Clin Orthop Surg.  2009 Jun;1(2):68-73. 10.4055/cios.2009.1.2.68.

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

• Jung YB
• Nam CH
• Jung HJ
• Lee YS
• Ko YB

• KMID: 1122635
• DOI: http://doi.org/10.4055/cios.2009.1.2.68

Abstract

BACKGROUND: To 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.
METHODS
Between 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 30degrees and 90degrees 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.
RESULTS
In posterior subluxation, the mean side-to-side difference in the thigh-foot angle was 11.56 +/- 3.01degrees at 30degrees of knee flexion and 11.88 +/- 4.03degrees at 90degrees of knee flexion. In the sequential dial test performed with the tibia reduced, the mean side-to-side difference was 15.94 +/- 4.17degrees (p < 0.05) at 30degrees of knee flexion and 16.88 +/- 4.42degrees (p = 0.001) at 90degrees of knee flexion. The mean tibial external rotation was 5.31 +/- 2.86degrees and 6.87 +/- 3.59degrees higher in the reduced position than in the posterior subluxation at both 30degrees and 90degrees of knee flexion.
CONCLUSIONS
In 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.

Keyword

Posterolateral rotatory instability; Dial test; Thigh-foot angle

MeSH Terms

Adolescent
Adult
Biomechanics
Female
Humans
Joint Instability/*diagnosis/physiopathology
Knee Joint/*physiopathology
Male
Middle Aged
*Physical Examination
Posterior Cruciate Ligament/*injuries/physiopathology
Range of Motion, Articular
Tibia/*physiopathology
Young Adult

Figure

• 

  Fig. 1 Thigh-foot angle was measured with an external rotation stress applied to the tibia at both 30° and 90° of knee flexion. Before applying the torque, a neutral force (A) and anterior force (B) was applied to the tibia.

• 

  Fig. 2 Difference in thigh-foot angle between 30° and 90° of knee flexion. The difference was greater in the reduced position than in posterior subluxation during test.

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