The pivot-shift phenomenon: a clinical and biomechanical perspective

The current literature on the assessment, treatment and effect of the pivot shift is reviewed. Various questions pertaining to the cause of the pivot shift, the three-dimensional dynamic kinematics and the specific procedures required to reconstruct a knee that demonstrates the pivot shift are found to be unanswered. Biomechanical studies are presented, but it is unlikely that any research will be able to refute or reconcile all of the conflicting statements published in the literature, because of the notable differences in geometry, anatomy and soft tissue properties between different knees. However, there is scope for clarifying and explaining these results. (C) 1998 Elsevier Science B.V. All rights reserved.