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The necessity of clinical application of tibial reduction for detection of underestimated posterolateral rotatory instability in combined posterior cruciate ligament and posterolateral corner deficient knee

Abstract

Purpose

The purpose of this study was to evaluate the usefulness of tibial reduction during dial test for clinical detection of underestimated posterolateral rotatory instability (PLRI) in combined posterior cruciate ligament (PCL)–posterolateral corner (PLC) deficient knee in terms of external rotation laxity and clinical outcomes.

Methods

Twenty-one patients who classified as grade I PLRI using dial test with subluxated tibia, but classified as grade II with tibial reduction evaluated retrospectively. The mean follow-up was 39.3 months (range 24–61 months). Each patient was evaluated by the following variables: posterior translation and varus laxity on radiograph, KT-1000 arthrometer, dial test (reduced and subluxated position), International Knee Documentation Committee, Orthopädische Arbeitsgruppe Knie scoring system and Tegner activity scale.

Results

There were significant improvements in posterior tibial translation (8.6 ± 2.0 to 2.1 ± 1.0 mm; P < 0.001), varus laxity (3.3 ± 1.3 to 1.4 ± 0.5 mm; P < 0.001) and external rotation (13.2° ± 0.8° to 3.6° ± 1.1° at 30°, 13.3° ± 0.9° to 3.6° ± 0.9° at 90°; P < 0.001). The clinical scores were improved significantly at the last follow-up (P < 0.001). The external tibial rotation during dial test with tibial reduction increased from 6.8° ± 0.9 to 13.2° ± 0.8° at 30° of knee flexion, from 7.0° ± 0.8° to 13.3° ± 0.9° at 90° (P < 0.001).

Conclusions

The clinical application of reduction of posteriorly subluxated tibia during the dial test was essential for an appropriate treatment of underestimated PLRI in combined PCL–PLC deficient knee.

Level of evidence

Retrospective case series, Level IV.

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Fig. 1

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The authors declare that they have no conflict of interest.

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Correspondence to Yong-Beom Park.

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Lee, HJ., Park, YB., Ko, YB. et al. The necessity of clinical application of tibial reduction for detection of underestimated posterolateral rotatory instability in combined posterior cruciate ligament and posterolateral corner deficient knee. Knee Surg Sports Traumatol Arthrosc 23, 3062–3069 (2015). https://doi.org/10.1007/s00167-014-3138-7

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  • DOI: https://doi.org/10.1007/s00167-014-3138-7

Keywords

  • Posterior cruciate ligament
  • Posterolateral rotator instability
  • Dial test
  • Tibial reduction