It was such an honour to be part of this superb faculty of the advanced knee course in Munich, with Karl-Heinz Frosch, Mathieu Thaunat and Atesch Ateschrang, and sharing my experience with ACL repair.
There were really engaging delegates with all their experience, and as always I learned something fundamental where the 'penny had never dropped' for me before - something that I had always questioned but for which I had never had a good answer. This was 'how can you have a 3+ positive pivot shift in external rotation - what causes that?' - and I heard the answer from Karl-Heinz Frosch in his lecture when he told us about the sling effect of the semimembranosus tendon slinging the medial side of the femur and providing stability. When this is damaged when the medial side has been injured you lose the sling effect and it then allows the femur to move abnormally on the tibia and you get a pivot with external rotation.
I also totally agree that a positive pivot shift in internal rotation is not possible with an isolated ACL rupture and only possible with combined ACL rupture and ALL (anterolateral ligament) lesion.
I am delighted to have heard the lectures and to have learned so much, and I am pleased that my live demonstration went so well! I showed a PCL repair using the internal brace technique and completed it in 15 minutes.
The other faculty members include Karl-Heinz Frosch, Mathieu Thaunat and Atesch Ateschrang.