Evaluation of a simulated pivot shift test: a biomechanical study

  • Lars EngebretsenEmail author
  • Coen A. Wijdicks
  • Colin J. Anderson
  • Benjamin Westerhaus
  • Robert F. LaPrade



Double-bundle anterior cruciate reconstructions have led to an increased interest in quantifying anterolateral rotatory stability. The application of combined internal rotation and valgus torques to the knee can more nearly recreate the anterolateral subluxation that occurs in the pivot shift test in vitro compared to coupled internal rotation torque and anterior tibial loads.


Twelve non-paired cadaveric knees were biomechanically tested with the ACL intact and sectioned. For each test state, six-degree-of-freedom positional data were collected for two simulated pivot shift loads consisting of a 5-Nm internal rotation torque coupled with either a 10-Nm valgus torque or an 88 N anterior tibial load at 0°, 20°, 30°, 60°, and 90° of knee flexion.


The coupled internal rotation and valgus torques produced a significant increase in anterolateral subluxation between the ACL intact and sectioned states at all tested angles except 90º (5.9 ± 0.4 mm at 0°, 4.3 ± 0.6 mm at 20°, 3.5 ± 0.6 mm at 30°, 2.1 ± 0.6 mm at 60°). The coupled internal rotation and an anterior tibial load produced significant increases between the ACL intact and sectioned states at all tested angles except 30º (5.4 ± 0.5 mm at 0°, 3.7 ± 0.5 mm at 20°, 2.1 ± 0.8 mm at 60°, 1.4 ± 0.3 mm at 90°).


We found that the coupled internal rotation and valgus torques best recreated the anterolateral subluxation that occurs in the pivot shift in vitro. This study describes an anterolateral subluxation test for ACL integrity in the laboratory setting.


Anterior cruciate ligament Pivot shift test Anterior tibial translation Coupled loads Anterolateral subluxation 



Funding for this study was provided by the Health South-East of Norway Grant #2009064. We would also like to thank Conrad Lindquist, and Steinar Johansen MD for their contributions.


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Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Lars Engebretsen
    • 1
    Email author
  • Coen A. Wijdicks
    • 2
  • Colin J. Anderson
    • 3
  • Benjamin Westerhaus
    • 3
  • Robert F. LaPrade
    • 2
  1. 1.Department of Orthopaedic SurgeryOslo University Hospital and Faculty of MedicineOsloNorway
  2. 2.Steadman Philippon Research InstituteVailUSA
  3. 3.Department of Orthopaedic SurgeryUniversity of MinnesotaMinneapolisUSA

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