Initial Evaluation of Posterior Cruciate Ligament Injuries: History, Physical Examination, Imaging Studies, Surgical and Nonsurgical Indications

Abstract

Compared with anterior cruciate ligament injuries, posterior cruciate ligament injuries are a rare event. The mechanisms are predictable and a thorough physical examination is mandatory to rule out or define combined injury patterns. Stress radiography and magnetic resonance imaging studies are very helpful adjuncts. Acute and chronic injuries require slightly different approaches. As our understanding of normal and pathologic knee joint kinematics develops, nonoperative rehabilitation goals and operative techniques continue to evolve.

Treatment of isolated lesions of the posterior cruciate ligament

“…8 It is well established that PCL repair in bone avulsions leads to an excellent static and functional outcome, but the dilemma persists as to knowing the best option in intrasubstance injuries (B). 9 In 1987, Fowler and Messiah performed a prospective study with a minimum follow-up of 2.6 years on 13 patients with intrasubstance PCL injuries submitted to nonoperative treatment.…”

“…The indications for surgical treatment of PCL injuries also show controversies on the precise indications for ligament reconstruction, due to the lack of randomized clinical trials (D) 8 (C).…”

“…14 For patients with high sports performance, isolated ligament reconstruction of the PCL can be conducted on grade II injuries, but this statement depends on the surgeon's experience and the patient's own wishes and factors (D) 8 (B). 10 Fanelli et al argue that tibial posteriorization equal to or greater than 8 mm would be an indication for PCL reconstruction.…”

“…They concluded that grade I and II injuries should be managed non-surgically, while grade III injuries also showed good subjective and functional results after intense physical therapy treatment (B). 9 Thus, most authors recommend conservative treatment for isolated, low-grade (grades I and II), acute or chronic, mildly symptomatic PCL injuries and for those patients with low demand in daily life or professional activities (D) 8,11 (B). 9,10 In 1999, Shelbourne et al published a prospective study on the natural history of the disease, reporting good functional results from conservative treatment on 133 athletes with isolated PCL injuries after a follow-up of 5.4 years, despite a certain degree of instability (looseness) remaining posterior to the affected knee.…”

“…14 Most authors support ligament reconstruction for patients with isolated grade III lesions, tears associated with other knee ligament injuries and bone avulsion injuries (D) 8,15,16 (C). 14 For patients with high sports performance, isolated ligament reconstruction of the PCL can be conducted on grade II injuries, but this statement depends on the surgeon's experience and the patient's own wishes and factors (D) 8 (B).…”