Skip to main content
SpringerLink
Log in

Stress radiography to measure posterior cruciate ligament insufficiency: a comparison of five different techniques

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

Abstract

Stress radiography presents the golden standard to quantify posterior laxity in posterior cruciate ligament (PCL) insufficiency. Several different techniques are currently available, but comparative data are insufficient. Different stress radiographic techniques result in different values for posterior laxity. Comparative controlled clinical study was designed. Prior to PCL reconstruction 30 patients underwent a series of stress radiographs: Telos device, hamstring contraction, kneeling view, gravity view, and an axial view. Posterior displacement, side-to-side difference (SSD), condyle rotation, required time, and pain were measured. Posterior displacement was: Telos 12.7 ± 3 mm (SSD 10.6 ± 3.1 mm), hamstring contraction 11.2 ± 3.2 mm (SSD 8.5 ± 3.4 mm), kneeling 14.4 ± 3.8 mm (SSD 10.2 ± 3.5 mm), gravity view 10.5 ± 2.8 mm (SSD 9.1 ± 2.4 mm), and axial view 19.4 ± 6.9 mm (SSD 8.5 ± 4.1 mm). In comparison to Telos the hamstring contraction, gravity, and the axial view underestimated the SSD by approximately 2 mm. Telos and kneeling caused significantly more pain than all other techniques (P < 0.001). The axial view was fastest (115 s, P < 0.001) and Telos longest (305 s, P < 0.001), respectively. Telos indicated the lowest rotational error with a significant difference between kneeling and gravity (P < 0.003). In contrast to Telos as the golden standard, hamstring contraction, gravity, and axial view underestimated the SSD. Kneeling and Telos are comparable with respect to SSD and pain. Although kneeling indicates a greater rotational error than Telos, it seems to be a reliable alternative for quantifying posterior tibial displacement in a more simple and fast way.

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
Fig. 6

Similar content being viewed by others

References

  1. Boyer P, Djian P, Christel P, Paoletti X, Degeorges R (2004) [Reliability of the KT-1000 arthrometer (Medmetric) for measuring anterior knee laxity: comparison with Telos in 147 knees]. Rev Chir Orthop Reparatrice Appar Mot 8:757–764

    Google Scholar 

  2. Chassaing VDF, Touzard R et al (1995) Etude radiologique du L.C.P.`a 90 de flexion. Rev Chir Orthop 81:35–38

    Google Scholar 

  3. Daniel DM, Stone ML, Sachs R, Malcom L (1985) Instrumented measurement of anterior knee laxity in patients with acute anterior cruciate ligament disruption. Am J Sports Med 6:401–407

    Google Scholar 

  4. Hewett TE, Noyes FR, Lee MD (1997) Diagnosis of complete and partial posterior cruciate ligament ruptures. Stress radiography compared with KT-1000 arthrometer and posterior drawer testing. Am J Sports Med 5:648–655

    Google Scholar 

  5. Jacobsen K (1976) Stress radiographical measurement of the anteroposterior, medial and lateral stability of the knee joint. Acta Orthop Scand 3:335–4

    Google Scholar 

  6. Jardin C, Chantelot C, Migaud H, Gougeon F, Debroucker MJ, Duquennoy A (1999) [Reliability of the KT-1000 arthrometer in measuring anterior laxity of the knee: comparative analysis with Telos of 48 reconstructions of the anterior cruciate ligament and intra- and interobserver reproducibility]. Rev Chir Orthop Reparatrice Appar Mot 7:698–707

    Google Scholar 

  7. Louisia S, Siebold R, Canty J, Bartlett RJ (2005) Assessment of posterior stability in total knee replacement by stress radiographs: prospective comparison of two different types of mobile bearing implants. Knee Surg Sports Traumatol Arthrosc 6:476–482

    Article  Google Scholar 

  8. Margheritini F, Mancini L, Mauro CS, Mariani PP (2003) Stress radiography for quantifying posterior cruciate ligament deficiency. Arthroscopy 7:706–711

    Article  Google Scholar 

  9. Passler HH, Marz S (1986) [The radiologic Lachman test—a simple and sure method for the detection of damage to the cruciate ligament]. Unfallchirurgie 6:295–300

    Google Scholar 

  10. Puddu GGE, Chambat P, Paulis F (2000) The axial view in evaluating tibial translation in cases of insufficiency of the posterior cruciate ligament. Arthroscopy 16:217–220

    Article  PubMed  CAS  Google Scholar 

  11. Schulz MS, Russe K, Lampakis G, Strobel MJ (2005) Reliability of stress radiography for evaluation of posterior knee laxity. Am J Sports Med 4:502–506

    Article  Google Scholar 

  12. Staubli HU, Jakob RP (1990) Posterior instability of the knee near extension. A clinical and stress radiographic analysis of acute injuries of the posterior cruciate ligament. J Bone Joint Surg Br 2:225–230

    Google Scholar 

  13. Staubli HU, Noesberger B, Jakob RP (1992) Stressradiography of the knee. Cruciate ligament function studied in 138 patients. Acta Orthop Scand Suppl 249:1–27

    PubMed  CAS  Google Scholar 

  14. Stedtfeld HW, Strobel M (1983) Choice of suitable measurement procedures for stress roentgen images of the knee joint. Unfallheilkunde 11:463–471

    Google Scholar 

  15. Strobel M, Stedtfeld HW (1986) Stress roentgen study of the knee joint–an evaluation of status. Unfallchirurg 6:272–279

    Google Scholar 

  16. Strobel MJ, Weiler A, Eichhorn HJ (2000) Diagnosis and therapy of fresh and chronic posterior cruciate ligament lesions. Chirurg 9:1066–1081

    Article  Google Scholar 

  17. Strobel MJ, Weiler A (2001) Management of the posterior cruciate ligament-deficient knee. Tech Orthop 2:167–194

    Article  Google Scholar 

  18. Strobel MJ, Weiler A, Schulz MS, Russe K, Eichhorn HJ (2002) Fixed posterior subluxation in posterior cruciate ligament-deficient knees: diagnosis and treatment of a new clinical sign. Am J Sports Med 1:32–38

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Sports Traumatology & Arthroscopy Service, Center for Musculoskeletal Surgery, Charité, Campus Virchow-Klinikum, Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany

    Tobias M. Jung, Carsten Reinhardt, Sven U. Scheffler & Andreas Weiler

Authors
  1. Tobias M. Jung
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Carsten Reinhardt
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sven U. Scheffler
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Andreas Weiler
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Andreas Weiler.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Jung, T.M., Reinhardt, C., Scheffler, S.U. et al. Stress radiography to measure posterior cruciate ligament insufficiency: a comparison of five different techniques. Knee Surg Sports Traumatol Arthrosc 14, 1116–1121 (2006). https://doi.org/10.1007/s00167-006-0137-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-006-0137-3

Keywords

Search

Navigation