Knee ligament injuries: pivot shift test: practice question

A Orthopaedics question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Orthopaedics · Knee ligament injuries: pivot shift test

Sample item

An examiner extends the knee, applies a valgus force with internal rotation of the tibia and then flexes the knee. At about 30 degrees the patient feels a sudden clunk as the lateral tibial plateau reduces. Which diagnosis does this test support?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Anterior cruciate ligament deficiency

The pivot shift reproduces the anterolateral rotatory instability of an ACL-deficient knee: the tibia subluxes forward in extension and reduces with a clunk as the knee flexes. It is specific for ACL rupture and is best done without pain or guarding. A posterior sag and quadriceps active test assess the PCL.

Option by option

  • A. Patellar maltracking

    Patellar maltracking produces an apprehension or J sign instead.

  • B. Medial meniscus bucket-handle tear

    A bucket-handle tear causes locking and does not produce a rotatory subluxation.

  • C. Posterior cruciate ligament rupture

    A PCL rupture gives a posterior sag, not this clunk.

  • D. Anterior cruciate ligament deficiency (correct)

    Correct. The reduction clunk is the pivot shift of ACL deficiency.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Orthopaedics question

What is the answer to this Orthopaedics question?

The best answer is D, Anterior cruciate ligament deficiency. The pivot shift reproduces the anterolateral rotatory instability of an ACL-deficient knee: the tibia subluxes forward in extension and reduces with a clunk as the knee flexes.

Why is "Patellar maltracking" not the answer?

Patellar maltracking produces an apprehension or J sign instead.

Why is "Medial meniscus bucket-handle tear" not the answer?

A bucket-handle tear causes locking and does not produce a rotatory subluxation.

Why is "Posterior cruciate ligament rupture" not the answer?

A PCL rupture gives a posterior sag, not this clunk.

What concept does this question test?

It tests Knee ligament injuries: pivot shift test in Orthopaedics. It is specific for ACL rupture and is best done without pain or guarding. A posterior sag and quadriceps active test assess the PCL.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Knee ligament injuries: pivot shift test?

Pair each fracture with its classic complication and nerve injured. Then use the flashcards and the other Orthopaedics questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.