The Nonoperative Treatment of Acute, Isolated (Partial or Complete) Posterior Cruciate Ligament-Deficient Knees: An Intermediate-term Follow-up Study

Abstract

Fifty-seven consecutive patients (58 knees) with an acute, isolated, posterior cruciate ligament (PCL) injury were treated nonoperatively. Clinical, radiographic, and functional assessment was performed at a mean follow-up of 6.9 years (range 2 to 19.3 years) after the initial diagnosis. At the time of initial documentation of the injury, the posterior drawer test was grade A in 17 knees and grade B in 41 knees. The mean preinjury Tegner activity level was 7 (range 4 to 10). At latest follow-up, 38 knees had no pain, 14 had mild pain, and 6 had moderate pain on exertion. Fifty-four knees had no swelling, 3 had mild, intermittent swelling, and 1 had a moderate swelling on exertion. The posterior drawer test was grade A in 14 knees and grade B in 44 knees. The mean Lysholm-II knee score was 85.2 points (range 51 to 100 points) and the mean Tegner activity level was 6.6 (range 3 to 10). Based on Lysholm-II knee scoring system, the results were excellent in 23 knees (40%), good in 30 knees (52%), fair in 2 knees (3%), and poor in 3 knees (5%). No statistically significant correlation (p=0.097) was seen between the grade of PCL laxity and Lysholm-II knee score. Plain radiographs showed mild (grade I) medial compartment osteoarthritis (OA) in 7 knees, and moderate (grade II) medial compartment OA in 3 knees. Mild patellofemoral OA was seen in 4 knees. We believe that most patients with acute, isolated PCL injuries do well with nonoperative treatment at a mean follow-up of 6.9 years. The level of evidence for this retrospective cohort study is level III.

Nonoperative Treatment and Natural History of Posterior Cruciate Ligament Injuries

“…Only a few PCL studies report long-term subjective or objective results for isolated, PCL injuries in patients followed prospectively after an acute injury [25][26][27].…”

“…Patel et al [26] evaluated 57 patients (58 knees) who were seen acutely for isolated PCL injuries and were treated nonoperatively with rehabilitation to restore the knee ROM and strength. Patients were evaluated again at a mean of 6.9 years after the injury and they were not being seen because they were having troubling symptoms.…”

“…The incidence of patellofemoral arthrosis has been reported to be between 7 and 16 % with follow-up between 6 and 14 years [12,25,26,32]. Anterior knee pain can be seen in patients with PCL laxity, but the pain may be caused from the posterior translation of the tibia on the femur and anterior impingement of the meniscus with knee extension versus arthrosis of the patellofemoral joint as has been proposed.…”

Multimodal and interdisciplinary management of an isolated partial tear of the posterior cruciate ligament: a case report

“…1 In clinical practice, PCL injuries are considered rare compared with anterior www.journalchiromed.com cruciate ligament (ACL) injuries. 2 Posterior cruciate ligament injury is regarded as one of functional disability, not functional instability as seen with ACL disruption. 3 Depending on the mechanism of injury, PCL tears can occur in isolation or in combination with other knee ligament structures, particularly the posterior lateral corner (PLC).…”

Estudo para validação de um referencial anatômico para controle fluoroscópico na preparação do túnel tibial em cirurgia de reconstrução do ligamento cruzado posterior

“…As lesões do LCP, com maior instabilidade, geralmente se associam a déficit funcional, dor crônica e degeneração condral, evidenciada nos exames radiográficos (BOYNTON;TIETJENS, 1996;DANDY;PUSEY, 1982;HERMANS;CORTEN;BELLEMANS, 2009;KELLER et al, 1993;PAROLIE;BERGFELD, 1986;PATEL et al, 2007;DAVIS;PATEL, 1999). A evidência, portanto, indica que o tratamento cirúrgico deve ser considerado em casos selecionados em que seja identificada instabilidade moderada, incapacidade funcional e limitação das atividades da vida cotidiana.…”