Advertisement

Stress Radiographs for Ligamentous Knee Injuries

      Abstract: Stress radiographs can provide an objective, quantifiable assessment of ligamentous knee injury. Commonly utilized techniques include varus, valgus, and posterior stress radiographs and can be used to augment findings on physical examination and magnetic resonance imaging. Both in vitro and in vivo studies have demonstrated reliability and validity of stress radiographs for diagnosing isolated and multiple ligament knee injuries. Varus stress radiographs are clinician applied at 20° flexion to detect injuries to the fibular collateral ligament and posterolateral corner. Valgus stress radiographs are clinician applied at 20° flexion to detect injuries to the medial collateral ligament or posteromedial corner. To evaluate the posterior cruciate ligament, posterior kneeling stress radiographs are obtained with the patient kneeling at 90° flexion on a firm platform. Bilateral radiographs are obtained and the side-to-side difference is compared to established criteria for injury severity. Stress radiographs support accurate diagnosis of complex knee injuries and also provide an objective measure of knee stability following ligament reconstruction. These imaging techniques can be performed in an ambulatory clinic setting with minimal additional equipment, and are thereby cost-effective, efficient, and support clinical decision-making in the treatment of complex knee injuries.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Arthroscopy
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      Bibliography

        • Jackman T.
        • LaPrade R.F.
        • Pontinen T.
        • Lender P.A.
        Intraobserver and interobserver reliability of the kneeling technique of stress radiography for the evaluation of posterior knee laxity.
        Am J Sports Med. 2008; 36: 1571-1576
        • Kane P.W.
        • Cinque M.E.
        • Moatshe G.
        • et al.
        Fibular collateral ligament: varus stress radiographic analysis using 3 different clinical techniques.
        Orthop J Sports Med. 2018; 6 (2325967118770170)
        • Kane P.W.
        • DePhillipo N.N.
        • Cinque M.E.
        • et al.
        Increased accuracy of varus stress radiographs versus magnetic resonance imaging in diagnosing fibular collateral ligament Grade III tears.
        Arthroscopy. 2018; 34: 2230-2235
        • LaPrade R.F.
        • Bernhardson A.S.
        • Griffith C.J.
        • Macalena J.A.
        • Wijdicks C.A.
        Correlation of valgus stress radiographs with medial knee ligament injuries: an in vitro biomechanical study.
        Am J Sports Med. 2010; 38: 330-338
        • LaPrade R.F.
        • Heikes C.
        • Bakker A.J.
        • Jakobsen R.B.
        The reproducibility and repeatability of varus stress radiographs in the assessment of isolated fibular collateral ligament and grade-III posterolateral knee injuries. An in vitro biomechanical study.
        J Bone Joint Surg Am. 2008; 90: 2069-2076