An apparatus for inserting a medical implant, comprising: a handle; an outer shaft extending from the handle along a shaft axis; an inner control shaft extending through the outer shaft along the shaft axis; an actuator disposed with the handle and cooperating with the inner control shaft to move the inner control shaft within the outer shaft in response to user manipulation of the actuator; and pivotable connection means disposed on the outer shaft opposite the handle and cooperating with the inner shaft to engage or release an implant, and to angularly position the implant with respect to the shaft axis in response to movement of the inner control shaft, said pivotable connection means including user selectable lock means for selectively locking an implant engaged thereon at a fixed angle relative to the shaft axis, wherein the inner control shaft is rotatable in response to user manipulation of the actuator and the pivotable connection means comprises: a pivot cage mounted on the outer shaft having an annular wall defining a central opening transverse to the outer shaft and a window opening in line with the outer shaft; a pivot head disposed within the central opening of the pivot cage, the pivot head being rotatable within the pivot cage central opening about an axis transverse to the outer shaft; and an attachment screw rotatably mounted in the pivot head and extending through said window opening along a screw axis, said attachment screw operatively connected to the inner shaft to permit rotational drive of the attachment screw through variable angles between the screw axis and shaft axis. a handle; an outer shaft extending from the handle along a shaft axis; an inner control shaft extending through the outer shaft along the shaft axis; an actuator disposed with the handle and cooperating with the inner control shaft to move the inner control shaft within the outer shaft in response to user manipulation of the actuator; and pivotable connection means disposed on the outer shaft opposite the handle and cooperating with the inner shaft to engage or release an implant, and to angularly position the implant with respect to the shaft axis in response to movement of the inner control shaft, said pivotable connection means including user selectable lock means for selectively locking an implant engaged thereon at a fixed angle relative to the shaft axis, wherein the inner control shaft is rotatable in response to user manipulation of the actuator and the pivotable connection means comprises: a pivot cage mounted on the outer shaft having an annular wall defining a central opening transverse to the outer shaft and a window opening in line with the outer shaft; a pivot head disposed within the central opening of the pivot cage, the pivot head being rotatable within the pivot cage central opening about an axis transverse to the outer shaft; and an attachment screw rotatably mounted in the pivot head and extending through said window opening along a screw axis, said attachment screw operatively connected to the inner shaft to permit rotational drive of the attachment screw through variable angles between the screw axis and shaft axis. a pivot cage mounted on the outer shaft having an annular wall defining a central opening transverse to the outer shaft and a window opening in line with the outer shaft; a pivot head disposed within the central opening of the pivot cage, the pivot head being rotatable within the pivot cage central opening about an axis transverse to the outer shaft; and an attachment screw rotatably mounted in the pivot head and extending through said window opening along a screw axis, said attachment screw operatively connected to the inner shaft to permit rotational drive of the attachment screw through variable angles between the screw axis and shaft axis.