The Pivot Shift’s Usual Suspects

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For orthopedic surgeons, the pivot shift test remains one of the most telling — and sometimes most dramatic — moments of the ACL exam.

Performed under anesthesia, it can transform a quiet knee into a startling demonstration of rotational instability. The tibia subluxates forward, then snaps back into place as the knee flexes — a biomechanical magic trick that reveals just how unstable the joint has become.