The effects of tibial rotation on posterior translation in knees in which the posterior cruciate ligament has been cut

Background: One of the most useful clinical tests for diagnosing an isolated injury of the posterior cruciate ligament is the posterior drawer maneuver performed with the knee in 90 degrees of flexion. Previously, it was thought that internally rotating the tibia during posterior drawer testing would decrease posterior laxity in a knee with an isolated posterior cruciate ligament injury. In this study, we evaluated the effects of internal and external tibial rotation on posterior laxity with the knee held in varying degrees of flexion after the posterior cruciate and meniscofemoral ligaments had been cut. Materials and Methods: Twenty cadaveric knees were used. Each knee was mounted in a fixture with six degrees of freedom, and anterior and posterior forces of 150 N were applied. The testing was conducted with the knee in 90 degrees, 60 degrees, 30 degrees, and 0 degrees of flexion with the tibia in neutral, internal, and external rotation. All knees were tested with the posterior cruciate and meniscofemoral ligaments intact and transected. Repeated-measures analysis of variance was used for statistical analysis. Results: At 30 degrees, 60 degrees, and 90 degrees of flexion, there was a significant increase in posterior laxity following transection of the posterior cruciate and meniscofemoral ligaments. At 60 degrees and 90 degrees of flexion, there was significantly less posterior laxity when the tibia was held in internal compared with external rotation. At 0 degrees and 30 degrees of flexion, there was no significant difference in posterior laxity when the tibia was held in internal compared with external rotation. Conclusions: After the posterior cruciate and meniscofemoral ligaments had been out, posterior laxity was significantly decreased by both internal and external rotation of the tibia. Internal tibial rotation resulted in significantly less laxity than external tibial rotation did at 60 degrees and 90 degrees of knee flexion. Clinical Relevance: An isolated injury of the posterior cruciate ligament is best detected when a posterior drawer test is performed with the knee in 90 degrees of flexion. Repeating this test with the tibia internally rotated will result in a substantial decrease in the amount of posterior laxity at 60 degrees and 90 degrees of knee flexion.