ISAKOS Congress 2021

2021 ISAKOS Biennial Congress Paper


Comparative Assessment Between Physical Examination And Stress Radiography In Multigamentary Knee Injuries

Igor Pedrinha, MD, Rio De Janeiro, Rio de Janeiro BRAZIL
José Leonardo Rocha De Faria , MD, MSc, Rio De Janeiro, RJ BRAZIL
Marcos Castro Moreirão, MD, Petropolis, RJ BRAZIL
Douglas M. Pavão, MD, MSc, Petrópolis, RJ BRAZIL
RODRIGO S. PIRES E Albuquerque
Marcelo Mandarino, MD, Rio De Janeiro, Rio de Janeiro BRAZIL
Alan P. Mozella, Rio de Janeiro, RJ BRAZIL

National Institute of Traumatology and Orthopedics of Brazil, Rio de Janeiro, RJ, BRAZIL

FDA Status Not Applicable


Stress radiography is a useful and inexpensive tool, already widely used in the evaluation of knee ligament injuries. This study demonstrates the importance of performing this exam in patients with multi-ligaments injuries of the knee, as the physical exam is examiner dependent



This study aims to assess the reliability of the physical examination in the presence of stress radiography in multigamentary knee injuries. Stress radiography is a useful and inexpensive tool, already widely used in the evaluation of knee ligament injuries and the physical examination in this context can be complex and challenging.


In the face of injury to multiple knee ligaments, physical examination can be confusing and not always reliable. In this context, we assume that the radiograph with stress would present a certain disagreement with the examination of surgeons alone.

Materials And Methods

22 patients were summoned, physical examination performed by two surgeons on their knees alone without any imaging exam or prior knowledge of the diagnosis and then twelve radiographs with anterior, medial, lateral and posterior stress by manual force and their objective parameters evaluated and compared.


It was found that there is significant agreement in the surgical diagnosis of medial, lateral and posterior injury for surgeon 1 in relation to surgeon 2. In general, the agreement was of good degree. There was no significant agreement for the anterior cruciate ligament injury (p = 0.51). In 40.9% of the patients analyzed, there was agreement between the examiners of the diagnosis of the lesions as a whole and of this percentage, 55.5% correlated with the result of the radiography with stress.


The physical examination shows great interobserver disagreement and a certain disagreement with the stress radiography, showing low accuracy in this context of multiligament injuries, being imperative the use of the greatest number of different ways to better characterize the diagnosis and treatment schedule, such as radiography with stress, nuclear magnetic resonance and / or arthroscopy.

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