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Does Physiologic Posterolateral Laxity Influence Clinical Outcomes of Anterior Cruciate Ligament Reconstruction?
Sung-Jae Kim, MD, PhD1; Duck-Hyun Choi, MD1; Yu Mei, MD1; Byoung-Yoon Hwang, MD1
1 Department of Orthopaedic Surgery and the Arthroscopy & Joint Research Institute, Yonsei University College of Medicine, 134 Shinchon-dong, Seodaemun-gu, Seoul 120-752, South Korea. E-mail address for B.-Y. Hwang: sogood95@hanmail.net
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Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. None of the authors, or their institution(s), have had any financial relationship, in the thirty-six months prior to submission of this work, with any entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. Also, no author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

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Investigation performed at the Arthroscopy and Joint Research Institute, Department of Orthopaedic Surgery, Yonsei University Health System, Seoul, South Korea

Copyright © 2011 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2011 Nov 02;93(21):2010-2014. doi: 10.2106/JBJS.J.01868
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The purpose of this retrospective study was to evaluate the influence of physiologic posterolateral rotatory laxity on anterior cruciate ligament (ACL) reconstruction in terms of anterior knee stability and clinical outcomes.


We retrospectively studied 113 patients who had undergone ACL reconstruction between June 2004 and August 2008. Patients were categorized into three groups according to the degree of tibial external rotation at 90° of knee flexion: Group 1 (<40°), Group 2 (40° to 50°), and Group 3 (≥50°). Ligament stability was determined with use of the Lachman test, the pivot-shift test, and KT-2000 arthrometer testing. Function was assessed with use of the Lysholm score and the International Knee Documentation Committee (IKDC) score. Clinical outcomes were determined from data obtained before surgery and at the twenty-four-month follow-up visit.


We observed differences in postoperative knee translation between the groups (p < 0.001). A post hoc test showed increased mean knee translation in Group 3 compared with Groups 1 and 2. The degree of external rotation at 90° was positively correlated with anterior knee translation (r = 0.428; p = 0.007). However, there was an inverse correlation with the Lysholm knee scores (r = −0.146; p = 0.015) and IKDC scores (r = −0.205; p = 0.003).


The stability and functional scores after ACL reconstruction had a negative correlation with the degree of external rotation of the tibia at 90° (physiologic posterolateral rotatory laxity). After ACL reconstruction, patients with ≥50° of tibial external rotation had increased anterior translation and worse functional outcomes in comparison with those who had <50° of tibial external rotation.

Level of Evidence: 

Prognostic Level II. Retrospective comparative study. See Instructions for Authors for a complete description of levels of evidence.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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