The ACL posterolateral bundle is tightest in extension, when the pivot shift test is most provocative. Its reconstruction in double-bundle ACL surgery specifically addresses the rotational laxity that produces the pivot shift phenomenon, the anterolateral subluxation and sudden reduction of the lateral tibial plateau that produces the giving way sensation in ACL-deficient knees.
| Origin | Posterolateral portion of the ACL femoral footprint |
|---|---|
| Insertion | Posterolateral portion of the ACL tibial footprint |
| Actions |
|
|---|
Resists anterior translation and rotatory laxity of the tibia near full extension.
The pivot shift test (valgus, internal rotation of the leg while extending from flexion) primarily stresses the PL bundle. Residual pivot shift after single-bundle AM reconstruction explains persistent rotational instability in some patients. Adding an anterolateral ligament reconstruction (ALL reconstruction) or double-bundle surgery reduces pivot shift in high-demand athletes. In partial ACL tears with an intact PL bundle, selective augmentation that preserves the remaining bundle is an option.
PL bundle deficiency producing rotational instability addressed by anterolateral ligament reconstruction or double-bundle ACL surgery.
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