Dial Test - Everything You Need To Know - Dr. Nabil

Dial Test
The Dial test is a clinical examination test that is performed to diagnose posterolateral instability due to posterolateral corner injury with or without posterior cruciate ligament injury (PCL injury). The three main structures of the posterolateral corner are the lateral collateral ligament, the popliteofibular ligament, and the popliteus tendon. Isolated injuries of the posterolateral corner are rare and often cause instability and varus thrust. By performing the Dial test, you can detect if there is an isolated or combined injury of the posterolateral corner of the knee. The combined injury with the posterior cruciate ligament injury is more than the combined injury with the anterior cruciate ligament injury. Failure to identify the posterolateral corner injury combined with injury to the ACL will lead to failure of ACL reconstruction. Therefore, it is important to properly diagnose this injury. Injury to the PCL should be suspected when there is a positive reverse pivot shift test and a negative posterior drawer test. This means that the posterolateral corner is injured, and the posterior cruciate ligament is not injured. There may be an avulsion fracture of the fibular called the arcuate fracture. Long standing radiographs are important to evaluate the alignment of the extremity. The patient may have a bony varus, but also ligamentous varus on top of the bony varus. The ligamentous varus can come from injury to the lateral collateral ligament (LCL) and an occult injury can be from the posterolateral corner. MRI is a great study to diagnose the posterolateral corner injury, and if there is a combined injury, especially the PCL. The dial test can be performed with the patient in the supine or the prone position. Both knees are put into the position of 30 degrees of flexion and 90 degrees of flexion. Some physicians prefer to perform the test in the prone position. Make sure that you support the thigh so that it does not move, especially if you are going to perform the test in the supine position. The tibia is passively externally rotated on the femur, and this is done by applying external rotation force to both feet. The amount of external rotation to both lower extremities is measured at both ankles. Testing of the injured extremity in 30 degrees of flexion is done to determine injury to the posterolateral corner. Flexion at the 90 degree angle will test the posterior cruciate ligament (PCL) for injury. 10 degrees of external rotation asymmetry at 30 degrees and 90 degrees of flexion of the knee is consistent with posterolateral corner (PLC) and posterior cruciate ligament (PCL) combined injury. An increase of external rotation at 30 degrees but no at 90 degrees of flexion indicates an isolated injury to the posterolateral corner (PLC). Proximal tibial osteotomy should be done for the bony varus of the knee before reconstruction of the posterolateral corner, otherwise this reconstruction will fail. You obtain long leg standing x0rays before surgery to check if the varus is primary or secondary.

[@masterhyohwan]

good imformation thanks

[@universeusa]

Doc, thanks a million for your educational videos.

[@molebasic]

Wonderful teacher!

[@laithhasm4380]

⛤🖒جزاك الله خير وكتب أجرك بالعلم النافع.

[@drha6646]

thanks sir! very helpful lecture

[@apnikilaas120]

Very helpful Sir thanks a lot😊

[@alien3143]

Simply superb

[@ahmedsrssamir8192]

Thanks

[@alberto-4642]

Thanks doc!

[@kuldipyadav4797]

Dhanyabad..sir

[@robinf9008]

I had LCL reconstruction because of posterlateral corner injury in feb 2018.. I still suffer from extreme pain, when bending knee slightly feels like a knife into my kneecap and when I walk the out corner where the lcl is, seems swollen still and hurts with each step. Doc says I will not recover 100% is there anything I can do?

[@هشامالقصبي-ي9د]

جميل اوى يادكتور ربنا يخليك

[@norapaley9168]

Very clear!