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The Journal of Bone and Joint Surgery, Vol 73, Issue 1 30-36, Copyright © 1991 by Journal of Bone and Joint Surgery, Inc
Tests for posterolateral instability of the knee in normal subjects. Results of examination under anesthesia
DE Cooper
Sports Medicine Service, Hospital for Special Surgery, Cornell University Medical Center, New York City.
An apparently normal knee was examined in each of 100 subjects while they
were under general or epidural anesthesia for an unrelated operation. The
Lachman, anterior drawer, posterior drawer, and pivot-shift tests were
negative in all knees. All knees were stable to varus and valgus stress at
both 0 and 30 degrees of flexion. The external-rotation recurvatum test
also was negative in all knees. A positive reversed pivot-shift sign was
present in 35 per cent of the knees, suggesting that it may not signify
abnormality, at least not without a negative test on the contralateral
knee. The results of the posterolateral drawer test were variable,
difficult to quantify, and did not always have a firm end-point. The amount
of maximum external rotation of the tibia, measured from the reference line
of the medial border of the foot, was extremely variable at both 30 and 90
degrees of flexion of the knee. External rotation, as determined by this
reference, was slightly greater (averaging 9 degrees) at 90 than at 30
degrees of flexion. The normal range of maximum external rotation of the
foot was 10 to 45 degrees at 30 degrees of flexion of the knee and 15 to 70
degrees at 90 degrees of flexion. The presence of a large angle of external
rotation and a positive reversed pivot-shift sign correlated strongly with
increased ligamentous laxity and mild varus alignment of the knee.
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