Evaluation of posterolateral rotatory knee instability using the dial test according to tibial positioning.
OBJECTIVE
This study examined the effect of the anteroposterior (AP) direction force on the tibial external rotation of a posterior cruciate ligament (PCL)/posterolateral corner (PLC)-deficient knee in a clinical setting.


METHODS
Between December 2006 and December 2007, 21 patients with a PCL-PLC injury were assessed using a dial test. The thigh-foot angle (TFA) and patella-tubercle angle (PTA) were measured with an external rotation stress applied to the tibia at both 30 degrees and 90 degrees of knee flexion in 2 different positions (reduced and posterior subluxed). The test was performed with the patient in the supine position and with an AP force applied to the tibia by an assistant. To reduce intra- and interobserver bias, the measurements were taken twice by 2 orthopaedic surgeons for all patients.


RESULTS
In the subluxed position, the mean side-to-side differences in the TFA at 30 degrees and 90 degrees knee flexion were 12.6 degrees +/- 2.0 degrees and 12.3 degrees +/- 1.4 degrees , respectively. In the reduced position, the mean side-to-side differences in the TFA at 30 degrees and 90 degrees knee flexion were 18.4 degrees +/- 1.4 degrees and 18.5 degrees +/- 1.5 degrees , respectively. In the subluxed position, the mean side-to-side differences in the PTA at 30 degrees and 90 degrees knee flexion were 9.1 degrees +/- 0.8 degrees and 9.0 degrees +/- 0.7 degrees , respectively. In the reduced position, the mean side-to-side differences in the PTA at 30 degrees and 90 degrees knee flexion were 13.3 degrees +/- 0.6 degrees and 13.2 degrees +/- 0.6 degrees , respectively.


CONCLUSIONS
The reduction of a posteriorly subluxed knee increased the tibial external rotation (TFA and PTA) during the dial test of combined PCL-PLC injuries in a clinical setting. The accuracy of the dial test may help present surgeons from missing a combined PLC injury that should be corrected in a PCL deficient knee.


METHODS
Level I, testing of previously developed diagnostic criteria in series of consecutive patients.
Jung
Young-Bok
YB
Department of Orthopaedics, Chung-Ang University Medical Center, Seoul, Korea.
Lee
Yong Seuk
YS
Jung
Ho-Joong
HJ
Nam
Chang-Hyun
CH
D001696:Biomechanical Phenomena; D016025:Bone Transplantation; D006801:Humans; D007593:Joint Instability / Q000503:physiopathology* / Q000601:surgery*; D007719:Knee Joint / Q000502:physiology / Q000503:physiopathology* / Q000601:surgery; D010329:Patella / Q000601:surgery / Q000637:transplantation; D016119:Posterior Cruciate Ligament / Q000601:surgery* / Q000637:transplantation*; D011187:Posture; D016059:Range of Motion, Articular; D019651:Plastic Surgery Procedures / Q000379:methods*; D012399:Rotation; D013314:Stress, Mechanical; D013977:Tibia / Q000601:surgery*