Active non-operative treatment of acute isolated posterior cruciate ligament injury with cylinder cast immobilization

Abstract

The objective of our study was to investigate the outcome of an active non-operative treatment of the acute isolated posterior cruciate ligament (PCL) injury using cylinder cast immobilization and brace with tibial supporter. This study included 17 acute and isolated PCL injuries with two years or more of follow-up for each patient. We applied a cylinder cast immobilization with tibial supporter with full extension of the knee for 6 weeks, and then another 6 weeks of PCL brace with tibial supporter and posterior elastic rubber band to prevent posterior sagging of the proximal tibia. There was improved anteroposterior stability with some residual laxity and improved clinical results at the last follow-up. The conservative treatment utilizing cylinder cast immobilization and brace may be one of the recommendable treatment methods in an isolated and acute PCL injury.

Clinical, Functional, and Morphological Evaluations of Posterior Cruciate Ligament Reconstruction With Remnant Preservation

“…24,52 However, based on long-term follow-up studies, nonoperative treatment results in sustained instability, residual pain, cartilage degeneration, and additional meniscal injuries. 12,27 Interest in PCL reconstruction has increased, and surgical techniques have evolved with advances in arthroscopic instruments. However, the debate continues on the optimal technique, as a 20% to 60% frequency of osteoarthritis has been reported.…”

The necessity of clinical application of tibial reduction for detection of underestimated posterolateral rotatory instability in combined posterior cruciate ligament and posterolateral corner deficient knee

“…To date, most studies have suggested that isolated PCL injuries can be treated conservatively, resulting in favourable short-term clinical outcomes [1,15] Over the past few years, some evidences have emerged suggesting that the preservation of remnant of the ruptured cruciate ligament will improve the postoperative knee laxity and the recovery of proprioception [2,12]. In the present study, the tensioning of the remnant PCL and augmentation of the anterolateral bundle described by Jung et al [12] was used for contributing to posterior knee stability and proprioception.…”

Rehabilitation of Complex Knee Injuries and Key Points

“…The effect of gravity is the largest risk factor in PCL graft elongation. In unsupported positions, gravity creates posterior tibial translation or "tibial sag," which increases the distance between the femoral and tibial attachment sites, straining the PCL graft and preventing healing at the correct length (Jung et al 2008). Attempts to limit tibial sag have included cylindrical casting in full extension (Jung et al 2008) and use of a knee immobilizer (Johnson 2009).…”

“…In unsupported positions, gravity creates posterior tibial translation or "tibial sag," which increases the distance between the femoral and tibial attachment sites, straining the PCL graft and preventing healing at the correct length (Jung et al 2008). Attempts to limit tibial sag have included cylindrical casting in full extension (Jung et al 2008) and use of a knee immobilizer (Johnson 2009). These techniques use additional padding on the posterior tibia to supply an anterior force, but they have not been evaluated for biomechanical efficacy (Jansson et al 2012).…”