NDLI: A clinically relevant assessment of posterior cruciate ligament and posterolateral corner injuries. Evaluation of isolated and combined deficiency.

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A clinically relevant assessment of posterior cruciate ligament and posterolateral corner injuries. Evaluation of isolated and combined deficiency.

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A clinically relevant assessment of posterior cruciate ligament and posterolateral corner injuries. Evaluation of isolated and combined deficiency.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Sekiya, Jon K. Whiddon, David R. Zehms, Chad T. Miller, Mark D.
Description	Country affiliation: United States Author Affiliation: Sekiya JK ( Bone and Joint/Sports Medicine Institute, Naval Medical Center Portsmouth, Portsmouth, Virginia, USA. sekiya@umich.edu)
Abstract	BACKGROUND: The treatment of symptomatic posterior cruciate ligament injuries of the knee is controversial. Identification of concomitant injuries of the posterolateral corner is important to optimize surgical and clinical outcomes, although this diagnosis is sometimes difficult. The purpose of this study was to determine the physical examination and stress radiography parameters of isolated injuries of the posterior cruciate ligament and combined injuries of the posterior cruciate ligament and posterolateral corner. Our hypothesis was that Grade-3 posterior drawer laxity is an indicator of a concomitant injury of the posterolateral corner. METHODS: Ten pairs of cadaver knees (a total of twenty knees) were evaluated with posterior drawer testing, dial testing, and stress radiography. Stress radiography was performed by applying a 200-N posterior drawer at 90 degrees of knee flexion. The knees were tested while intact and then retested following the sequential resection of the posterior cruciate ligament followed by the posterolateral corner structures. RESULTS: All intact specimens were rated as Grade 0 on posterior drawer testing. Sectioning of the posterior cruciate ligament resulted in Grade-2 posterior drawer in all specimens. The additional resection of the posterolateral corner resulted in Grade-3 posterior drawer in all specimens. Dial testing of the intact knees resulted in a mean (and standard error) of 10.5 degrees +/- 1.0 degrees and 10.5 degrees +/- 0.80 degrees of external rotation at 30 degrees and 90 degrees, respectively. This increased significantly to 15.1 degrees +/- 1.1 degrees and 16.2 degrees +/- 0.89 degrees, respectively, following sectioning of the posterior cruciate ligament (p < 0.05). After resection of the posterolateral corner, rotation was further increased to a mean of 21.6 degrees +/- 1.5 degrees at 30 degrees and 27.5 degrees +/- 1.6 degrees at 90 degrees (p < 0.05). On stress radiography, the average posterior displacements measured 2.9 +/- 0.5 mm in the intact specimens, 12.7 +/- 1.0 mm after resection of the posterior cruciate ligament, and 22.3 +/- 1.6 mm after the additional resection of the posterolateral corner (p < 0.05). The corrected posterior displacement, calculated by subtracting the displacement in the intact knees, was 9.8 mm after resection of the posterior cruciate ligament and 19.4 mm after the additional resection of the posterolateral corner. CONCLUSIONS: A grade of 3 on posterior drawer testing and >10 mm of posterior tibial translation on stress radiography correlate with the presence of a posterolateral corner injury in addition to a complete disruption of the posterior cruciate ligament.
File Format	HTM / HTML
ISSN	00219355
Issue Number	8
Volume Number	90
e-ISSN	15351386
Journal	The Journal of Bone and Joint Surgery-American Volume
Language	English
Publisher	Lippincott Williams & Wilkins
Publisher Date	2008-08-01
Publisher Place	United States
Access Restriction	One Nation One Subscription (ONOS)
Subject Keyword	Discipline Orthopedic surgery Knee Injuries Physiopathology Posterior Cruciate Ligament Injuries Adult Aged Aged, 80 And Over Analysis Of Variance Biomechanical Phenomena Cadaver Female Humans Male Middle Aged Physical Examination Radiography Stress, Mechanical Journal Article Research Support, Non-u.s. Gov't Research Support, U.s. Gov't, Non-p.h.s.
Content Type	Text
Resource Type	Article
Subject	Orthopedics and Sports Medicine Surgery Sports Science

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