Evaluation of the Reliability of the Dial Test for Posterolateral Rotatory Instability: A Cadaveric Study Using an Isotonic Rotation Machine

Ji Hoon Bae, In Chul Choi, Seung-Woo Suh, Hong Chul Lim, Tae Soo Bae, Kyung Wook Nha, Joon Ho Wang

Research output: Contribution to journalArticle

37 Citations (Scopus)

Abstract

Purpose: The purpose of our study was to evaluate the reliability of the dial test by assessing the correlation between the severity of posterolateral corner injuries and the amount of external rotation of the tibia. Methods: Fourteen paired cadaveric legs were fixed into a custom-made isotonic rotation machine with the knee flexed at 30°. For group I (7 right knees), the lateral collateral ligament, popliteofibular ligament, popliteus tendon, and posterior cruciate ligament (PCL) were cut serially. For group II (7 left knees), the PCL, lateral collateral ligament, popliteofibular ligament, and popliteus tendon were cut. The external rotation angles were measured with a 6-Nm rotational torque. Results: For group I, the mean increase in the external rotation angle after cutting of the 3 posterolateral ligament structures was 17.9° ± 6.4°. The additional increase in mean external rotation after cutting of the PCL was 4.7° ± 2.1°. For group II, the mean increase in the external rotation angle after cutting of the PCL was 8° ± 4°. Cutting the 3 posterolateral ligament structures increased the external rotation by 10.7° ± 5.3°. The increase in external rotation was significant in group I after cutting of the 3 posterolateral structures and in group II after cutting of the PCL and 2 posterolateral structures (P = .05, Duncan test). Conclusions: The dial test may be a valuable diagnostic method in cases of injury to 3 posterolateral structures or combined injuries to the PCL and 2 posterolateral structures. However, posterolateral instability with injuries to only 1 or 2 posterolateral structures may not be clinically detected by the dial test. Clinical Relevance: In the case of posterolateral instability with only 1 or 2 structure injuries, comprehensive diagnostic methods including the patient's history, other physical examinations, radiographs, and magnetic resonance imaging should be used to diagnose posterolateral rotatory instability.

Original languageEnglish
Pages (from-to)593-598
Number of pages6
JournalArthroscopy - Journal of Arthroscopic and Related Surgery
Volume24
Issue number5
DOIs
Publication statusPublished - 2008 May 1

Fingerprint

Posterior Cruciate Ligament
Ligaments
Ankle Lateral Ligament
Wounds and Injuries
Knee
Tendons
Torque
Tibia
Physical Examination
Leg
Magnetic Resonance Imaging

Keywords

  • Anterior cruciate ligament
  • Dial test
  • Knee
  • Posterior cruciate ligament
  • Posterolateral rotatory instability

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Surgery

Cite this

Evaluation of the Reliability of the Dial Test for Posterolateral Rotatory Instability : A Cadaveric Study Using an Isotonic Rotation Machine. / Bae, Ji Hoon; Choi, In Chul; Suh, Seung-Woo; Lim, Hong Chul; Bae, Tae Soo; Nha, Kyung Wook; Wang, Joon Ho.

In: Arthroscopy - Journal of Arthroscopic and Related Surgery, Vol. 24, No. 5, 01.05.2008, p. 593-598.

Research output: Contribution to journalArticle

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abstract = "Purpose: The purpose of our study was to evaluate the reliability of the dial test by assessing the correlation between the severity of posterolateral corner injuries and the amount of external rotation of the tibia. Methods: Fourteen paired cadaveric legs were fixed into a custom-made isotonic rotation machine with the knee flexed at 30°. For group I (7 right knees), the lateral collateral ligament, popliteofibular ligament, popliteus tendon, and posterior cruciate ligament (PCL) were cut serially. For group II (7 left knees), the PCL, lateral collateral ligament, popliteofibular ligament, and popliteus tendon were cut. The external rotation angles were measured with a 6-Nm rotational torque. Results: For group I, the mean increase in the external rotation angle after cutting of the 3 posterolateral ligament structures was 17.9° ± 6.4°. The additional increase in mean external rotation after cutting of the PCL was 4.7° ± 2.1°. For group II, the mean increase in the external rotation angle after cutting of the PCL was 8° ± 4°. Cutting the 3 posterolateral ligament structures increased the external rotation by 10.7° ± 5.3°. The increase in external rotation was significant in group I after cutting of the 3 posterolateral structures and in group II after cutting of the PCL and 2 posterolateral structures (P = .05, Duncan test). Conclusions: The dial test may be a valuable diagnostic method in cases of injury to 3 posterolateral structures or combined injuries to the PCL and 2 posterolateral structures. However, posterolateral instability with injuries to only 1 or 2 posterolateral structures may not be clinically detected by the dial test. Clinical Relevance: In the case of posterolateral instability with only 1 or 2 structure injuries, comprehensive diagnostic methods including the patient's history, other physical examinations, radiographs, and magnetic resonance imaging should be used to diagnose posterolateral rotatory instability.",
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AU - Suh, Seung-Woo

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N2 - Purpose: The purpose of our study was to evaluate the reliability of the dial test by assessing the correlation between the severity of posterolateral corner injuries and the amount of external rotation of the tibia. Methods: Fourteen paired cadaveric legs were fixed into a custom-made isotonic rotation machine with the knee flexed at 30°. For group I (7 right knees), the lateral collateral ligament, popliteofibular ligament, popliteus tendon, and posterior cruciate ligament (PCL) were cut serially. For group II (7 left knees), the PCL, lateral collateral ligament, popliteofibular ligament, and popliteus tendon were cut. The external rotation angles were measured with a 6-Nm rotational torque. Results: For group I, the mean increase in the external rotation angle after cutting of the 3 posterolateral ligament structures was 17.9° ± 6.4°. The additional increase in mean external rotation after cutting of the PCL was 4.7° ± 2.1°. For group II, the mean increase in the external rotation angle after cutting of the PCL was 8° ± 4°. Cutting the 3 posterolateral ligament structures increased the external rotation by 10.7° ± 5.3°. The increase in external rotation was significant in group I after cutting of the 3 posterolateral structures and in group II after cutting of the PCL and 2 posterolateral structures (P = .05, Duncan test). Conclusions: The dial test may be a valuable diagnostic method in cases of injury to 3 posterolateral structures or combined injuries to the PCL and 2 posterolateral structures. However, posterolateral instability with injuries to only 1 or 2 posterolateral structures may not be clinically detected by the dial test. Clinical Relevance: In the case of posterolateral instability with only 1 or 2 structure injuries, comprehensive diagnostic methods including the patient's history, other physical examinations, radiographs, and magnetic resonance imaging should be used to diagnose posterolateral rotatory instability.

AB - Purpose: The purpose of our study was to evaluate the reliability of the dial test by assessing the correlation between the severity of posterolateral corner injuries and the amount of external rotation of the tibia. Methods: Fourteen paired cadaveric legs were fixed into a custom-made isotonic rotation machine with the knee flexed at 30°. For group I (7 right knees), the lateral collateral ligament, popliteofibular ligament, popliteus tendon, and posterior cruciate ligament (PCL) were cut serially. For group II (7 left knees), the PCL, lateral collateral ligament, popliteofibular ligament, and popliteus tendon were cut. The external rotation angles were measured with a 6-Nm rotational torque. Results: For group I, the mean increase in the external rotation angle after cutting of the 3 posterolateral ligament structures was 17.9° ± 6.4°. The additional increase in mean external rotation after cutting of the PCL was 4.7° ± 2.1°. For group II, the mean increase in the external rotation angle after cutting of the PCL was 8° ± 4°. Cutting the 3 posterolateral ligament structures increased the external rotation by 10.7° ± 5.3°. The increase in external rotation was significant in group I after cutting of the 3 posterolateral structures and in group II after cutting of the PCL and 2 posterolateral structures (P = .05, Duncan test). Conclusions: The dial test may be a valuable diagnostic method in cases of injury to 3 posterolateral structures or combined injuries to the PCL and 2 posterolateral structures. However, posterolateral instability with injuries to only 1 or 2 posterolateral structures may not be clinically detected by the dial test. Clinical Relevance: In the case of posterolateral instability with only 1 or 2 structure injuries, comprehensive diagnostic methods including the patient's history, other physical examinations, radiographs, and magnetic resonance imaging should be used to diagnose posterolateral rotatory instability.

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KW - Posterior cruciate ligament

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