{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T23:26:43Z","timestamp":1781220403528,"version":"3.54.1"},"reference-count":29,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2024,9,11]],"date-time":"2024-09-11T00:00:00Z","timestamp":1726012800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["esskajournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Knee surg. sports traumatol. arthrosc."],"published-print":{"date-parts":[[2025,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>Posterior stress radiography is recommended to identify isolated or combined posterior cruciate ligament (PCL) deficiencies. The posterior drawer in internal (IR) or external rotation (ER) helps to differentiate between these combined instabilities. The purpose of this study was to evaluate posterior stress radiography (PSR) in isolated and combined PCL deficiency with IR and ER compared to PSR in neutral rotation (NR) for diagnosing combined PCL instabilities.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Six paired fresh\u2010frozen human cadaveric legs (<jats:italic>n<\/jats:italic>\u2009=\u200912) were mounted in a Telos device for PSR. The tibia was rotated using an attached foot apparatus capable of rotating the foot 30\u00b0 internally and externally. A posterior tibial load of 15\u2009kp (147.1\u2009N) was applied to the tibial tubercle at 90\u00b0 knee flexion, and a lateral radiograph was obtained. This was repeated with the foot in 30\u00b0 IR and ER. The PCL, posterolateral complex (PLC), and posteromedial complex (PMC) were sectioned in six knees, while the PMC was sectioned before the PLC in the other six knees. Posterior tibial displacement (PTD) was measured radiographically. Statistical analysis was performed using a two\u2010way ANOVA and a mixed model with Bonferroni correction, and the significance was set at <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.05. Furthermore, intra\u2010 and interobserver reliability was determined.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Cutting the PCL significantly increased the radiographic PTD by 9.8\u2009\u00b1\u20091.8\u2009mm (side\u2010to\u2010side difference compared to the intact state of the knee, <jats:italic>n<\/jats:italic>\u2009=\u200912; <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). This further increased to 12.2\u2009\u00b1\u20092.3\u2009mm (<jats:italic>n<\/jats:italic>\u2009=\u20096; <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.01) with an additional PLC deficiency and to 15.4\u2009\u00b1\u20093.4\u2009mm (<jats:italic>n<\/jats:italic>\u2009=\u20096; <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.05) with an additional PMC deficiency. A combined PLC and PMC deficiency resulted in an increase of the PTD to 15.9\u2009\u00b1\u20094.5\u2009mm (<jats:italic>n<\/jats:italic>\u2009=\u200912; <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.01). In the PCL\/PLC deficient state, ER did not demonstrate a higher PTD, compared to the NR and IR posterior drawer. In the PCL\/PMC deficient state in IR, PTD was 1.6\u2009\u00b1\u20090.7\u2009mm (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.01) higher compared to NR and 3.2\u2009\u00b1\u20091.9\u2009mm (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.05) higher compared to ER. We showed excellent intra\u2010 and interobserver reliability (0.987\u20130.997).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Combined PCL instabilities resulted in a significant increase in posterior tibial displacement in posterior stress radiographs. However, PSR in IR or ER was unable to differentiate between these combined instabilities. Based on our data, additional stress radiographs in rotation are unlikely to provide any diagnostic benefit in the clinical setting.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of Evidence<\/jats:title><jats:p>There is no level of evidence as this study was an experimental laboratory study.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ksa.12458","type":"journal-article","created":{"date-parts":[[2024,9,11]],"date-time":"2024-09-11T04:49:00Z","timestamp":1726030140000},"page":"1586-1593","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Combined PCL instabilities cannot be identified using posterior stress radiographs in external or internal rotation: A cadaveric study"],"prefix":"10.1002","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3220-285X","authenticated-orcid":false,"given":"Thorben","family":"Briese","sequence":"first","affiliation":[{"name":"Department of Trauma, Hand and Reconstructive Surgery University Hospital M\u00fcnster Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Romy","family":"Riemer","sequence":"additional","affiliation":[{"name":"Department of Trauma, Hand and Reconstructive Surgery University Hospital M\u00fcnster Germany"},{"name":"Marien Hospital Soest Academic Teaching Hospital of the University of M\u00fcnster M\u00fcnster Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adrian","family":"Deichsel","sequence":"additional","affiliation":[{"name":"Department of Trauma, Hand and Reconstructive Surgery University Hospital M\u00fcnster Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Peez","sequence":"additional","affiliation":[{"name":"Department of Trauma, Hand and Reconstructive Surgery University Hospital M\u00fcnster Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elmar","family":"Herbst","sequence":"additional","affiliation":[{"name":"Department of Trauma, Hand and Reconstructive Surgery University Hospital M\u00fcnster Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johannes","family":"Glasbrenner","sequence":"additional","affiliation":[{"name":"Department of Trauma, Hand and Reconstructive Surgery University Hospital M\u00fcnster Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael J.","family":"Raschke","sequence":"additional","affiliation":[{"name":"Department of Trauma, Hand and Reconstructive Surgery University Hospital M\u00fcnster Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8507-5735","authenticated-orcid":false,"given":"Christoph","family":"Kittl","sequence":"additional","affiliation":[{"name":"Department of Trauma, Hand and Reconstructive Surgery University Hospital M\u00fcnster Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,9,11]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.otsm.2010.08.001"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-020-06336-3"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1136\/jisakos-2016-000078"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-021-06590-z"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.3758\/BRM.41.4.1149"},{"key":"e_1_2_12_7_1","first-page":"1","volume-title":"Reliability of measurement. The design and analysis of clinical experiments","author":"Fleiss J.","year":"1986"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-023-07582-x"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1177\/0363546507306466"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.asmr.2022.05.013"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.ST.17.00044"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.3109\/17453677608992002"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11999-014-3470-8"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-006-0137-3"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-018-5228-4"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-015-3584-x"},{"key":"e_1_2_12_17_1","doi-asserted-by":"publisher","DOI":"10.1177\/0363546510396182"},{"key":"e_1_2_12_18_1","doi-asserted-by":"publisher","DOI":"10.1097\/JSA.0b013e3181f88527"},{"key":"e_1_2_12_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2005.07.028"},{"key":"e_1_2_12_20_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-021-06731-4"},{"key":"e_1_2_12_21_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12178-013-9162-2"},{"key":"e_1_2_12_22_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-021-06483-1"},{"key":"e_1_2_12_23_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-023-07547-0"},{"key":"e_1_2_12_24_1","doi-asserted-by":"publisher","DOI":"10.1177\/0363546506289433"},{"key":"e_1_2_12_25_1","doi-asserted-by":"publisher","DOI":"10.1177\/2325967121989252"},{"key":"e_1_2_12_26_1","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.G.01365"},{"key":"e_1_2_12_27_1","doi-asserted-by":"publisher","DOI":"10.1177\/0363546513486771"},{"key":"e_1_2_12_28_1","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.72B2.2312560"},{"key":"e_1_2_12_29_1","doi-asserted-by":"publisher","DOI":"10.1136\/jisakos-2018-000221"},{"key":"e_1_2_12_30_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-020-06337-2"}],"container-title":["Knee Surgery, Sports Traumatology, Arthroscopy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/esskajournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ksa.12458","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,19]],"date-time":"2025-10-19T10:22:32Z","timestamp":1760869352000},"score":1,"resource":{"primary":{"URL":"https:\/\/esskajournals.onlinelibrary.wiley.com\/doi\/10.1002\/ksa.12458"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,9,11]]},"references-count":29,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2025,5]]}},"alternative-id":["10.1002\/ksa.12458"],"URL":"https:\/\/doi.org\/10.1002\/ksa.12458","archive":["Portico"],"relation":{},"ISSN":["0942-2056","1433-7347"],"issn-type":[{"value":"0942-2056","type":"print"},{"value":"1433-7347","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,9,11]]},"assertion":[{"value":"2024-05-22","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-08-22","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-09-11","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}