Reverse pivot shift test
With the knee in 90 degrees of flexion, hold the knee in maximal external rotation with a valgus stress. In a knee with posterolateral instability this will sublux the lateral tibial plateau behind the lateral femoral condyle.
As the knee is gently extended the lateral tibial plateau will reduce with a clunk as the iliotibial band moves from a flexor of the knee to an extensor. If the test is repeated with the foot held in internal rotation, the sign disappears.
A positive reverse pivot shift suggest that PCL, PLC, and the LCL are all torn.
1 Observations on rotatory instability of the lateral compartment of the knee: Experimental studies on the functional anatomy and pathomechanism of the true and reversed pivot shift sign. RP Jakob et al. Acta. Orthop. Scand. Suppl. Vol 191. 1981. p 1-32.
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