Diagnosis and Treatment of Rotatory Knee Instability

Overview

Journal J Exp Orthop

Publisher Wiley

Specialty Orthopedics

Date 2019 Dec 23

PMID 31865518

Citations 7

Authors

Jonathan D Hughes

Thomas Rauer

Christopher M Gibbs

Volker Musahl

Affiliations

Soon will be listed here.

Abstract

Background: Rotatory knee instability is an abnormal, complex three-dimensional motion that can involve pathology of the anteromedial, anterolateral, posteromedial, and posterolateral ligaments, bony alignment, and menisci. To understand the abnormal joint kinematics in rotatory knee instability, a review of the anatomical structures and their graded role in maintaining rotational stability, the importance of concomitant pathologies, as well as the different components of the knee rotation motion will be presented.

Main Body: The most common instability pattern, anterolateral rotatory knee instability in an anterior cruciate ligament (ACL)-deficient patient, will be discussed in detail. Although intra-articular ACL reconstruction is the gold standard treatment for ACL injury in physically active patients, in some cases current techniques may fail to restore native knee rotatory stability. The wide range of diagnostic options for rotatory knee instability including manual testing, different imaging modalities, static and dynamic measurement, and navigation is outlined. As numerous techniques of extra-articular tenodesis procedures have been described, performed in conjunction with ACL reconstruction, to restore anterolateral knee rotatory stability, a few of these techniques will be described in detail, and discuss the literature concerning their outcome.

Conclusion: In summary, the essence of reducing anterolateral rotatory knee instability begins and ends with a well-done, anatomic ACL reconstruction, which may be performed with consideration of extra-articular tenodesis in a select group of patients.

Citing Articles

The diagnostic accuracy of ultrasound in assessing anterior cruciate ligament tears: a systematic review and meta-analysis.

Schreiner G, Fucaloro S, Ward M, Krivicich L, Bragg J, Harkey M Skeletal Radiol. 2025; .

PMID: 39806120 DOI: 10.1007/s00256-025-04866-w.

Significant differences in knee kinematics of healthy subjects with high and low anterior tibial laxity.

Chen S, Chen S, Kang Q, Lin F, Zheng S, Liu X Front Bioeng Biotechnol. 2024; 12:1514516.

PMID: 39717532 PMC: 11664222. DOI: 10.3389/fbioe.2024.1514516.

[Imaging of the anterior cruciate ligament and anterolateral rotational instability of the knee joint].

Fritz B Radiologie (Heidelb). 2024; 64(4):261-270.

PMID: 38441595 PMC: 10973086. DOI: 10.1007/s00117-024-01278-0.

[Evaluation and diagnosis of knee joint diagonal lesion and surgical strategy and effectiveness].

Sun W, Li T, Li J, Xiong Y, Li J Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2022; 36(9):1090-1097.

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Evaluating the diagnostic pathway for acute ACL injuries in trauma centres: a systematic review.

Allott N, Banger M, McGregor A BMC Musculoskelet Disord. 2022; 23(1):649.

PMID: 35799147 PMC: 9261037. DOI: 10.1186/s12891-022-05595-0.

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