Diagnosing instability

The various definitions of instability are reviewed and preference is given to the definition of instability as a loss of stiffness. This definition fits with current laboratory observations. Roentgenographic changes, particularly those associated with degeneration, have no relationship to instability. Multiple roentgenographic images can be of use, but accuracy is limited, and often valuable information at midmotion range or in other planes is missing. Stereoroentgenography appears to offer some promise, but implanted metallic markers are necessary to attain adequate accuracy. Ionizing radiation dose levels are of concern in these techniques. External fixation techniques appear to be of use in some patients. Kinematic linkages and frames containing infrared light emitting diodes are extremely promising, because they give kinematic information in detail.