Execution
- 1Position the patient supine and grasp the foot and ankle.
- 2Flex the knee and hip while placing the tibia in external rotation.
- 3Apply valgus stress while moving the knee toward extension.
- 4Change tibial rotation as the knee approaches extension to provoke subluxation.
- 5Observe for sudden lateral tibial plateau subluxation or patient apprehension.
Positive outcome
A sudden shift, giving-way sensation, or apprehension during the rotatory maneuver is positive. The finding suggests anterolateral rotatory instability associated with ACL insufficiency. As with other pivot-shift variants, guarding can hide the finding.
Studies
| Study | Reliability | Sn | Sp | LR+ | LR− |
|---|---|---|---|---|---|
| Losee et al. (1978) | NA | NA | NA | NA | NA |
CommentLosee is another older ACL rotatory-instability maneuver. It can be clinically useful in experienced hands, but diagnostic accuracy is not as well established as Lachman or pivot shift. Use it as a descriptive rotatory laxity test rather than a primary ACL diagnostic test.
Low Clinical Value