Review ArticlesObjectifying the Pivot Shift TestHorvath, Alexandra MD*; Meredith, Sean J. MD†; Nishida, Kyohei MD, PhD‡; Hoshino, Yuichi MD, PhD‡; Musahl, Volker MD†Author Information *Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden †Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA ‡Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan Y.H., S.J.M., K.N., and A.H. carried out the literature review, and contributed to writing the manuscript. V.M. contributed to writing the manuscript. Disclosure: V.M. declares that he is codeveloper of an image analysis system analyzed with a tablet computer but the application does not receive financial revenue from this system. V.M. is a paid consultant for Smith and Nephew Orthopaedics and has received royalties from Springer. He is the deputy editor-in-chief for Knee Surgery, Sports Traumatology, Arthroscopy, a member of the International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine, and the Committee Chair of the ACL Study Group Program. The remaining authors declare no conflict of interest. Reprints: Alexandra Horvath, MD, Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, P.O. Göteborgsvägen 31, SE431 80 Mölndal, Sweden. Sports Medicine and Arthroscopy Review: June 2020 - Volume 28 - Issue 2 - p 36-40 doi: 10.1097/JSA.0000000000000260 Buy Metrics Abstract The pivot shift test is utilized for assessment of rotatory instability in the anterior cruciate ligament (ACL) deficient knee. There are multiple reports of the pivot shift maneuver, and there is a lack of consensus among clinicians as to a standardized maneuver. Measurement devices are a feasible option to evaluate rotatory knee instability, objectively or quantitatively. Traditionally, measurement systems have been invasive systems. More recently, electromagnetic system, inertial sensor, or imaging analysis systems, specifically with the utilization of a tablet computer, have emerged as noninvasive, and more importantly, validated options. It is important to recognize that anatomic structures other than the ACL contribute to rotatory knee stability. Addressing the tibial slope, anterolateral structures of the knee, specifically the iliotibial band, and menisci during ACL surgery may decrease residual pivot shift in an attempt to improve clinical outcomes and prevent reinjury. This review article describes the pivot shift maneuver, objective measurement tools, and clinical applications of the pivot shift test. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.