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The Journal of Bone and Joint Surgery, Vol 69, Issue 2 233-242, Copyright © 1987 by Journal of Bone and Joint Surgery, Inc
The role of the posterolateral and cruciate ligaments in the stability of the human knee. A biomechanical study
DL Gollehon, PA Torzilli and RF Warren
Injury to the posterolateral structures of the knee, including the
popliteus tendon and arcuate complex, frequently results in poorly
understood patterns of instability. To evaluate the static function of
these tissues, we used a mechanical testing apparatus that allowed five
degrees of freedom to test seventeen specimens from human cadavera at
angles of flexion that ranged from zero to 90 degrees. Selective section of
the lateral collateral ligament, popliteus-arcuate (deep) ligament complex,
anterior cruciate ligament, and posterior cruciate ligament was performed.
At all angles of flexion, the lateral collateral ligament and deep ligament
complex functioned together as the principal structures preventing varus
rotation and external rotation of the tibia, while the posterior cruciate
ligament was the principal structure preventing posterior translation.
However, at angles of flexion of 30 degrees or less, the amount of
posterior translation after section of only the lateral collateral ligament
and the deep structures was similar to that noted after isolated section of
the posterior cruciate ligament. Isolated section of the posterior cruciate
ligament did not affect varus or external rotation of the tibia at any
position of flexion of the knee. When the posterior cruciate ligament was
sectioned after the lateral collateral ligament and deep ligament complex
had been cut, a large increase in posterior translation and varus rotation
resulted at all angles of flexion. In addition, at angles of flexion of
more than 30 degrees, external rotation of the tibia also increased. The
application of internal tibial torque resulted in no increase in tibial
rotation after isolated section of the anterior cruciate ligament or
combined section of the lateral collateral ligament and deep ligament
complex. However, combined section of all three structures increased
internal rotation at 30 and 60 degrees of flexion. The increases in
external rotation that were produced by section of the lateral collateral
ligament and deep ligament complex were not changed by the addition of the
section of the anterior cruciate ligament.

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J. A. Recondo, E. Salvador, J. A. Villanúa, M. C. Barrera, C. Gervás, and J. M. Alústiza
Lateral Stabilizing Structures of the Knee: Functional Anatomy and Injuries Assessed with MR Imaging
RadioGraphics,
October 1, 2000;
20(90001):
91S - 102.
[Abstract]
[Full Text]
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F. S. Chen, A. S. Rokito, and M. I. Pitman
Acute and Chronic Posterolateral Rotatory Instability of the Knee
J. Am. Acad. Ortho. Surg.,
March 1, 2000;
8(2):
97 - 110.
[Abstract]
[Full Text]
[PDF]
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C. D. Harner, T. M. Vogrin, J. Hoher, C. B. Ma, and S. L-Y. Woo
Biomechanical Analysis of a Posterior Cruciate Ligament Reconstruction: Deficiency of the Posterolateral Structures as a Cause of Graft Failure
Am. J. Sports Med.,
January 1, 2000;
28(1):
32 - 39.
[Abstract]
[Full Text]
[PDF]
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D. E. Cooper
Snapping Popliteus Tendon Syndrome: A Cause of Mechanical Knee Popping in Athletes
Am. J. Sports Med.,
September 1, 1999;
27(5):
671 - 674.
[Abstract]
[Full Text]
[PDF]
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R. F. LaPrade, S. Resig, F. Wentorf, and J. L. Lewis
The Effects of Grade III Posterolateral Knee Complex Injuries on Anterior Cruciate Ligament Graft Force: A Biomechanical Analysis
Am. J. Sports Med.,
July 1, 1999;
27(4):
469 - 475.
[Abstract]
[Full Text]
[PDF]
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J. J. McDougall, W. R. Ferrell, and R. C. Bray
Neurogenic origin of articular hyperemia in early degenerative joint disease
Am J Physiol Regulatory Integrative Comp Physiol,
March 1, 1999;
276(3):
R745 - R752.
[Abstract]
[Full Text]
[PDF]
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H. A. Latimer, J. E. Tibone, N. S. ElAttrache, and P. J. McMahon
Reconstruction of the Lateral Collateral Ligament of the Knee With Patellar Tendon Allograft: Report of a New Technique in Combined Ligament Injuries
Am. J. Sports Med.,
September 1, 1998;
26(5):
656 - 662.
[Abstract]
[Full Text]
[PDF]
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C. D. Harner, J. Hoher, T. M. Vogrin, G. J. Carlin, and S. L-Y. Woo
The Effects of a Popliteus Muscle Load on In Situ Forces in the Posterior Cruciate Ligament and on Knee Kinematics: A Human Cadaveric Study
Am. J. Sports Med.,
September 1, 1998;
26(5):
669 - 673.
[Abstract]
[Full Text]
[PDF]
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J. R. Ritchie, J. A. Bergfeld, H. Kambic, and T. Manning
Isolated Sectioning of the Medial and Posteromedial Capsular Ligaments in the Posterior Cruciate Ligament-Deficient Knee: Influence on Posterior Tibial Translation
Am. J. Sports Med.,
May 1, 1998;
26(3):
389 - 394.
[Abstract]
[Full Text]
[PDF]
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R. J. Fox, C. D. Harner, M. Sakane, G. J. Carlin, and S. L.-Y. Woo
Determination of the In Situ Forces in the Human Posterior Cruciate Ligament Using Robotic Technology: A Cadaveric Study
Am. J. Sports Med.,
May 1, 1998;
26(3):
395 - 401.
[Abstract]
[Full Text]
[PDF]
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C. D. Harner and J. Hoher
Evaluation and Treatment of Posterior Cruciate Ligament Injuries
Am. J. Sports Med.,
May 1, 1998;
26(3):
471 - 482.
[Abstract]
[Full Text]
[PDF]
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Y.-F. Hsieh, L. F. Draganich, S. H. Ho, and B. Reider
The Effects of Removal and Reconstruction of the Anterior Cruciate Ligament on Patellofemoral Kinematics
Am. J. Sports Med.,
March 1, 1998;
26(2):
201 - 209.
[Abstract]
[Full Text]
[PDF]
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C. L. Eakin and W. D. Cannon Jr
Arthrometric Evaluation of Posterior Cruciate Ligament Injuries
Am. J. Sports Med.,
January 1, 1998;
26(1):
96 - 102.
[Abstract]
[Full Text]
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Y. Kaneda, H. Moriya, K. Takahashi, Y. Shimada, and T. Tamaki
Experimental Study on External Tibial Rotation of the Knee
Am. J. Sports Med.,
December 1, 1997;
25(6):
796 - 800.
[Abstract]
[PDF]
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M.L. Hull
Analysis of Skiing Accidents Involving Combined Injuries to the Medial Collateral and Anterior Cruciate Ligaments
Am. J. Sports Med.,
January 1, 1997;
25(1):
35 - 40.
[Abstract]
[PDF]
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F. R. Noyes and S. D. Barber-Westin
Surgical Restoration to Treat Chronic Deficiency of the Posterolateral Complex and Cruciate Ligaments of the Knee Joint
Am. J. Sports Med.,
July 1, 1996;
24(4):
415 - 426.
[Abstract]
[PDF]
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M. J. Maynard, Xianghua Deng, T. L. Wickiewicz, and R. F. Warren
The Popliteofibular Ligament: Rediscovery of a Key Element in Posterolateral Stability
Am. J. Sports Med.,
June 1, 1996;
24(3):
311 - 316.
[Abstract]
[PDF]
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D. M. Veltri, Xiang-Hua Deng, P. A. Torzilli, M. J. Maynard, and R. F. Warren
The Role of the Popliteofibular Ligament in Stability of the Human Knee: A Biomechanical Study
Am. J. Sports Med.,
January 1, 1996;
24(1):
19 - 27.
[Abstract]
[PDF]
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W. C. Burns II, L. F. Draganich, M. Pyevich, and B. Reider
The Effect of Femoral Tunnel Position and Graft Tensioning Technique on Posterior Laxity of the Posterior Cruciate Ligament-Reconstructed Knee
Am. J. Sports Med.,
July 1, 1995;
23(4):
424 - 430.
[Abstract]
[PDF]
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D. M. Veltri, X.-H. Deng, P. A. Torzilli, R. F. Warren, and M. J. Maynard
The Role of the Cruciate and Posterolateral Ligaments in Stability of the Knee: A Biomechanical Study
Am. J. Sports Med.,
July 1, 1995;
23(4):
436 - 443.
[Abstract]
[PDF]
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B. R. Bach JR, G. T. Jones, F. A. Sweet, and C. A. Hager
Arthroscopy-assisted Anterior Cruciate Ligament Reconstruction Using Patellar Tendon Substitution: Two- to Four-year Follow-up Results
Am. J. Sports Med.,
December 1, 1994;
22(6):
758 - 767.
[Abstract]
[PDF]
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P. A. Torzilli, Xianghua Deng, and R. F. Warren
The Effect of Joint-Compressive Load and Quadriceps Muscle Force on Knee Motion in the Intact and Anterior Cruciate Ligament-Sectioned Knee
Am. J. Sports Med.,
January 1, 1994;
22(1):
105 - 112.
[Abstract]
[PDF]
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D. C. Wascher, J. D. Grauer, and K. L. Markoff
Biceps tendon tenodesis for posterolateral instability of the knee: An in vitro study
Am. J. Sports Med.,
June 1, 1993;
21(3):
400 - 406.
[Abstract]
[PDF]
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F. R. Noyes, S. F. Stowers, E. S. Grood, J. Cummings, and L. A. VanGinkel
Posterior subluxations of the medial and lateral tibiofemoral compartments: An in vitro ligament sectioning study in cadaveric knees
Am. J. Sports Med.,
June 1, 1993;
21(3):
407 - 414.
[Abstract]
[PDF]
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S. L.-Y. Woo, J. M. Hollis, D. J. Adams, R. M. Lyon, and S. Takai
Tensile properties of the human femur-anterior cruciate ligament-tibia complex: The effects of specimen age and orientation
Am. J. Sports Med.,
June 1, 1991;
19(3):
217 - 225.
[Abstract]
[PDF]
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D. M. Daniel
Assessing the limits of knee motion
Am. J. Sports Med.,
March 1, 1991;
19(2):
139 - 147.
[Abstract]
[PDF]
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F. R. Noyes, J. F. Cummings, E. S. Grood, K. A. Walz-Hasselfeld, and R. R. Wroble
The diagnosis of knee motion limits, subluxations, and ligament injury
Am. J. Sports Med.,
March 1, 1991;
19(2):
163 - 171.
[Abstract]
[PDF]
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L. F. Draganich, B. Reider, and P. R. Miller
An in vitro study of the Muller anterolateral femorotibial ligament tenodesis in the anterior cruciate ligament deficient knee
Am. J. Sports Med.,
June 1, 1989;
17(3):
357 - 362.
[Abstract]
[PDF]
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B. R. Bach JR, R. F. Warren, and T. L. Wickiewicz
The pivot shift phenomenon: Results and description of a modified clinical test for anterior cruciate ligament insufficiency
Am. J. Sports Med.,
December 1, 1988;
16(6):
571 - 576.
[Abstract]
[PDF]
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