Gravity-assisted pivot-shift test for anterior cruciate ligament injury: a new procedure to detect anterolateral rotatory instability of the knee joint

  • Hiroya SakaiEmail author
  • Hisataka Yajima
  • Naoki Kobayashi
  • Toyohiko Kanda
  • Hisatada Hiraoka
  • Kazuya Tamai
  • Koichi Saotome


The denominated gravity-assisted pivot-shift test was introduced as a new procedure to detect anterolateral rotatory instability of the knee joint. The patient lies in the supine position or slightly rotated onto the affected side. The affected knee flexed approximately 60° and the ipsilateral hip flexed, abducted and externally rotated so that the plane of the knee motion runs parallel to the floor. The examiner instructs the patient to raise the affected leg off the examining table and to extend the affected knee gradually. If the lower leg is internally rotated suddenly, with the knee subluxated at an angle of approximately 20°, followed by the reduction in flexion, this test is regarded as positive. This test was investigated on 51 anterior cruciate ligament (ACL) deficient knees, being positive in 30 knees (Group P) and negative in 21 (Group N) with the positive rate of 59%. There was no significant correlation between the result of this test and the clinical features, but Group N included relatively small number of females and recurrent injuries tended to occur more frequently in Group P. Thirty-six knees received ACL reconstruction subsequently. There was no statistically significant difference between the groups in the side-to-side difference in anterior knee laxity at one year postoperatively. However, three patients with the side-to side difference of more than 3 mm belonged to Group P. Relatively low positive rate in ACL deficient knees suggests that it may not be used as a diagnostic procedure for ACL injury. It is possibly used for the prediction of high risk patients for symptomatic giving-way and/or patients with poor prognosis after ACL reconstruction.


Anterior cruciate ligament Anterolateral rotatory instability Pivot shift Gravity Reconstruction 



No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article. No funds were also received in support of this study. The authors declare that this study complies with the law of Japan.


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Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  • Hiroya Sakai
    • 1
    • 2
    Email author
  • Hisataka Yajima
    • 1
  • Naoki Kobayashi
    • 1
  • Toyohiko Kanda
    • 1
  • Hisatada Hiraoka
    • 3
  • Kazuya Tamai
    • 1
  • Koichi Saotome
    • 1
  1. 1.Department of Orthopaedic SurgeryDokkyo University School of MedicineTochigiJapan
  2. 2.Department of Orthopaedic Surgery, Saitama Medical CenterSaitama Medical SchoolKawagoe SaitamaJapan
  3. 3.Department of Orthopaedic SurgeryThe University of TokyoTokyoJapan

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