Description of the Posterolateral Rotatory Drawer Maneuver for the Identification of Posterolateral Corner Injury

Abstract

Injury to the posterolateral corner (PLC) is difficult to diagnose; most lesions of this type are included within the context of complex knee injuries. Study of the posterolateral complex is growing in importance because of the complex instability generated by these injuries. Although various physical examination tests are described for the diagnosis of PLC lesions, in 72% of cases these lesions are not identified at their initial presentation, which shows the difficulty in both performing these tests and interpreting the results. The maneuver described in this report is performed by executing external rotation of the leg. With the thumb of the proximally positioned hand, the examiner evaluates the positioning of the lateral tibial plateau in relation to the femoral condyle. With this maneuver, in lesions of the PLC and particularly lesions of its external rotationerestricting structures, we observe external rotation of the tibia and posterior subluxation of the lateral tibial plateau that cause the anterior edge of the tibial plateau to be posteriorized in relation to the anterior edge of the lateral femoral condyle. The idea behind this maneuver is not to eliminate the use of other tests but, rather, to add it to a diagnostic arsenal that still has interpretation flaws.

Functional assessment of combined reconstruction of the anterior cruciate ligament and posterolateral corner with a single femoral tunnel: a two-year minimum follow-up

“…In addition to being difficult to treat, PLC injuries often also pass unnoticed [21] because of their difficult diagnosis [2,4]. In the United States, approximately 200,000 ACL reconstructions are performed annually, which implies a significant number of PLC reconstructions when we consider that 11 % of injuries are associated with these structures [11,19].…”

Extra-articular and transcutaneous migration of the poly- l / d -lactide interference screw after popliteal tendon reconstruction

“…The posterior and anterior drawer test were positive, as well as posterolateral tibial rotation and varus stress; therefore, posterior cruciate ligament (PCL), PC, and ACL lesions were diagnosed 9, 10…”

Physical Examination and Imaging Studies in Posterolateral Corner Injuries

“…Emphasis should be placed on a thorough physical examination, and MRI findings alone should not be the determinant for surgical intervention. [34][35][36] The PLC is best assessed using both the coronal and the axial sequences. 31 PLC injuries are characterized by posterolateral and lateral soft-tissue edema.…”