Assessment of Pivot Shift Phenomenon Under Anesthesia in Anterior Cruciate Ligament-Deficient Knees

Background: The pivot shift phenomenon is a key indicator of rotational instability in ACL-deficient knees, typically assessed under anesthesia for diagnostic and surgical planning purposes. Objective: To determine the prevalence and grade of positive pivot shift tests under anesthesia in patients with confirmed ACL deficiency. Methods: A prospective study of 75 ACL-deficient patients (52 males, 23 females; mean age 28.5 years) was conducted at Jamalpur Medical College in 2023. Diagnoses were confirmed via clinical tests and MRI. An experienced orthopedic surgeon performed the pivot shift test under general anesthesia using a standardized technique. Grades were recorded per Noyes classification, along with reduction point and presence of clunk. Results: 68 patients (90.7%) showed a positive pivot shift: Grade I in 35 (51.5%), Grade II in 25 (36.8%), and Grade III in 8 (11.8%). Reduction commonly occurred at 20–30° knee flexion, with a clunk observed in 55 patients (80.9%). Seven patients (9.3%) showed no pivot shift. Conclusion: A high prevalence (90.7%) of positive pivot shift under anesthesia was observed, with most cases graded as mild to moderate. The test's reliability in evaluating rotational instability highlights its diagnostic and surgical planning value in ACL-deficient knees.