A Seated Single-Person Dial-Test for Posterolateral Corner and Posterior Cruciate Ligament Knee Injuries

DOI: 10.4236/ojcd.2014.41004   PDF   HTML   XML   4,289 Downloads   5,665 Views  

Abstract

Background: Injuries to the posterolateral corner of the knee (PLC) can be difficult to diagnose and are often missed. The prone dial test can be difficult to perform in the acute setting and the supine dial test requires an assistant. Purpose: We present a simple single person seated dial test that can easily be performed in all patients with a suspected diagnosis of PLC injury. Study Design: Case Series. Method: The patient is seated on the edge of the examination couch with their knees flexed over the side and their calves pressed against the couch to reduce any posterior tibial subluxation. The patients’ knees are placed together ensuring the pelvis is square; the knees are at the same level, and the patellae are facing anteriorly. The patients place their hands against the side of their knees and hold their knees together in this position. The examiner then grasps the patient’s feet, approximates the medial malleoli and exerts a lateral rotational force at 30 and 90 degrees of knee flexion. Results: This test has 100% accuracy for diagnosing PLC injury in our institution. Conclusion: We present a sample to use alternative to traditional dial testing that does not require an assistant and also does not require the patient to be prone, thus limiting discomfort in the acute setting.


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Joseph, J. and Dearing, J. (2014) A Seated Single-Person Dial-Test for Posterolateral Corner and Posterior Cruciate Ligament Knee Injuries. Open Journal of Clinical Diagnostics, 4, 17-21. doi: 10.4236/ojcd.2014.41004.

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1] Bae, J.H., Choi, I.C., Suh, S.W., Lim, H.C., Bae, T.S., Nha, K.W. and Wang, J.H. (2008) Evaluation of the Reliability of the Dial Test for Posterolateral Rotatory Instability: A Cadaveric Study Using an Isotonic Rotation Machine. Arthroscopy: The Journal of Arthroscopic and Related Surgery, 24, 593-598. http://dx.doi.org/10.1016/j.arthro.2007.12.003
[2] Hughston, J.C. and Jacobson, K.E. (1985) Chronic Posterolateral Rotatory Instability of the Knee. The Journal of Bone & Joint Surgery. American Volume, 67, 351-359.
[3] Veltri, D.M. and Warren, R.F. (1995) Posterolateral Instability of the Knee. Instructional Course Lectures, 44, 441-453.
[4] Loomer, R.L. (1991) A Test for Knee Posterolateral Rotatory Instability. Clinical Orthopaedic Related Research, 264, 235-238.
[5] Jung, Y.B., Lee, Y.S., Jung, H.J. and Nam, C.H. (2009) Evaluation of Posterolateral Rotatory Knee Instability Using the Dial Test According to Tibial Positioning. Arthroscopy: The Journal of Arthroscopic and Related Surgery, 25, 257-261. http://dx.doi.org/10.1016/j.arthro.2008.10.007
[6] Alam, M., Bull, A.M.J., de Thomas, W.R. and Amis, A.A. (2011) Measurement of Rotational Laxity of the Knee. In Vitro Comparison of Accuracy between the Tibia, Overlying Skin, and Foot. The American Journal of Sports Medicine, 39, 2575-2581. http://dx.doi.org/10.1177/0363546511424872
[7] Hughston, J.C. and Norwood Jr., L.A. (1980) The Posterolateral Drawer Test and External Rotational Recurvatum Test for Posterolateral Instability of the Knee. ClinOrthop, 147, 82-87.
[8] Jakob, R.P., Hassler, H. and Staeubli, H.U. (1981) 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 Orthopaedica Scandinavica. Supplementum, 191, 1-32.
[9] Marx, R.G., Shindle, M.K. and Warren, R.F. (2009) Management of Posterior Cruciate Ligament Injury. Operative Techniques in Sports Medicine, 17, 162-166.
[10] DeLee, J.C., Rile, M.B. and Rockwood Jr., C.A. (1983) Acute Posterolateral Rotatory Instability of the Knee. The American Journal of Sports Medicine, 11, 199-207. http://dx.doi.org/10.1177/036354658301100403
[11] Gollehon, D.L., Torzilli, P.A. and Warren, R.F. (1987) The Role of the Posterolateral and Cruciate Ligaments in the Stability of the Human Knee: A Biomechanical Study. The Journal of Bone & Joint Surgery. American Volume, 69, 233-242.
[12] Grood, E.S., Stowers, S.F. and Noyes, F.R. (1988) Limits of Movement in the Human Knee: Effect of Sectioning the Posterior Cruciate Ligament and Posterolateral Structures. The Journal of Bone & Joint Surgery. American Volume, 70, 88-97.
[13] Shelbourne, K.D., Benedict, F., McCarrol, J.R. and Retting, A.C. (1989) Dynamic Posterior Shift: An Adjuvant in Evaluation of Posterior Tibial Subluxation. The American Journal of Sports Medicine, 17, 275-277. http://dx.doi.org/10.1177/036354658901700221
[14] Strauss, E.J., Ishak, C., Inzerillo, C., Walsh, M., Yildirim, G., Walker, P., Jazrawi, L. and Rosen, J. (2007) Effect of Tibial Positioning on the Diagnosis of Posterolateral Rotatory Instability in the Posterior Cruciate Ligament-Deficient Knee. British Journal of Sports Medicine, 41, 481-485. http://dx.doi.org/10.1136/bjsm.2006.030767
[15] Jung, Y.B., Nam, C.H., Jung, H.J., Lee, Y.S. and Ko, Y.B. (2009) The Influence of Tibial Positioning on the Diagnostic Accuracy of Combined Posterior Cruciate Ligament and Posterolateral Rotatory Instability of the Knee. Clinics OrthopSurg, 68-73.

  
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