Skip to main content
SpringerLink
Log in

Correlation between the rotational degree of the dial test and arthroscopic and physical findings in posterolateral rotatory instability

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Diagnosing posterolateral rotatory instability (PLRI) is difficult because it occurs rarely, takes time to manifest, and no single definitive tool exists in diagnosing posterolateral corner injuries. We sought to evaluate the correlation between rotational degrees in the dial test and physical and arthroscopic findings that surgically verified PLRI in the knee joint. Patients (n = 67) who were diagnosed as having PLRI and received posterolateral reconstruction (n = 57) and repair (n = 10) from 1998 to 2006 were recruited. Preoperative physical findings were evaluated under anesthesia, and arthroscopic findings during surgeries were analyzed. A dial test with post-anesthesia (spinal or general) was conducted. We divided patients into three subgroups (A: <15°, B: 15–20°, and C: >20°), according to differences in rotational degrees in the dial test. All tests showed significant differences among the three groups and positive findings increased as the rotational degrees increased. No test showed a statistically significant difference in the specific group. All tests except for popliteal hiatus widening showed significant differences among the three groups and positive findings also increased as the rotational degrees increased. The total incidence and positive rate of each physical examination and the popliteal hiatus arthroscopic findings in PLRI significantly increased as the rotational degree in the dial test increased. The number of positive findings on physical examination was larger than the number of positive findings by arthroscopy in all three groups.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Albright JP, Brown AW (1998) Management of chronic posterolateral rotatory instability of the knee: surgical technique for the posterolateral corner sling procedure. Instr Course Lect 47:369–378

    CAS  PubMed  Google Scholar 

  2. Bae JH, Choi IC, Suh SW, Lim HC, Bae TS, Nha KW, Wang JH (2008) Evaluation of the reliability of the dial test for posterolateral rotatory instability: a cadaveric study using an isotonic rotation machine. Arthroscopy 24:593–598

    PubMed  Google Scholar 

  3. Bahk MS, Cosgarea AJ (2006) Physical examination and imaging of the lateral collateral ligament and posterolateral corner of the knee. Sports Med Arthrosc 14:12–19

    Article  PubMed  Google Scholar 

  4. Bolog N, Hodler J (2007) MR imaging of the posterolateral corner of the knee. Skeletal Radiol 36:715–728

    Article  PubMed  Google Scholar 

  5. Cooper DE (1991) Tests for posterolateral instability of the knee in normal subjects. Results of examination under anesthesia. J Bone Joint Surg Am 73:30–36

    CAS  PubMed  Google Scholar 

  6. Fanelli GC, Edson CJ (2004) Combined posterior cruciate ligament-posterolateral reconstructions with Achilles tendon allograft and biceps femoris tendon tenodesis: 2- to 10-year follow-up. Arthroscopy 20:339–345

    PubMed  Google Scholar 

  7. Ferrari DA (2005) Arthroscopic evaluation of the popliteus: clues to posterolateral laxity. Arthroscopy 21:721–726

    Article  PubMed  Google Scholar 

  8. Ferrari DA, Ferrari JD, Coumas J (1994) Posterolateral instability of the knee. J Bone Joint Surg Br 76:187–192

    CAS  PubMed  Google Scholar 

  9. Fineberg MS, Duquin TR, Axelrod JR (2008) Arthroscopic visualization of the popliteus tendon. Arthroscopy 24:174–177

    PubMed  Google Scholar 

  10. Gollehon DL, Torzilli PA, Warren RF (1987) The role of the posterolateral and cruciate ligaments in the stability of the human knee. A biomechanical study. J Bone Joint Surg Am 69:233–242

    CAS  PubMed  Google Scholar 

  11. Harner CD, Vogrin TM, Hoher J, Ma CB, Woo SL (2000) Biomechanical analysis of a posterior cruciate ligament reconstruction. Deficiency of the posterolateral structures as a cause of graft failure. Am J Sports Med 28:32–39

    CAS  PubMed  Google Scholar 

  12. Hassine D, Rougereau G, Feron JM, Henry-Feugeas MC, Fabre V, Sadik JC, Schouman-Claeys E (1994) MR imaging of posteromedial and posterolateral stabilisers of the knee: anatomic basis and patterns of lesions in knee injuries. Surg Radiol Anat 16:293–301

    Article  CAS  PubMed  Google Scholar 

  13. Hughston JC, Jacobson KE (1985) Chronic posterolateral rotatory instability of the knee. J Bone Joint Surg Am 67:351–359

    CAS  PubMed  Google Scholar 

  14. Jung YB, Jung HJ, Kim SJ, Park SJ, Song KS, Lee YS, Lee SH (2008) Posterolateral corner reconstruction for posterolateral rotatory instability combined with posterior cruciate ligament injuries: comparison between fibular tunnel and tibial tunnel techniques. Knee Surg Sports Traumatol Arthrosc 16:239–248

    Article  PubMed  Google Scholar 

  15. Jung YB, Jung HJ, Tae SK, Lee YS, Lee KH (2005) Reconstruction of the posterior cruciate ligament with a mid-third patellar tendon graft with use of a modified tibial inlay method. J Bone Joint Surg Am 87(Suppl 1):247–263

    Article  PubMed  Google Scholar 

  16. Jung YB, Jung HJ, Tae SK, Lee YS, Yang DL (2006) Tensioning of remnant posterior cruciate ligament and reconstruction of anterolateral bundle in chronic posterior cruciate ligament injury. Arthroscopy 22:329–338

    Article  PubMed  Google Scholar 

  17. Jung YB, Lee YS, Jung HJ, Nam CH (2009) Evaluation of posterolateral rotatory knee instability using the dial test according to tibial positioning. Arthroscopy 25:257–261

    Article  PubMed  Google Scholar 

  18. Kim JG, Ha JG, Lee YS, Yang SJ, Jung JE, Oh SJ (2009) Posterolateral corner anatomy and its anatomical reconstruction with single fibula and double femoral sling method: anatomical study and surgical technique. Arch Orthop Trauma Surg 129(3):381–385

    Article  PubMed  Google Scholar 

  19. Krukhaug Y, Molster A, Rodt A, Strand T (1998) Lateral ligament injuries of the knee. Knee Surg Sports Traumatol Arthrosc 6:21–25

    Article  CAS  PubMed  Google Scholar 

  20. LaPrade RF (1997) Arthroscopic evaluation of the lateral compartment of knees with grade 3 posterolateral knee complex injuries. Am J Sports Med 25:596–602

    Article  CAS  PubMed  Google Scholar 

  21. LaPrade RF, Gilbert TJ, Bollom TS, Wentorf F, Chaljub G (2000) The magnetic resonance imaging appearance of individual structures of the posterolateral knee. A prospective study of normal knees and knees with surgically verified grade III injuries. Am J Sports Med 28:191–199

    CAS  PubMed  Google Scholar 

  22. LaPrade RF, Heikes C, Bakker AJ, Jakobsen RB (2008) The reproducibility and repeatability of varus stress radiographs in the assessment of isolated fibular collateral ligament and grade-III posterolateral knee injuries. An in vitro biomechanical study. J Bone Joint Surg Am 90:2069–2076

    Article  PubMed  Google Scholar 

  23. LaPrade RF, Ly TV, Griffith C (2008) The external rotation recurvatum test revisited: reevaluation of the sagittal plane tibiofemoral relationship. Am J Sports Med 36:709–712

    Article  PubMed  Google Scholar 

  24. LaPrade RF, Resig S, Wentorf F, Lewis JL (1999) The effects of grade III posterolateral knee complex injuries on anterior cruciate ligament graft force. A biomechanical analysis. Am J Sports Med 27:469–475

    CAS  PubMed  Google Scholar 

  25. LaPrade RF, Wentorf F (2002) Diagnosis and treatment of posterolateral knee injuries. Clin Orthop Relat Res 402:110–121

    Article  PubMed  Google Scholar 

  26. LaPrade RF, Wentorf FA, Fritts H, Gundry C, Hightower CD (2007) A prospective magnetic resonance imaging study of the incidence of posterolateral and multiple ligament injuries in acute knee injuries presenting with a hemarthrosis. Arthroscopy 23:1341–1347

    Article  PubMed  Google Scholar 

  27. Loomer RL (1991) A test for knee posterolateral rotatory instability. Clin Orthop Relat Res 264:235–238

    PubMed  Google Scholar 

  28. Margheritini F, Mancini L, Mauro CS, Mariani PP (2003) Stress radiography for quantifying posterior cruciate ligament deficiency. Arthroscopy 19:706–711

    Article  PubMed  Google Scholar 

  29. Mariani PP, Margheritini F, Christel P, Bellelli A (2005) Evaluation of posterior cruciate ligament healing: a study using magnetic resonance imaging and stress radiography. Arthroscopy 21:1354–1361

    Article  PubMed  Google Scholar 

  30. Markolf KL, Graves BR, Sigward SM, Jackson SR, McAllister DR (2007) Effects of posterolateral reconstructions on external tibial rotation and forces in a posterior cruciate ligament graft. J Bone Joint Surg Am 89:2351–2358

    Article  PubMed  Google Scholar 

  31. Miller TT, Gladden P, Staron RB, Henry JH, Feldman F (1997) Posterolateral stabilizers of the knee: anatomy and injuries assessed with MR imaging. Am J Roentgenol 169:1641–1647

    CAS  Google Scholar 

  32. Noyes FR, Barber-Westin SD, Albright JC (2006) An analysis of the causes of failure in 57 consecutive posterolateral operative procedures. Am J Sports Med 34:1419–1430

    Article  PubMed  Google Scholar 

  33. Noyes FR, Dunworth LA, Andriacchi TP, Andrews M, Hewett TE (1996) Knee hyperextension gait abnormalities in unstable knees. Recognition and preoperative gait retraining. Am J Sports Med 24:35–45

    Article  CAS  PubMed  Google Scholar 

  34. Noyes FR, Stowers SF, Grood ES, Cummings J, VanGinkel LA (1993) Posterior subluxations of the medial and lateral tibiofemoral compartments. An in vitro ligament sectioning study in cadaveric knees. Am J Sports Med 21:407–414

    Article  CAS  PubMed  Google Scholar 

  35. O’Brien SJ, Warren RF, Pavlov H, Panariello R, Wickiewicz TL (1991) Reconstruction of the chronically insufficient anterior cruciate ligament with the central third of the patellar ligament. J Bone Joint Surg Am 73:278–286

    PubMed  Google Scholar 

  36. Pacholke DA, Helms CA (2007) MRI of the posterolateral corner injury: a concise review. J Magn Reson Imag 26:250–255

    Article  Google Scholar 

  37. Peduto AJ, Nguyen A, Trudell DJ, Resnick DL (2008) Popliteomeniscal fascicles: anatomic considerations using MR arthrography in cadavers. Am J Roentgenol 190:442–448

    Article  Google Scholar 

  38. Rajeswaran G, Lee JC, Healy JC (2007) MRI of the popliteofibular ligament: isotropic 3D WE-DESS versus coronal oblique fat-suppressed T2W MRI. Skelet Radiol 36:1141–1146

    Article  CAS  Google Scholar 

  39. Ross G, Chapman AW, Newberg AR, Scheller AD Jr (1997) Magnetic resonance imaging for the evaluation of acute posterolateral complex injuries of the knee. Am J Sports Med 25:444–448

    Article  CAS  PubMed  Google Scholar 

  40. Sekiya JK, Whiddon DR, Zehms CT, Miller MD (2008) A clinically relevant assessment of posterior cruciate ligament and posterolateral corner injuries. Evaluation of isolated and combined deficiency. J Bone Joint Surg Am 90:1621–1627

    Article  PubMed  Google Scholar 

  41. Staubli HU, Birrer S (1990) The popliteus tendon and its fascicles at the popliteal hiatus: gross anatomy and functional arthroscopic evaluation with and without anterior cruciate ligament deficiency. Arthroscopy 6:209–220

    Article  CAS  PubMed  Google Scholar 

  42. Veltri DM, Deng XH, Torzilli PA, Warren RF, Maynard MJ (1995) The role of the cruciate and posterolateral ligaments in stability of the knee. A biomechanical study. Am J Sports Med 23:436–443

    Article  CAS  PubMed  Google Scholar 

  43. Veltri DM, Warren RF (1995) Posterolateral instability of the knee. Instr Course Lect 44:441–453

    CAS  PubMed  Google Scholar 

  44. Vinson EN, Major NM, Helms CA (2008) The posterolateral corner of the knee. Am J Roentgenol 190:449–458

    Article  Google Scholar 

  45. Yu JS, Salonen DC, Hodler J, Haghighi P, Trudell D, Resnick D (1996) Posterolateral aspect of the knee: improved MR imaging with a coronal oblique technique. Radiology 198:199–204

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopedics, Inje University Seoul Paik Hospital, Seoul, Korea

    Jin Goo Kim, Young Jae Kim, Jeong Ku Ha, Sang Jin Yang & Soo Jin Oh

  2. Department of Orthopaedic Surgery, Korea University Ansan Hospital, 516 Gozan-dong, Danwon-gu, Ansan, 425-707, Korea

    Yong Seuk Lee

  3. Department of Radiology, Inje University Seoul Paik Hospital, Seoul, Korea

    Jae Chan Shim

  4. Department of Family Medicine, Inje University Seoul Paik Hospital, Seoul, Korea

    Hyun Ah Park

Authors
  1. Jin Goo Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yong Seuk Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Young Jae Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jae Chan Shim
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jeong Ku Ha
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hyun Ah Park
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Sang Jin Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Soo Jin Oh
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yong Seuk Lee.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kim, J.G., Lee, Y.S., Kim, Y.J. et al. Correlation between the rotational degree of the dial test and arthroscopic and physical findings in posterolateral rotatory instability. Knee Surg Sports Traumatol Arthrosc 18, 123–129 (2010). https://doi.org/10.1007/s00167-009-0850-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-009-0850-9

Keywords

Search

Navigation