Quantifying “the Look” of the Pivot Shift

  • Paulo H. AraujoEmail author
  • Bruno Ohashi
  • Maurício KfuriJr


The pivot-shift test is the most specific physical exam to detect the ACL insufficiency and the only manual test capable to predict the knee function and the development of osteoarthrosis after an ACL reconstruction. However, the lack of a standardized maneuver for the pivot-shift test makes the interpretation subjective and dependent on examiner’s experience.

Attempts to objectively measure the pivot-shift phenomenon have been made throughout the years. Quantifiable parameters of the pivot shift, such as the acceleration of the tibial reduction and the amount of lateral knee compartment translation, have been correlated to “the feeling” and to “the look” of the pivot shift, respectively.

The image analysis system was developed to quantify “the look” of the pivot shift, i.e., the anterior translation of the lateral tibial plateau during the pivot-shift phenomenon. This method consists in the analysis of video images, frame by frame, of the pivot-shift test taken from the lateral aspect of the knee using an ordinary digital camera.

In order to simplify the frame-by-frame processing of the video images and to obtain immediate quantitative results of the pivot-shift test, the image analysis system evolved to an iPad technology. From this application, automatic results of the pivot shift are collected in a graph curve, translation (millimeters) over time (seconds).

Both image analysis system and iPad technology consist in a simple, reliable, and accessible tool to measure “the look” of the pivot shift.


Pivot Shift International Knee Documentation Committee Anterior Tibial Translation Fibular Head Anterior Translation 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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Copyright information

© Springer International Publishing Switzerland 2017

Authors and Affiliations

  • Paulo H. Araujo
    • 1
    • 2
    Email author
  • Bruno Ohashi
    • 3
  • Maurício KfuriJr
    • 1
  1. 1.Department of Biomechanics, Medicine and Rehabilitation of Locomotor System - Ribeirao Preto Medical SchoolSão Paulo UniversityPittsburghUSA
  2. 2.Department of Orthopaedic SurgeryUniversity of PittsburghPittsburghUSA
  3. 3.Department of Orthopaedic SurgeryUniversity of PittsburghPittsburghUSA

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