Posterior Cruciate Ligament Injury
Original Editors - Sigrid Bortels
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Search Strategy[edit | edit source]
Database: Pubmed, Web of Science, Pedro, Google
Key words: Posterior cruciate ligament injury, PCL, nonoperative treatment, conservative treatments
Time line: (1986-2008)
Definition/Description[edit | edit source]
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Clinically Relevant Anatomy[edit | edit source]
The posterior cruciate ligament (PCL) is found in the knee joint, and runs from the medial femoral condyle of the femur to the tibia platuea. It crosses the anterior cruciate ligament to form an 'X'.
The PCL is twice as thick as the anterior cruciate ligament (ACL). This means that it is much stronger, which results in less injuries than the ACL. [1]
It is the major stabilizing ligament of the knee, and prevents the tibia from moving backwards too far. [2]
Epidemiology /Etiology[edit | edit source]
- Motor vehicle accidents or 'dashboard injuries' (MRI is a good option in this situation)[3]
- Sports: football, soccer, skiing
- A simple misstep
[4]
Characteristics/Clinical Presentation[edit | edit source]
Characteristics
- Grade 1 Sprains. The ligament is slightly stretched.
- Grade 2 Sprains. The ligament is stretched to the point were it becomes loose.
This is called a partial tear.
- Grade 3 Sprains. This is a complete tear of the ligament.
The ligament has been split into two pieces, and the knee joint is unstable. [5]
Clinical presentation
- Movement restrictions and pain
- A weak feeling in the knee
- Swelling
- Knee joint instability
- Difficulty walking
[5]
Differential Treatements[edit | edit source]
Grade 1 sprains. Conservative treatment
Grade 2 sprains. The treatment options are somewhat controversial, but the following guidelines can be considered as general guidelines:
- An isolated acute PCL tear with less than 10 mm of posterior laxity at 90 degrees of flexion will probably be treated with physical therapy. [6]
- An acute PCL tear that causes more than 10 to 15 mm posterior laxity or more than one ligament injury, will be treated with surgery in order to repair or reconstruct the PCL. [6]
- Sometimes, a portion of bone is pulled off with the torn ligament. If the fragment is large enough, the bone is usually reattached. If the fragment is too small, it is discarded and the PCL is repaired or reconstructed. [6]
- All chronic PCL injuries are initially treated with an aggressive quadriceps rehabilitation program. But if the aggressive rehabilitation program fails, if there is more than 10 to 15 mm posterior laxity in the knee, or if degenerative changes in the knee joint can be seen on x-rays, surgery may be required. An operation to treat a long-term PCL injury does not make the knee normal, but it may decrease its laxity. [6]
-> These are the general guidelines, but after reading some articles about the conservative treatment of grade 2 sprains, it is clear that the results are controversial.
Some experiments are rather positive about conservative treatment, and conclude that almost all patients can resume their normal sport activities after treatment, without further problems. [7][8]
But there are also other studies that are rather negative. One study concluded that significant symptoms and degenerative changes increase with increasing interval from injury. [9] But can early reconstruction prevent degenerative changes? According to another article, this still remains uncertain. [10]
Another study concludes that the posterior instability of the PCL injured patients showed little improvement when compared with the initial status before the treatment and that residual laxity still remained. [11]
It is probably necessary to realize more studies in order to know what treatment is best for grade 2 injuries.
Grade 3 sprains. Use of an operative treatment. This means repairing the ligament by reattaching the torn fibres to each other.
If not enough fibres remain to repair the PCL or if the tissue has degenerated beyond repair, the PCL can be reconstructed. The ligament will be replaced with tissue from another part of the body or from a donor. Part of the patellar tendon (tissue that connects the muscle to the patella) or hamstrings can be used in the reconstruction. [12]
Diagnostic Procedures[edit | edit source]
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Outcome Measures[edit | edit source]
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Examination[edit | edit source]
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Medical Management
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Physical Therapy Management
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Key Research[edit | edit source]
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Resources
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Clinical Bottom Line[edit | edit source]
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Recent Related Research (from Pubmed)[edit | edit source]
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References[edit | edit source]
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