Execution
- 1Position the patient supine and stand on the side of the tested knee.
- 2Flex the hip and knee while applying valgus stress and tibial rotation as described for rotatory instability testing.
- 3Move the knee through the provocative arc from extension into flexion.
- 4Watch and palpate for a sudden jolt or subluxation-reduction event.
- 5Compare with the opposite side and note apprehension when a jolt is not clearly seen.
Positive outcome
A sudden jolt, clunk, or rotatory subluxation-reduction event is positive for ACL-related anterolateral rotatory instability. Apprehension may be the only finding in a guarded patient. The test is one of several pivot-shift variants rather than a distinct high-evidence singleton.
Studies
| Study | Reliability | Sn | Sp | LR+ | LR− |
|---|---|---|---|---|---|
| Nakajima et al. (1976) | NA | NA | NA | NA | NA |
CommentMagee lists multiple rotatory instability tests and note that the examiner should become proficient in a few rather than perform all variants. Modern diagnostic literature is dominated by Lachman, anterior drawer, pivot shift, and lever sign, not the Nakajima variant. Value is low because standalone validation is limited.
Low Clinical Value