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Pivot Bearings

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Related Experiment Video

Updated: May 26, 2026

Method to Measure Tone of Axial and Proximal Muscle

Method to Measure Tone of Axial and Proximal Muscle

Published on: December 14, 2011

What does it take to have a high-grade pivot shift?

M Tanaka¹, D Vyas, G Moloney

¹Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, NY, USA.

Knee Surgery, Sports Traumatology, Arthroscopy : Official Journal of the ESSKA

|January 7, 2012

Summary

High-grade pivot shift in ACL-deficient knees is linked to lateral knee structures. Injuries to the lateral meniscus, capsule, and IT band, along with tibial plateau shape, contribute to this instability.

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Area of Science:

Orthopedic surgery
Sports medicine
Biomechanics of knee joint

Background:

The pivot shift test is crucial for diagnosing rotatory knee instability after anterior cruciate ligament (ACL) injury.
Understanding the anatomical basis of a high-grade pivot shift is essential for effective ACL reconstruction.

Purpose of the Study:

To identify the anatomical structures contributing to a high-grade pivot shift in ACL-deficient knees.
To explore the role of these structures in customizing ACL reconstruction strategies.

Main Methods:

Literature review of studies investigating the pivot shift phenomenon and associated knee anatomy.
Analysis of factors contributing to and potentially masking high-grade pivot shifts.

Main Results:

Disruption of lateral compartment secondary stabilizers (lateral meniscus, anterolateral capsule, IT band) contributes to high-grade pivot shift.
Lateral tibial plateau morphology (increased posterior slope, smaller size) also plays a role.
Medial compartment injury, MCL injury, patient guarding, and osteoarthritis can decrease the observed pivot shift grade.

Conclusions:

A high-grade pivot shift in ACL-deficient knees often indicates an incompetent lateral soft tissue envelope.
Concomitant injuries can lead to an underestimation of rotatory laxity when assessed by the pivot shift test.