. 2021 Oct 10;142(12):3721–3736. doi: 10.1007/s00402-021-04200-8

Table 3.

Description of studies analyzing medial collateral ligament injury with stress radiography

References	Patient knees/controls	Age (mean, range)	X-ray method	Medial joint space opening/main findings	Intraobserver/interobserver reliability	Sensitivity (%)/specificity (%)	PPV/NPV
Jacobsen et al. 1977 (PS) [25]	153/151	n.r., 13–67	Bilateral comparison with simultaneous stress at 20° flexion (9 kg)	Match between stress radiography and operative findings (not defined), medial gap difference of 2.0 mm was defined an upper limit: 63 of 89 cases true positive, 21 of 89 cases true negative, 0 of 89 cases false positive, 5 of 89 cases false negative	n.r./n.r	93/100^a	1.00/0.81^a
Sawant et al. 2004 (PS) [37]	23/23	33, 17–50	Bilateral comparison with simultaneous stress	MCL injury: Mean overall injuries: 16.0 mm, range: 10.0—29.0 mm Mean isolated MCL injury: 15.0 mm, range: 10.0—18.0 mm Mean combined MCL with ACL/PCL injury: 17.0 mm, range: 10.0—29.0 mm Mean control group: 8.0 mm, range: 5.0—11.0 mm	0.96/0.95	94/86^b	0.94/0.86^b
LaPrade et al. 2010 (CS) [26]	18/–	76, 66–86	a.p. radiographs at 0° and 20° knee FL with a fluoroscopy C-arm, clinical valgus and 10Nm two cutting sequences: 1. intact—proximal sMCL—MF—POL—distal sMCL—MT—ACL—PCL 2. intact—distal sMCL—MT—proximal sMCL—MF—POL—PCL—ACL	Sectioning of proximal sMCL: Increase of MG by 1.5 mm (at 0° knee FL) and 3.2 mm (20° knee FL) in clinical examination Sectioning of distal sMCL: Increase of MG by 2.0 mm (at 0° knee FL) and 3.1 mm (20° knee FL) in clinical examination 1. Complete meniscofemoral injury without cruciate ligament: increase of MG by 4.3 mm (at 0° knee FL) and 6.7 mm (20° knee FL) in clinical examination 2. Complete meniscotibial injury without cruciate ligament: Increase of MG by 3.6 mm (at 0° knee FL) and 5.4 mm (20° knee FL) in clinical examination	0.99/0.98	n.r./n.r	n.r./n.r

References

Patient knees/controls

Age (mean, range)

X-ray method

Medial joint space opening/main findings

Intraobserver/interobserver reliability

Sensitivity (%)/specificity (%)

PPV/NPV

Jacobsen et al. 1977 (PS) [25]

153/151

n.r., 13–67

Bilateral comparison with simultaneous stress at 20° flexion (9 kg)

Match between stress radiography and operative findings (not defined), medial gap difference of 2.0 mm was defined an upper limit:

63 of 89 cases true positive, 21 of 89 cases true negative, 0 of 89 cases false positive, 5 of 89 cases false negative

n.r./n.r

93/100^a

1.00/0.81^a

Sawant et al. 2004 (PS) [37]

23/23

33, 17–50

Bilateral comparison with simultaneous stress

MCL injury:

Mean overall injuries: 16.0 mm, range: 10.0—29.0 mm

Mean isolated MCL injury: 15.0 mm, range: 10.0—18.0 mm

Mean combined MCL with ACL/PCL injury: 17.0 mm, range: 10.0—29.0 mm

Mean control group: 8.0 mm, range: 5.0—11.0 mm

0.96/0.95

94/86^b

0.94/0.86^b

LaPrade et al. 2010 (CS) [26]

18/–

76, 66–86

a.p. radiographs at 0° and 20° knee FL with a fluoroscopy C-arm, clinical valgus and 10Nm

two cutting sequences:

1. intact—proximal sMCL—MF—POL—distal sMCL—MT—ACL—PCL

2. intact—distal sMCL—MT—proximal sMCL—MF—POL—PCL—ACL

Sectioning of proximal sMCL:

Increase of MG by 1.5 mm (at 0° knee FL) and 3.2 mm (20° knee FL) in clinical examination

Sectioning of distal sMCL:

Increase of MG by 2.0 mm (at 0° knee FL) and 3.1 mm (20° knee FL) in clinical examination

1. Complete meniscofemoral injury without cruciate ligament:

increase of MG by 4.3 mm (at 0° knee FL) and 6.7 mm (20° knee FL) in clinical examination

2. Complete meniscotibial injury without cruciate ligament:

Increase of MG by 3.6 mm (at 0° knee FL) and 5.4 mm (20° knee FL) in clinical examination

0.99/0.98

n.r./n.r

ACL anterior cruciate ligament, CS cadaveric study, FL flexion, MCL medial collateral ligament, MF meniscofemoral attachment of deep MCL, MG medial gap, MT meniscotibial attachment of deep MCL, NPV negative predictive value, n.r not reported, PCL posterior cruciate ligament, POL posterior oblique ligament, PPV positive predictive value, PS prospective study

^aOperative findings (not defined)

^bArthroscopy findings (not defined)