Background: We have devised a modified Pivot Shift test with which to assess ACL deficiency which does not require forced tibio-femoral subluxation. The test is scored on patient reaction to the initiation of the pivot shift without actually having to elicit that ‘shift’ which can be painful. We call the test the Pivot Apprehension test.

Methods: We retrospectively analysed a cohort of 81 patients who were potentially ACL deficient and sought orthopaedic intervention over a period of 3 years and correlate their initial ‘pivot apprehension’ score with the degree of ACL deficiency found at subsequent arthros-copy and/or MRI.

Results: Using contingency tables and Fishers Exact test we calculate that the test has a positive predictive value (for predicting ACL Rupture) of 94% (p=0.026) and a sensitivity of 89% (Specificity 60%). Linear Regression analysis shows a correlation coefficient (r) of 0.47 (p=0.0008).

Conclusion: The data we have collected in this study show that the ‘Pivot Apprehension Score’ is a clinical tool with a high positive predictive value for ACL injury which provides the same information as the Pivot shift test without having to cause painful tibio-femoral sub-luxation thus obviating the clinical need to elicit ‘pivot shift’ in the conscious patient.