The Accuracy of the Clinical Examination in the Setting of Posterior Cruciate Ligament Injuries

Abstract

Thirty-nine subjects volunteered for this blinded, randomized, and controlled study to assess the clinical examination skills of orthopaedic surgeons with fellowship training in sports medicine. Eighteen of the patients had 19 chronic isolated posterior cruciate ligament tears. The controls were 9 patients with 9 anterior cruciate ligament-deficient knees, 12 subjects with normal knees, and the contralateral normal knees of the ligament-deficient patients. To eliminate preexamination bias, all examiners were blinded from the examinee's history, identity, and diagnosis. The overall clinical examination accuracy for all orthopaedic surgeons was 96%. The accuracy for detecting a posterior cruciate ligament tear was 96%, with a 90% sensitivity and a 99% specificity. The examination accuracy was higher for grade II and III posterior laxity than for grade I laxity. Eighty-one percent of the time, the examiners agreed on the grade of the posterior cruciate ligament tear for any given patient. The posterior drawer test, which included palpation of the tibia-femur step-off, was the most sensitive and specific clinical test. A thorough and precise physical examination, coupled with a patient history, can be considered diagnostic in the majority of isolated posterior cruciate ligament injuries. With this accuracy level known, the natural history of isolated posterior cruciate ligament tears can be reliably documented and studied.

Role of High Tibial Osteotomy in Chronic Posterior Cruciate Ligament and Posterolateral Corner Knee Instability

“…Posterior Sag Sign (Barton et al, 1984;Mayo Robson, 1903) has 79% sensitivity and 100% specificity (Rubinstein et al, 1994). The patient lies in the supine position with both knees and hip at 90° of flexion while the examiner holds the heels of the patient and compares side by side the posterior translation of the tibia from a lateral view.…”

“…The patient lies in the supine position with both knees and hip at 90° of flexion while the examiner holds the heels of the patient and compares side by side the posterior translation of the tibia from a lateral view. -Posterior Drawer Test (Paessler & Michel, 1992;Strobel et al, 1990) has 90% sensitivity and 99% specificity (Rubinstein et al, 1994). The patient lies in the supine position, with the knee at 90° of flexion, the examiner sits on the foot of the patient and applies a posterior force on the anterior tibial shaft comparing side by side the posterior tibial translation.…”

“…The patient lies in the supine position, with the knee at 90° of flexion, the examiner sits on the foot of the patient and applies a posterior force on the anterior tibial shaft comparing side by side the posterior tibial translation. -Quadriceps contraction (Daniel et al, 1988) has 54% sensitivity and 97% specificity (Rubinstein et al, 1994). The patient lies in the supine position with the knee in the drawer position and is asked to slide the foot down the table, if a PCL lesion is present the tibia translates anteriorly more than 2 mm during quadriceps contraction.…”

Reliability and Diagnostic Accuracy of the Lachman Test Performed in a Prone Position

“…The palpatory loss of the tibia-femur step-off relationship has been shown to be a sensitive and specific means by which to detect the presence of a PCL injury. 24 The quadriceps active drawer test is performed by the patient gently contracting the quadriceps, with the knee flexed at 90° and the foot stabilized on the treatment plinth. The posterior displacement of the tibia will be reduced with this isometric contraction in the presence of a PCL tear.…”

“…This maneuver has been reported to have a specificity of 97% and a sensitivity of 54%. 24 All preliminary exclusion tests were performed by the examiner who first performed the stability assessment (J.H.L.) and were confirmed by the therapist with 30 years experience (E.P.M.…”