{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T03:50:50Z","timestamp":1792727450768,"version":"4.5.0"},"reference-count":32,"publisher":"SAGE Publications","issue":"2","license":[{"start":{"date-parts":[[1991,3,1]],"date-time":"1991-03-01T00:00:00Z","timestamp":667785600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Am J Sports Med"],"published-print":{"date-parts":[[1991,3]]},"abstract":"<jats:p>The description of the pivot shift test and its modifica tions is for the most part based on clinical observations. We wished to precisely determine the knee motions and medial-lateral tibiofemoral compartment subluxa tions that examiners induce in the knee joint to produce the pivot shift phenomenon. Eleven skilled knee sur geons performed the pivot shift test on an instrumented cadaveric lower limb. The anterior cruciate and super ficial medial collateral ligaments (long fibers) of one limb were sectioned to produce an abnormal state. An in strumented spatial linkage allowed all six degrees of freedom motions to be measured. Before and after ligament sectioning we determined the limits of knee motion under defined loading conditions. The tibial and femoral bony landmarks were digitized to determine the positions of the medial and lateral tibial plateaus in reference to the femoral condyles during the pivot shift tests.<\/jats:p>\n                  <jats:p>Each examiner performed his pivot shift test. The analysis of the data showed that examiners typically induced a coupled anterior translation and internal tibial rotation to produce an anterior tibial subluxation, and a coupled posterior translation and external tibial rotation to induce the reduction event. The magnitude of ante rior subluxation of each plateau depended upon the examiner's technique. The maximal anterior subluxa tion of the lateral tibial plateau varied from 14 to 19.8 mm (mean, 17.2 \u00b1 2.0 mm), whereas anterior sublux ation of the medial tibial plateau ranged from 6 to 16.9 mm (mean, 11.2 \u00b1 3.3 mm). This variation was due to the different amounts of internal tibial rotation that an examiner induced in the knee. Increased internal rota tion significantly limited the amount of anterior sublux ation of the medial tibial plateau (P &lt; 0.01). Conversely, increased external tibial rotation (after the reduction event) induced anterior subluxation of the medial tibial plateau.<\/jats:p>\n                  <jats:p>We concluded that more diagnostic information on the magnitude of the anterior knee subluxation in the anterior cruciate deficient knee is available by perform ing the pivot shift test starting with the tibia in external rotation and using a technique that enhances anterior tibial translation and avoids excessive internal tibial rotation. We also concluded that grading of the pivot shift test would vary considerably because of the dif ferences we measured between examiners. We believe there is an unmet need for reliable measurement of medial and lateral tibiofemoral rotational subluxations under specified loading conditions.<\/jats:p>","DOI":"10.1177\/036354659101900210","type":"journal-article","created":{"date-parts":[[2007,6,21]],"date-time":"2007-06-21T20:46:52Z","timestamp":1182458812000},"page":"148-155","source":"Crossref","is-referenced-by-count":210,"title":["An analysis of the pivot shift phenomenon"],"prefix":"10.1177","volume":"19","author":[{"given":"Frank R.","family":"Noyes","sequence":"first","affiliation":[{"name":"Cincinnati Sportsmedicine and Orthopaedic Center, Deaconess Hospital, University of Cincinnati, Cincinnati, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edward S.","family":"Grood","sequence":"additional","affiliation":[{"name":"Noyes-Giannestras Biomechanics Laboratories, Department of Aerospace Engineering and Engineering Mechanics, University of Cincinnati, Cincinnati, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John F.","family":"Cummings","sequence":"additional","affiliation":[{"name":"Noyes-Giannestras Biomechanics Laboratories, Department of Aerospace Engineering and Engineering Mechanics, University of Cincinnati, Cincinnati, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Randall R.","family":"Wroble","sequence":"additional","affiliation":[{"name":"Cincinnati Sportsmedicine and Orthopaedic Center, Deaconess Hospital, University of Cincinnati, Cincinnati, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[1991,3,1]]},"reference":[{"key":"atypb1","doi-asserted-by":"crossref","unstructured":"Allum R., Jones D., Mowbray Mas, et al. Triaxial electrogoniometric examination of the pivot shift sign for rotatory instability of the knee Clin Orthop 183. 144-146, 1984","DOI":"10.1097\/00003086-198403000-00023"},{"key":"atypb2","doi-asserted-by":"publisher","DOI":"10.1177\/036354658801600603"},{"key":"atypb3","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-197961050-00010"},{"key":"atypb4","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-198264020-00018"},{"key":"atypb5","unstructured":"Galway RD, Beaupr\u00e9 A., Maclntosh DL Pivot shift A clinical sign of symptomatic anterior cruciate insufficiency (abstract). J Bone Joint Surg 54B 763-764, 1972"},{"key":"atypb6","doi-asserted-by":"crossref","unstructured":"Galway HR, Maclntosh DL The lateral pivot shift: A symptom and sign of anterior cruciate ligament insufficiency Clin Orthop 147 45-50, 1980","DOI":"10.1097\/00003086-198003000-00008"},{"key":"atypb7","unstructured":"Grood ES, Noyes FR Diagnosis and classification of knee ligament injuries Part I Biomechanical precepts, in Feagin J Jr (ed) The Crucial Ligaments New York, Churchill Livingstone, 1987, pp 245-260"},{"key":"atypb8","doi-asserted-by":"publisher","DOI":"10.1115\/1.3138397"},{"key":"atypb9","doi-asserted-by":"crossref","unstructured":"Hughston JC, Andrews JR, Cross MF, et al. Classification of knee ligament instabilities. Part I The medial compartment and cruciate ligaments J Bone Joint Surg 58A 159-172, 1981","DOI":"10.2106\/00004623-197658020-00001"},{"key":"atypb10","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-197658020-00002"},{"key":"atypb11","doi-asserted-by":"publisher","DOI":"10.3109\/ort.1981.52.suppl-191.01"},{"key":"atypb12","doi-asserted-by":"crossref","unstructured":"Jakob RP, Staubli HU, Deland JT Grading the pivot shift Objective tests with implications for treatment J Bone Joint Surg 698 294-299, 1987","DOI":"10.1302\/0301-620X.69B2.3818763"},{"key":"atypb13","doi-asserted-by":"publisher","DOI":"10.1177\/036354658901700418"},{"key":"atypb14","doi-asserted-by":"publisher","DOI":"10.1177\/036354658601400115"},{"key":"atypb15","doi-asserted-by":"crossref","unstructured":"Larson RL Physical examination in the diagnosis of rotatory instability. Clin Orthop 172 38-44, 1983","DOI":"10.1097\/00003086-198301000-00009"},{"key":"atypb16","unstructured":"Lemaire M. Rupture anciennes du ligament croise anterieur du genou J Chir (Paris) 93 311-320, 1967"},{"key":"atypb17","unstructured":"Lemaire M., Miremad C. Les instabilites chroniques anteneures et internes du genou etude theorique, diagnostic clinique et radiologique Rev Chir Orthop 69: 3-16, 1983"},{"key":"atypb18","doi-asserted-by":"crossref","unstructured":"Losee RE Concepts of the pivot shift Clin Orthop 172 45-51, 1983","DOI":"10.1097\/00003086-198301000-00010"},{"key":"atypb19","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-197860080-00001"},{"key":"atypb20","doi-asserted-by":"publisher","DOI":"10.1177\/036354658401200303"},{"key":"atypb21","unstructured":"Mueller W. The Knee Form, Function, and Ligament Reconstruction Berlin , Springer-Verlag, 1983"},{"key":"atypb22","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-198062050-00001"},{"key":"atypb23","doi-asserted-by":"publisher","DOI":"10.1177\/036354659101900212"},{"key":"atypb24","unstructured":"Noyes FR, Grood ES Classification of ligament injuries. Why an anterolateral laxity or anteromedial laxity is not a diagnostic entity. Inst Course Lect XXXVI 185-200, 1987"},{"key":"atypb25","unstructured":"Noyes FR, Grood ES Diagnosis and classification of knee ligament injuries Part II Clinical concepts , in Feagin J Jr (ed) The Crucial Ligaments New York, Churchill Livingstone, 1987, pp 261-285"},{"key":"atypb26","doi-asserted-by":"publisher","DOI":"10.3109\/17453678909154185"},{"key":"atypb27","unstructured":"Noyes FR, Grood ES, Suntay WJ, et al The three dimensional laxity of the anterior cruciate deficient knee as determined by clinical laxity tests lowa Orthop J 3 32-44, 1983"},{"key":"atypb28","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-198971030-00027"},{"key":"atypb29","doi-asserted-by":"publisher","DOI":"10.1177\/036354658901700403"},{"key":"atypb30","doi-asserted-by":"crossref","unstructured":"Slocum DB, James SL, Larson RL, et al. Clinical test for anterolateral rotatory instability of the knee Clin Orthop 118 63-69, 1976","DOI":"10.1097\/00003086-197607000-00012"},{"key":"atypb31","doi-asserted-by":"publisher","DOI":"10.1177\/036354658100900107"},{"key":"atypb32","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-198163060-00014"}],"container-title":["The American Journal of Sports Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/036354659101900210","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/036354659101900210","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T09:36:52Z","timestamp":1777369012000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/036354659101900210"}},"subtitle":["The knee motions and subluxations induced by different examiners"],"short-title":[],"issued":{"date-parts":[[1991,3]]},"references-count":32,"journal-issue":{"issue":"2","published-print":{"date-parts":[[1991,3]]}},"alternative-id":["10.1177\/036354659101900210"],"URL":"https:\/\/doi.org\/10.1177\/036354659101900210","relation":{},"ISSN":["0363-5465","1552-3365"],"issn-type":[{"value":"0363-5465","type":"print"},{"value":"1552-3365","type":"electronic"}],"subject":[],"published":{"date-parts":[[1991,3]]}}}