The tibial external rotation test for injury to the posterolateral corner

AbstractInjury to the posterolateral corner (PLC) of the knee can lead to both varus and rotational instability. Multiple PLC reconstruction techniques have been described, including one-tailed graft (fibula-based constructs) or two-tailed graft (combined fibula- and tibia-based constructs). The purpose of our study was to evaluate the clinical outcomes of anatomical two-tailed graft reconstruction of the PLC in the setting of multiligament knee injuries (MKLIs) with grade III varus instability. Patients were identified through a prospective MLKI database between 2004 and 2013. Patients who received fibular collateral ligament and PLC reconstructions using a two-tailed graft and had a minimum follow-up of 2 years were included. Patients were assessed for clinical laxity grade, range of motion, and functional outcomes using Lysholm and International Knee Documentation Committee (IKDC) scores. Twenty patients (16 male, 4 female) with a mean age of 30.7 (range: 16–52) and a mean follow-up of 52.2 months (range: 24–93 months) were included. Knee dislocation (KD) grades included: 4 KD-1, 10 KD 3-L, 5 KD-4, and 1 KD-5. No patients had isolated PLC injuries. Mean IKDC and Lysholm score were 73.1 ± 25.8 and 78 ± 26, respectively. Mean range of motion was –1.1 to 122.8. In full extension, two patients (10%) had grade 1 laxity to varus stress. In 30 degrees of knee flexion, five (25%) patients had grade 1 laxity, and two (10%) had grade 2 laxity. Anatomical two-tailed PLC reconstruction can reliably restore varus stability when performed on patients with MLKIs and type C posterolateral instability with hyperextension external rotation recurvatum deformity. Satisfactory functional outcome scores were achieved in the majority of patients. This study supports the use of an anatomical two-tailed PLC reconstruction in the multiligament injured knee. The level of evidence is IV, case series.

Download Full-text

Outcome of the treatment of chronic isolated and combined posterolateral corner knee injuries with 2- to 6-year follow-up

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967117s00078 ◽

2017 ◽

Vol 5 (2_suppl2) ◽

pp. 2325967117S0007

Author(s):

Gökay Görmeli ◽

Cemile Ayşe Görmeli ◽

Nurzat Elmalı ◽

Mustafa Karakaplan ◽

Kadir Ertem ◽

...

Keyword(s):

External Rotation ◽

Posterolateral Corner ◽

Anatomical Reconstruction ◽

Pivot Shift Test ◽

Reconstruction Technique ◽

Popliteus Tendon ◽

Knee Stability ◽

Stress Radiographs ◽

Significant Difference ◽

Varus Stress

Introduction: Injuries of the posterolateral corner (PLC) of the knee are rare. They are difficult to diagnose and can cause severe disability. This study presents the 20- to 70-month clinical and radiological outcomes of the anatomical reconstruction technique of LaPrade et al. Materials and methods Twenty-one patients with chronic PLC injuries underwent anatomical PLC reconstruction. The anatomical locations of the popliteus tendon, fibular collateral ligament, and popliteofibular ligament were reconstructed using a 2-graft technique. The patients were evaluated subjectively with the Tegner, Lysholm, and International Knee Documentation Committee (IKDC) subjective knee scores and objectively with the IKDC objective scores; additionally, varus stress radiographs were taken to evaluate knee stability. Results: Significant (p\0.05) improvements were observed in the postoperative Lysholm, IKDC-s, and Tegner scores compared with preoperatively. The IKDC objective subscores (lateral joint opening at 20_______________of knee extension, external rotation at 30_______________and 90_______________, and the reverse pivot-shift test) had improved significantly at the time of the final 40.9 ± 13.7-month follow-up.Lateralcompartment opening on the varus stress radiographs had decreased significantly in the postoperative period. However, there was still a significant difference compared with the uninjured knee. There was no significant improvement in the IKDC-s, Lysholm, or Tegner scores between the nine patients with isolated PLC injuries and twelve with multiligament injuries. Conclusions: Significant improvement in the objective knee stability scores and clinical outcomes with anatomical reconstruction showed that this technique can be used to treat patients with chronic PLC injured knees. However, longer-term multicentre studies and studies with larger groups comparing multiple techniques are required to determine the best treatment method for PLC injuries.

Download Full-text

Kinematics of the posterolateral corner of the knee: A human cadaveric cutting study.

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967117s00136 ◽

2017 ◽

Vol 5 (4_suppl4) ◽

pp. 2325967117S0013

Author(s):

Tobias Drenck ◽

Christoph Domnick ◽

Mirco Herbort ◽

Michael Raschke ◽

Karl-Heinz Frosch

Keyword(s):

Knee Flexion ◽

External Rotation ◽

Lateral Collateral Ligament ◽

Posterolateral Corner ◽

Clinical Diagnostics ◽

Popliteus Tendon ◽

Collateral Ligament ◽

Intact State ◽

Posterior Tibial ◽

Intact Knee

Aims and Objectives: The posterolateral corner of the knee consists of different structures, which contribute to instability when damaged after injury or within surgery. Knowing the kinematic influences may help to improve clinical diagnostics and surgical techniques. The purpose was to determine static stabilizing effects of the posterolateral corner by dissecting stepwise all fibers and ligaments (the arcuat complex, AC) connected with the popliteus tendon (PLT) and the influence on lateral stability in the lateral collateral ligament (LCL) intact-state. Materials ans Methods: Kinematics were examined in 13 fresh-frozen human cadaveric knees using a robotic/UFS testing system with an optical tracking system. The knee kinematics were determined for 134 N anterior/posterior loads, 10 Nm valgus/varus loads and 5 Nm internal/external rotational loads in 0°, 20°, 30°, 60° and 90° of knee flexion. The posterolateral corner structures were consecutively dissected: The I.) intact knee joint, II.) with dissected posterior cruciate ligament, III.) meniscofibular/-tibial fibers, IV.) popliteofibular ligament, V.) popliteotibial fascicle (last structure of static AC), VI.) PLT and VII.) LCL. Results: The external rotation angle increased significantly by 2.6° to 7.9° (P<.05) in 0° to 90° of knee flexion and posterior tibial translation increased by 2.9 mm to 5.9 mm in 20° to 90° of knee flexion (P<.05) after cutting the AC/PLT structures (with intact LCL) in contrast to the PCL deficient knee. Differences between dissected static AC and dissected PLT were only found in 60° and 90° external rotation tests (by 2.1° and 3.1°; P<.05). In the other 28 kinematic tests, no significant differences between PLT and AC were found. Cutting the AC/PLT complex did not further decrease varus, valgus or anterior tibial stability in any flexion angle in comparison to the PCL dissected state. Conclusion: The arcuat complex is an important static stabilizer for external rotatory and posterior tibial loads of the knee, even in the lateral collateral ligament intact-state. After dissecting the major parts of the arcuat complex, the static stabilizing function of the popliteus tendon is lost. The arcuat complex has no varus-stabilizing function in the LCL-intact knee. The anatomy and function of these structures for external-rotational and posterior-translational stabilization should be considered for clinical diagnostics and when performing surgery in the posterolateral corner.

Download Full-text

KINEMATIC DIFFERENCES IN LUMBOPELVIC AND HIP MOVEMENT PATTERNS DURING A LOWER LIMB MOVEMENT TEST BETWEEN TWO GROUPS OF PEOPLE WITH LOW BACK PAIN

Journal of Mechanics in Medicine and Biology ◽

10.1142/s0219519417500300 ◽

2017 ◽

Vol 17 (02) ◽

pp. 1750030 ◽

Cited By ~ 1

Author(s):

MEISSAM SADEGHISANI ◽

MOHAMMAD JAFAR SHATERZADEH ◽

MOHAMMAD TAGHI KARIMI ◽

FRANCIS FATOYE ◽

MARJAN AKBARI ◽

...

Keyword(s):

Low Back Pain ◽

Lower Limb ◽

External Rotation ◽

Movement Pattern ◽

Low Back ◽

Pelvic Rotation ◽

Rotation Test ◽

Lower Limb Movement ◽

Hip Rotation ◽

Movement Test

Increased lumbopelvic motion during limb movements’ tests was reported in low back pain (LBP) patients with and without rotational demand activities. The aim of this study was to compare lumbopelvic movement pattern between two groups of LBP patients with and without rotational demand activity during active hip external rotation test. A total of 39 patients with non-specific chronic LBP participated in this study. Patients were allocated into two groups, in first group 15 subjects (mean [Formula: see text] years) with rotational demand activities such as tennis, squash and golf, and in second group 24 subjects (mean [Formula: see text]) without rotational demand activities participated in current study. Kinematic data from lumbopelvic-hip region during active hip external rotation test (AHER) were collected by a 3D motion analysis system. Variables including range of motion (ROM) of hip external rotation, pelvic rotation, pelvic rotation during first half of hip rotation motion and timing of pelvic-hip movement were calculated by MATLAB software for both sides and after this, independent t-test was used to compare the variables between two groups of study. The mean lumbopelvic rotation in lower extremities tests for both sides and lumbopelvic rotation in the dominant limb external rotation test in the patients with rotational demand activities were significantly more than other group ([Formula: see text]). During dominant lower limb movement test, pelvic rotation in first half of movement and in patients with rotational activities was greater than in non-rotational group but hip rotation was statistically lesser than other group ([Formula: see text]). Other variables between the two groups were not significantly different ([Formula: see text]). The result of the study suggest that LBP patients who have rotational demand sports activities may move their lumbopelvic region in a greater magnitude during the AHER test than LBP people without rotational demand activities. Therefore, Lumbopelvic movement pattern in different groups of patients with LBP and based on their specific activities is different with each other.

Download Full-text

Clinical Significance of Ankle Arthroscopy in the Diagnosis of Type B Ankle Fracture Associated with the Distal Tibiofibular Syndesmosis Injury

Foot & Ankle Orthopaedics ◽

10.1177/2473011419s00350 ◽

2019 ◽

Vol 4 (4) ◽

pp. 2473011419S0035

Author(s):

Huang Qiang ◽

Xu Xiangyang

Keyword(s):

Internal Fixation ◽

Ankle Fracture ◽

External Rotation ◽

Ankle Arthroscopy ◽

Tibiofibular Syndesmosis ◽

Type B ◽

Rotation Test ◽

Distal Tibiofibular Syndesmosis ◽

Syndesmosis Injury ◽

Mri Diagnosis

Category: Arthroscopy, Trauma Introduction/Purpose: To investigate clinical significance of ankle arthroscopy in the diagnosis of type B ankle fracture associated with the distal tibiofibular syndesmosis injury. Methods: From February 2014 to December 2016, the authors diagnosed and treated 35 cases of type B ankle fractures. including 23 males and 12 females; with an average age of (43.05±12.480) years. Each patient underwent preoperative assessment: according to the patient’s clinical manifestations and imaging examination, and before the operation and after internal fixation of ankle fracture, the Cotton test and the external rotation test were done in the C arm X-ray, the initial diagnosis whether there is the distal tibiofibular syndesmosis injury. When the Cotton test and the external rotation test was used, Ankle arthroscopy was used to observe and evaluate whether there is the distal tibiofibular syndesmosis injury. For patients with the distal tibiofibular syndesmosis injury, In addition to the internal fixation of the ankle fracture, the TightRope was used to repair the injury. And observation of repair effect by ankle arthroscopy. Results: After internal fixation of ankle fracture, the Cotton test and the external rotation test was performed under the C arm X-ray, there were no the distal tibiofibular syndesmosis injury in 22 patients. Preoperative CT showed 6 cases of combined the distal tibiofibular syndesmosis injury, Preoperative MRI showed 13 cases of combined the distal tibiofibular syndesmosis injury. Ankle arthroscopy confirmed 11 cases of combined the distal tibiofibular syndesmosis injury. The sensitivity of ankle arthroscopy and MRI diagnosis combined with the distal tibiofibular syndesmosis injury was higher than that of CT sensitivity(P<0.05). The sensitivity of ankle arthroscopy for the diagnosis of the distal tibiofibular syndesmosis injury was weaker than that of MRI in the diagnosis of the distal tibiofibular syndesmosis injury (P<0.05). MRI diagnosis of the distal tibiofibular syndesmosis injury can be false positive. Conclusion: Ankle arthroscopy can directly observe the medial triangle ligament of the ankle, the distal tibiofibular syndesmosis injury, which provides the basis for correct diagnosis and treatment of Type B ankle fracture with the distal tibiofibular syndesmosis injury. And it can evaluate the stability of ankle after repairing the distal tibiofibular syndesmosis injury.

Download Full-text

Biomechanical Analysis of a Combined Double-Bundle Posterior Cruciate Ligament and Posterolateral Corner Reconstruction

The American Journal of Sports Medicine ◽

10.1177/0363546504268039 ◽

2005 ◽

Vol 33 (3) ◽

pp. 360-369 ◽

Cited By ~ 70

Author(s):

Jon K. Sekiya ◽

Marcus J. Haemmerle ◽

Kathryne J. Stabile ◽

Tracy M. Vogrin ◽

Christopher D. Harner

Keyword(s):

Posterior Cruciate Ligament ◽

External Rotation ◽

Cruciate Ligament ◽

Double Bundle ◽

Posterolateral Corner ◽

Biomechanical Analysis ◽

Popliteus Tendon ◽

Posterolateral Corner Reconstruction ◽

Intact Knee

Background Failure to address both components of a combined posterior cruciate ligament and posterolateral corner injury has been implicated as a reason for abnormal biomechanics and inferior clinical results. Hypothesis Combined double-bundle posterior cruciate ligament and posterolateral corner reconstruction restores the kinematics and in situ forces of the intact knee ligaments. Study Design Controlled laboratory study Methods Ten fresh-frozen human cadaveric knees were tested using a robotic testing system through sequential cutting and reconstructing of the posterior cruciate ligament and posterolateral corner. The knees were subjected to a 134-N posterior tibial load and a 5-N.m external tibial torque at multiple flexion angles. The double-bundle posterior cruciate ligament reconstruction was performed using Achilles and semitendinosus tendons. The posterolateral corner reconstruction consisted of reattaching the popliteus tendon to its femoral origin and reconstructing the popliteofibular ligament with a gracilis tendon. Results Under the posterior load, the combined reconstruction reduced posterior translation to within 1.2 - 1.5 mm of the intact knee. The in situ forces in the posterior cruciate ligament grafts were significantly less than those in the native posterior cruciate ligament at all angles except full extension. Conversely, the forces in the posterolateral corner grafts were significantly higher than those in the native structures at all angles. Under the external torque with the combined reconstruction, external rotation as well as in situ forces in the posterior cruciate ligament and posterolateral corner grafts were not different from the intact knee. Conclusions A combined posterior cruciate ligament and posterolateral corner reconstruction can restore intact knee kinematics at time zero. In situ forces in the intact posterior cruciate ligament and posterolateral corner were not reproduced by the reconstruction; however, the posterolateral corner reconstruction reduced the loads experienced by the posterior cruciate ligament grafts. Clinical Relevance By addressing both structures of this combined injury, this technique restores native kinematics under the applied loads at fixed flexion angles and demonstrates load sharing among the grafts creating a potentially protective effect against early failure of the posterior cruciate ligament grafts but with increased force in the posterolateral corner construct.

Download Full-text

The Resisted Supination External Rotation Test

The American Journal of Sports Medicine ◽

10.1177/0363546504273050 ◽

2005 ◽

Vol 33 (9) ◽

pp. 1315-1320 ◽

Cited By ~ 77

Author(s):

Thomas H. Myers ◽

Jason R. Zemanovic ◽

James R. Andrews

Keyword(s):

Physical Examination ◽

Predictive Value ◽

External Rotation ◽

Random Order ◽

Clinical History ◽

Clinical Test ◽

Level Of Evidence ◽

Rotation Test ◽

Supination External Rotation ◽

Anterior Posterior

Purpose To evaluate a new clinical test, the resisted supination external rotation test, for the diagnosis of superior labral anterior posterior lesions of the shoulder. Study Design Cohort study (diagnosis); Level of evidence, 2. Methods Forty athletes (average age, 23.9 years) with activity-related shoulder pain were enrolled in the study. The patients underwent 3 different tests designed specifically to detect superior labral anterior posterior lesions (the resisted supination external rotation test, the crank test, and the active compression test); the tests were performed in a random order on the affected shoulder. The results of the tests were compared with arthroscopic findings. Results Out of 40 athletes, 29 (72.5%) had superior labral anterior posterior tears. The resisted supination external rotation test had the highest sensitivity (82.8%), specificity (81.8%), positive predictive value (92.3%), negative predictive value (64.3%), and diagnostic accuracy (82.5%) of all tests performed. Conclusion By re-creating the peel-back mechanism, the resisted supination external rotation test is more accurate than 2 other commonly used physical examination tests designed to diagnose superior labral anterior posterior tears in overhead-throwing athletes. By using this test in the context of a thorough clinical history and physical examination, lesions of the superior labrum can be more reliably diagnosed.

Download Full-text

The external rotation test for syndesmosis ankle strain

Physical Diagnosis of Pain ◽

10.1016/b978-0-323-71260-6.00277-x ◽

2021 ◽

pp. 406

Author(s):

Steven D. Waldman

Keyword(s):

External Rotation ◽

Rotation Test

Download Full-text