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Lateral pivot shift (test of MacIntosh)


The subject lies supine with the hip flexed to about 30° and slightly medially rotated.The knee is extended. The examiner supports the patient’s leg, with one hand at the foot and the other at the knee, the thumb behind the fibular head.


The hand at the foot rotates the tibia internally, while the other hand exerts a mild
valgus stress at the knee. The examiner flexes the knee gradually, maintaining the internal rotation and valgus stress. In anterolateral rotatory instability the lateral tibial condyle will first subluxate anteriorly and, at approximately 30° of
flexion, reduce suddenly backwards. This posterior bouncing is seen and felt both by examiner and subject and indicates a positive test.

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