J Knee Surg 2015; 28(06): 435-440
DOI: 10.1055/s-0035-1559803
Special Focus Section
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Physical Examination and Imaging Studies in Posterolateral Corner Injuries

R. Kyle Martin
1   Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
,
Randa Berdusco
1   Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
,
Peter B. MacDonald
2   Section of Orthopaedics, University of Manitoba, Winnipeg, Manitoba, Canada
› Author Affiliations
Further Information

Publication History

19 May 2015

14 June 2015

Publication Date:
26 September 2015 (online)

Abstract

Posterolateral corner (PLC) knee injuries are relatively rare, but can lead to significant instability, dysfunction, and chronic knee pathologies. Early identification and timely management of PLC injuries is important to ensure that the best clinical outcomes are obtained. Appropriate use of physical examination tests and imaging studies is a crucial part of the initial assessment, allowing identification of all associated injuries and accurate preoperative planning. In this article, we will present an evidence-based approach for the initial assessment of PLC injuries by focusing on the physical examination and relevant imaging studies.

 
  • References

  • 1 Schulz MS, Russe K, Weiler A, Eichhorn HJ, Strobel MJ. Epidemiology of posterior cruciate ligament injuries. Arch Orthop Trauma Surg 2003; 123 (4) 186-191
  • 2 Harner CD, Höher J. Evaluation and treatment of posterior cruciate ligament injuries. Am J Sports Med 1998; 26 (3) 471-482
  • 3 Levy BA, Dajani KA, Whelan DB , et al. Decision making in the multiligament-injured knee: an evidence-based systematic review. Arthroscopy 2009; 25 (4) 430-438
  • 4 Howells NR, Brunton LR, Robinson J, Porteus AJ, Eldridge JD, Murray JR. Acute knee dislocation: an evidence based approach to the management of the multiligament injured knee. Injury 2011; 42 (11) 1198-1204
  • 5 DeLee JC, Riley MB, Rockwood Jr CA. Acute posterolateral rotatory instability of the knee. Am J Sports Med 1983; 11 (4) 199-207
  • 6 Malone AA, Dowd GSE, Saifuddin A. Injuries of the posterior cruciate ligament and posterolateral corner of the knee. Injury 2006; 37 (6) 485-501
  • 7 Magee DJ. Orthopedic Physical Assessment. St. Louis, MO: Elsevier; 2014
  • 8 Wind Jr WM, Bergfeld JA, Parker RD. Evaluation and treatment of posterior cruciate ligament injuries: revisited. Am J Sports Med 2004; 32 (7) 1765-1775
  • 9 Hughston JC, Andrews JR, Cross MJ, Moschi A. Classification of knee ligament instabilities. Part I. The medial compartment and cruciate ligaments. J Bone Joint Surg Am 1976; 58 (2) 159-172
  • 10 Lopez-Vidriero E, Simon DA, Johnson DH. Initial evaluation of posterior cruciate ligament injuries: history, physical examination, imaging studies, surgical and nonsurgical indications. Sports Med Arthrosc Rev 2010; 18 (4) 230-237
  • 11 Sekiya JK, Whiddon DR, Zehms CT, Miller MD. A clinically relevant assessment of posterior cruciate ligament and posterolateral corner injuries. Evaluation of isolated and combined deficiency. J Bone Joint Surg Am 2008; 90 (8) 1621-1627
  • 12 Daniel DM, Stone ML, Barnett P, Sachs R. Use of the quadriceps active test to diagnose posterior cruciate-ligament disruption and measure posterior laxity of the knee. J Bone Joint Surg Am 1988; 70 (3) 386-391
  • 13 Lee BK, Nam SW. Rupture of posterior cruciate ligament: diagnosis and treatment principles. Knee Surg Relat Res 2011; 23 (3) 135-141
  • 14 Hughston JC, Norwood Jr LA. The posterolateral drawer test and external rotational recurvatum test for posterolateral rotatory instability of the knee. Clin Orthop Relat Res 1980; (147) 82-87
  • 15 LaPrade RF, Ly TV, Griffith C. The external rotation recurvatum test revisited: reevaluation of the sagittal plane tibiofemoral relationship. Am J Sports Med 2008; 36 (4) 709-712
  • 16 Jakob RP, Hassler H, Staeubli HU. Observations on rotatory instability of the lateral compartment of the knee. Experimental studies on the functional anatomy and the pathomechanism of the true and the reversed pivot shift sign. Acta Orthop Scand Suppl 1981; 191: 1-32
  • 17 Lubowitz JH, Bernardini BJ, Reid III JB. Current concepts review: comprehensive physical examination for instability of the knee. Am J Sports Med 2008; 36 (3) 577-594
  • 18 Medina O, Arom GA, Yeranosian MG, Petrigliano FA, McAllister DR. Vascular and nerve injury after knee dislocation: a systematic review. Clin Orthop Relat Res 2014; 472 (9) 2621-2629
  • 19 Barnes CJ, Pietrobon R, Higgins LD. Does the pulse examination in patients with traumatic knee dislocation predict a surgical arterial injury? A meta-analysis. J Trauma 2002; 53 (6) 1109-1114
  • 20 Mills WJ, Barei DP, McNair P. The value of the ankle-brachial index for diagnosing arterial injury after knee dislocation: a prospective study. J Trauma 2004; 56 (6) 1261-1265
  • 21 Ko SH, Bandyk DF. Interpretation and significance of ankle-brachial systolic pressure index. Semin Vasc Surg 2013; 26 (2-3) 86-94
  • 22 LaPrade CM, Civitarese DM, Rasmussen MT, LaPrade RF. Emerging updates on the posterior cruciate ligament: a review of the current literature (e-pub ahead of print). Am J Sports Med 2015; ; doi: 10.1177/0363546515572770
  • 23 Schulz MS, Steenlage ES, Russe K, Strobel MJ. Distribution of posterior tibial displacement in knees with posterior cruciate ligament tears. J Bone Joint Surg Am 2007; 89 (2) 332-338
  • 24 Mariani PP, Margheritini F, Christel P, Bellelli A. Evaluation of posterior cruciate ligament healing: a study using magnetic resonance imaging and stress radiography. Arthroscopy 2005; 21 (11) 1354-1361
  • 25 Shindell R, Walsh WM, Connolly JF. Avulsion fracture of the fibula: the ‘arcuate sign’ of posterolateral knee instability. Nebr Med J 1984; 69 (11) 369-371
  • 26 Claes D, Vereecke E, Maes M, Victor J, Verdonk P, Bellemans J. Anatomy of the anterolateral ligament of the knee. J Anat 2013; 223 (4) 321-328
  • 27 Gottsegen CJ, Eyer BA, White EA, Learch TJ, Forrester D. Avulsion fractures of the knee: imaging findings and clinical significance. Radiographics 2008; 28 (6) 1755-1770
  • 28 Fischer SP, Fox JM, Del Pizzo W, Friedman MJ, Snyder SJ, Ferkel RD. Accuracy of diagnoses from magnetic resonance imaging of the knee. A multi-center analysis of one thousand and fourteen patients. J Bone Joint Surg Am 1991; 73 (1) 2-10
  • 29 Gross ML, Grover JS, Bassett LW, Seeger LL, Finerman GA. Magnetic resonance imaging of the posterior cruciate ligament. Clinical use to improve diagnostic accuracy. Am J Sports Med 1992; 20 (6) 732-737
  • 30 Polly Jr DW, Callaghan JJ, Sikes RA, McCabe JM, McMahon K, Savory CG. The accuracy of selective magnetic resonance imaging compared with the findings of arthroscopy of the knee. J Bone Joint Surg Am 1988; 70 (2) 192-198
  • 31 Hash II TW. Magnetic resonance imaging of the knee. Sports Health 2013; 5 (1) 78-107
  • 32 LaPrade RF, Gilbert TJ, Bollom TS, Wentorf F, Chaljub G. 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 2000; 28 (2) 191-199
  • 33 Ross G, Chapman AW, Newberg AR, Scheller Jr AD. Magnetic resonance imaging for the evaluation of acute posterolateral complex injuries of the knee. Am J Sports Med 1997; 25 (4) 444-448
  • 34 Devitt BM, Whelan DB. Physical examination and imaging of the lateral collateral ligament and posterolateral corner of the knee. Sports Med Arthrosc Rev 2015; 23 (1) 10-16
  • 35 Bonadio MB, Helito CP, Gury LA, Demange MK, Pécora JR, Angelini FJ. Correlation between magnetic resonance imaging and physical exam in assessment of injuries to posterolateral corner of the knee. Acta Ortop Bras 2014; 22 (3) 124-126
  • 36 Angelini FJ, Bonadio MB, Helito CP, da Mota E Albuquerque RF, Pécora JR, Camanho GL. Description of the posterolateral rotatory drawer maneuver for the identification of posterolateral corner injury. Arthrosc Tech 2014; 3 (2) e299-e302
  • 37 Chen FS, Rokito AS, Pitman MI. Acute and chronic posterolateral rotatory instability of the knee. J Am Acad Orthop Surg 2000; 8 (2) 97-110
  • 38 Becker EH, Watson JD, Dreese JC. Investigation of multiligamentous knee injury patterns with associated injuries presenting at a level I trauma center. J Orthop Trauma 2013; 27 (4) 226-231
  • 39 Sekiya JK, Swaringen JC, Wojtys EM, Jacobson JA. Diagnostic ultrasound evaluation of posterolateral corner knee injuries. Arthroscopy 2010; 26 (4) 494-499