: 45
Galway HR, Beaupré A, Macintosh DL (1972) Pivot shift. A clinical sign of anterior cruciate ligament instability. J Bone Joint Surg [Br] 54: 763
Hassler H, Jakob RP (1981) Ein Beitrag zur Ursache der an-terolateralen Instabilität des Kniegelenkes. Eine Studie an 20 Leichenknien unter besonderer Berücksichtigung des Tractus iliotibialis. Arch Orthop Trauma Surg 98: 45–50
Hey Groves EW (1920) The crucial ligaments of the knee joint: Their function, rupture, and the operative treatment of the same. Br J Surg 7: 505–515
Hughston JD, Andrews JR, Cross MJ et al (1976) Classification of knee ligament instabilities. Part I. The medial compartment and cruciate ligaments. J Bone Joint Surg [Am] 58:159
Jakob RP (1987a) Pathomechanical and clinical concepts of the pivot shift sign. Semin Orthop 2: 9–17
Jakob RP (1987b) Indikation, Behandlung und Evaluation bei chronischer vorderer Kreuzband-Instabilität. Ortho-pade 16: 130–139
Jakob RP, Noesberger B, Saxer U (1976) Der Wert des Pi-vot-shift-Phänomens und der lateralen Rekonstruktion; zur Diagnose und Therapie der vorderen Kreuzband-ruptur. Annual Meeting of the Schweiz Gesellschaft für Sportmedizin, Fribourg, October 21. Haupt, Bern, S 6984
Jakob RP, Noesberger B, Müller ME (1977) The diagnostic value of the pivot shift sign in anterior instability of the knee and specific lateral repair. In: Chapchal G (ed) Injuries of the ligaments and their repair. Hand - knee - foot. Seventh International Symposium on Topical Problems in Orthopaedic Surgery Lucerne. Thieme, Stuttgart, pp 95–102
Jakob RP, Hassler H, Stäubli H-U (1981) Observations on rotatory instability of the lateral compartment of the knee. Acta Orthop Scand 52 [Suppl 191]
Jakob RP, Stäubli H-U, Deland JT (1987) Grading the pivot shift. Objective tests with implications for treatment. J Bone Joint Surg [Br] 69: 294–299
Jakob RP, Kipfer W, Klaue K, Stäubli H-U, Gerber C (1988) Étude critique de la reconstruction du ligament croisé anté-rieur du genou par la plastie pédiculée sur le Hoffa à partir du tiers médian du tendon rotulien, 50 genoux opérés avec recul de 2 à 4 ans. Rev Chir Orthop 74: 44–51
Jones R, Smith A (1913) On rupture of the crucial ligaments of the knee and on fractures of the spine of the tibia. Br J Surg 1: 70–89
Lemaire M (1967) Ruptures anciennes du ligament croisé an-térieur du genou. J Chir (Paris) 93: 311–320
Lobenhoffer P, Posel P, Witt S, Piehler J, Wirth CJ (1987) Distal femoral fixation of the iliotibial tract. Arch Orthop Trauma Surg 106: 285–290
Losee RE (1983) Concepts of the pivot shift. Clin Orthop 172: 45–51
Losee RE, Johnson TR, Southwick WO (1978) Anterior subluxation of the lateral tibial plateau. A diagnostic text and operative repair. J Bone Joint Surg [Am] 60: 1015
Müller We (1983) The knee. Form, function and ligament reconstruction. Springer, Berlin Heidelberg New York Tokyo
Noyes FR, Basset RW, Grood ES et al. (1980) Arthroscopy in acute traumatic hemarthrosis of the knee. J Bone Joint Surg [Am] 62:687–695
Slocum DB, James SL, Larson RL et al. (1976) Clinical test for anterolateral rotatory instability of the knee. Clin Orthop 118: 63
Terry GC, Hughston JC, Norwood LA (1986) The anatomy of the iliotibial tract. Am J Sports Med 14: 39–45
Wirth CJ, Artmann M (1974) Verhalten der Roll-Gleit-Bewe-gung des belasteten Kniegelenkes bei Verlust und Ersatz des vorderen Kreuzbandes. Arch Orthop Unfallchir 78: 356
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 1992 Springer-Verlag Berlin Heidelberg
About this chapter
Cite this chapter
Jakob, R.P., Stäubli, HU. (1992). Pathomechanical and Clinical Concepts of the Pivot Shift Phenomenon. In: Jakob, R.P., Stäubli, HU. (eds) The Knee and the Cruciate Ligaments. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-84463-8_12
Download citation
DOI: https://doi.org/10.1007/978-3-642-84463-8_12
Publisher Name: Springer, Berlin, Heidelberg
Print ISBN: 978-3-642-84465-2
Online ISBN: 978-3-642-84463-8
eBook Packages: Springer Book Archive