Editorial Commentary: The Pivot-Shift Phenomenon Is Multifactorial

Abstract

The biomechanical study on the role of the anterior cruciate ligament and anterolateral structures in controlling internal tibial rotation has some major limitations: creation of a large injury to the anterolateral structures, examination only at 30° of flexion, only one outcome variable (internal rotation), and no application of different combined forces. This "worst-case scenario" does not represent the typical injury pattern, and therefore the results might overestimate the influence of these structures on rotatory laxity. Essentially, the pivot-shift phenomenon is multifactorial and injuries or insufficiency of the anterolateral structures are only one explanation.