Elimination of the pivot-shift sign after repair of an occult anterolateral ligament injury in an ACL-deficient knee

Several biomechanical studies have demonstrated the importance of the anterolateral ligament (ALL) in rotational instability of the knee.1,10,12,14 Despite this, the precise role of the ALL in eliminating the pivot shift remains controversial.9,11,13 This disparity exists secondary to the nature of cadaveric research and the subsequent creation of artificial injury patterns that are not a true representation of in vivo characteristics. This case report provides clinical evidence of the important role that the anterolateral structure plays in anterolateral rotational instability, as demonstrated by the pivot-shift sign.