BACKGROUND: Anterior cruciate ligament reconstruction does not necessarily restore normal knee movement. Increased tibial rotation has previously been noted during pivoting activities and may be due to the orientation of the anterior cruciate ligament graft associated with traditional single bundle reconstruction techniques. Recent research has shown that it is possible to limit rotation during level walking using a single bundle anterior cruciate ligament reconstruction. This study evaluated rotational knee kinematics during a pivot task in a group of patients who had undergone anterior cruciate ligament reconstruction using a single bundle technique and compared the findings to a normal control group. METHODS: In 27 anterior cruciate ligament reconstruction and 25 control participants, internal-external rotation was measured during a descend stairs and pivot task in a gait laboratory. FINDINGS: Results showed that the anterior cruciate ligament reconstruction patients had less internal tibial rotation (for both range of rotation and maximum rotation) than the control participants (effect size=0.7). INTERPRETATION: These results suggest that it is possible to limit rotation after anterior cruciate ligament reconstruction using a single bundle technique, even during a pivoting movement that places a high rotational load at the knee joint. The positioning of the femoral tunnel in a more anatomical position may be responsible for the reduced tibial rotation.