Execution
- 1Position the patient supine with the hip flexed and the knee flexed.
- 2Externally rotate the tibia and applies valgus stress.
- 3Extend the knee from flexion toward full extension.
- 4Observe for posterior subluxation of the lateral tibial plateau and reduction near extension.
- 5Compare the response with the opposite knee.
Positive outcome
A palpable or visible clunk as the tibia reduces, or apprehension during the maneuver, is positive. The test suggests posterolateral corner injury or posterolateral rotatory instability. Some asymptomatic knees may show a reverse pivot shift, so symptoms and side-to-side comparison matter.
Studies
| Study | Reliability | Sn | Sp | LR+ | LR− |
|---|---|---|---|---|---|
| Hughston et al. (1976) | NA | NA | NA | NA | NA |
CommentReverse pivot shift is a classic posterolateral corner test but can have false positives in lax individuals. It is more useful when combined with dial test, varus stress, and external rotation recurvatum findings. Standalone diagnostic accuracy is not robust.
Moderate Clinical Value