Published in:
01-10-2015 | Knee
Posterior tibial translation resulting from the posterior drawer manoeuver in cadaveric knee specimens: a systematic review
Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 10/2015
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Purpose
The purpose of this systematic review of cadaver-based biomechanical studies is to accurately quantify how much posterior tibial translation occurs during posterior drawer testing in normal and PCL-deficient knees.
Methods
A search of the electronic databases, MEDLINE and EMBASE, was performed to identify relevant cadaveric studies that reported posterior tibial translation during posterior drawer testing. Studies were combined to determine overall increase in posterior tibial translation after PCL sectioning at 90° of flexion. Methodological quality of included studies was assessed by two reviewers using a novel clinometric tool. An intraclass correlation coefficient with 95 % confidence intervals (CIs) was used to determine agreement between reviewers on quality scores.
Results
Combined analysis of 244 cadaveric specimens from 23 studies in which the PCL was sectioned yielded a mean net increase in tibial translation of 10.7 mm (95 % CI 9.68–11.8) with posterior drawer testing. Posterior tibial translation among cadaveric specimens with no disruption to any ligamentous structures was found to be 5.4 mm (95 % CI 4.3–6.6).
Conclusions
Cadaveric data support previous study findings of >8 mm of posterior tibial translation on stress radiographs being indicative of isolated PCL insufficiency. Use of fixed reference points and strict control of tibial rotation are imperative to ensure accurate results in cadaveric studies and in the clinical setting when performing the posterior drawer examination.
Level of evidence
III.