The Influence of Tibial Positioning on the Diagnostic Accuracy of Combined Posterior Cruciate Ligament and Posterolateral Rotatory Instability of the Knee

Abstract

BackgroundTo determine if tibial positioning affects the external rotation of the tibia in a dial test for posterolateral rotatory instability combined with posterior cruciate ligament (PCL) injuries.MethodsBetween April 2007 and October 2007, 16 patients with a PCL tear and posterolateral rotatory instability were diagnosed using a dial test. The thigh-foot angle was measured at both 30° and 90° of knee flexion with an external rotation stress applied to the tibia in 2 different positions (reduction and posterior subluxation). The measurements were performed twice by 2 orthopedic surgeons.ResultsIn posterior subluxation, the mean side-to-side difference in the thigh-foot angle was 11.56 ± 3.01° at 30° of knee flexion and 11.88 ± 4.03° at 90° of knee flexion. In the sequential dial test performed with the tibia reduced, the mean side-to-side difference was 15.94 ± 4.17° (p < 0.05) at 30° of knee flexion and 16.88 ± 4.42° (p = 0.001) at 90° of knee flexion. The mean tibial external rotation was 5.31 ± 2.86° and 6.87 ± 3.59° higher in the reduced position than in the posterior subluxation at both 30° and 90° of knee flexion.ConclusionsIn the dial test, reducing the tibia with an anterior force increases the ability of an examiner to detect posterolateral rotary instability of the knee combined with PCL injuries.

Posterolateral corner injuries of the knee

“…Veltri et al 30 suggested that external rotation at 30° may not be routinely reliable in detecting a combined injury to the ACL and posterolateral corner. More recently, Jung et al 31 showed that the extent of increased external rotation seen in the DIAL test depended on the amount of posterior tibial sag when the PCL was also injured. LaPrade, Thaun and Griffith 32 showed that the external rotation recurvatum test was only positive in patients with a posterolateral corner injury combined with an ACL deficiency.…”

Influence of knee flexion and femoral cross-pin insertion angle on posterolateral structures of the knee and lateral fixation lengths during ACL reconstruction

“…Soft tissue grafts for anterior cruciate ligament (ACL) reconstruction are widely used, and femoral cross-pin fixation is accepted as a good alternative option [1,10,11]. However, several factors must be considered during femoral fixation using this device.…”

Remnant Preservation is Helpful to Obtain Good Clinical Results in Posterior Cruciate Ligament Reconstruction: Comparison of Clinical Results of Three Techniques

“…The remaining PCL structures have the potential benefit of enhanced revascularization, preservation of proprioceptive function through the mechanoreceptors in the original PCL, as well as addition to the mechanical stability of the knee joint 11-14). In addition, the identification of concomitant injuries of the posterolateral corner (PLC) is important for optimizing the surgical and clinical outcomes 15-18)…”

“… 11 - 14) In addition, the identification of concomitant injuries of the posterolateral corner (PLC) is important for optimizing the surgical and clinical outcomes. 15 - 18) …”