Current Concepts Review: The Posterior Cruciate Ligament

Fanelli, Gregory C.; Beck, John D.; Edson, Craig J.

doi:10.1055/s-0030-1267466

Cited by 84 publications

(98 citation statements)

References 87 publications

(103 reference statements)

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“…[1][2][3][4] It is functionally divided into two bundles, the anterolateral (AL) band and the posteromedial (PM) band, named according to the direction taken by the bundles in the path between the tibia and the femur and its insertion into the bone. [1][2][3][4][5] With the knee in flexion, the AL bundle is tight and the PM loose, while with the knee in extension, the tensions are reversed (D). [1][2][3][4][5] PCL injuries are far less frequent than other knee ligament injuries (D).…”

Section: Introductionmentioning

confidence: 99%

“…[1][2][3][4][5] With the knee in flexion, the AL bundle is tight and the PM loose, while with the knee in extension, the tensions are reversed (D). [1][2][3][4][5] PCL injuries are far less frequent than other knee ligament injuries (D). [1][2][3][4]6 The incidence of these injuries in the general population is around 3%, rising sharply in the population susceptible to trauma, reaching 37% (D), [1][2][3]6 mainly in car accidents and high-energy incidents, where a high prevalence of associated injuries is observed (D).…”

Section: Introductionmentioning

confidence: 99%

“…[1][2][3][4][5] PCL injuries are far less frequent than other knee ligament injuries (D). [1][2][3][4]6 The incidence of these injuries in the general population is around 3%, rising sharply in the population susceptible to trauma, reaching 37% (D), [1][2][3]6 mainly in car accidents and high-energy incidents, where a high prevalence of associated injuries is observed (D). 1,6 Among the population of athletes, there is also a higher incidence of PCL injuries than in the general population, but this difference varies depending on the type of activity practiced (D) 1,6 (B).…”

Section: Introductionmentioning

confidence: 99%

“…1,6 Among the population of athletes, there is also a higher incidence of PCL injuries than in the general population, but this difference varies depending on the type of activity practiced (D) 1,6 (B). 7 Isolated PCL injuries are less common than associated injuries (D) 1,3 (B). 7 The main mechanism involved in general PCL injuries derives from direct trauma to the tibia in the anteroposterior direction with the knee in flexion (D).…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Treatment of isolated lesions of the posterior cruciate ligament

Meleiro¹,

Mendes²,

Kaleka³

et al. 2015

Rev. Assoc. Med. Bras.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Treatment of isolated lesions of the posterior cruciate ligament

Meleiro¹,

Mendes²,

Kaleka³

et al. 2015

Rev. Assoc. Med. Bras.

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“…Although isolated PCL deficiency has traditionally been treated nonoperatively with reasonable outcomes, a significant proportion of patients have a deterioration in knee function and premature development of medial and patellofemoral compartment osteoarthritis due to abnormally high contact forces. 1 The evolution of surgical arthroscopic techniques and instrumentation, combined with an improved understanding of PCL anatomy and biomechanics, has led to an increased impetus for posterior cruciate ligament reconstruction (PCLR). However, the optimal technique for PCLR has not yet been established, with almost every aspect of the surgical procedure and postoperative rehabilitation remaining controversial.…”

mentioning

confidence: 99%

TransMedial All-Inside Posterior Cruciate Ligament Reconstruction Using a Reinforced Tibial Inlay Graft

Nancoo

Lord

Yasen

et al. 2013

Arthroscopy Techniques

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Surgical reconstruction of the posterior cruciate ligament (PCL) is technically demanding. Potential challenges include visualization of the tibial footprint and drilling of the tibial tunnel without damaging posterior neurovascular structures, as well as graft selection, deployment, tensioning, and fixation. We present a novel TransMedial all-inside arthroscopic technique (technique designed by A. J. Wilson with support from Arthrex) using a single hamstring tendon graft, fixed with adjustable cortical suspensory devices. The technique simplifies the difficult steps encountered during PCL reconstruction and is safe and reproducible. All arthroscopic viewing is accomplished from the lateral portal, and femoral socket preparation is performed from the medial side with specially contoured instruments, which allow accurate marking, measuring, and anatomic positioning of the graft. The quadrupled semitendinosus graft can be augmented with composite polymer tape for increased strength and initial stability. We use outside-in drilling to create retrograde femoral and tibial sockets. Cortical suspensory fixation on the tibial side can be supplemented with anchor fixation. We use an arthroscopic tibial inlay technique that better approximates native knee anatomy. This also avoids the "killer turn," a problem seen in transtibial PCL reconstruction techniques, which theoretically induces graft laxity due to abrasion with cyclic loading. This technique can be further adapted to allow a modified double-bundle or TriLink graft (technique designed by A. J. Wilson with support from Arthrex.).

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Acute Knee Injuries in Children and Adolescents

2021

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ne-third of all musculoskeletal complaints in primary care officesareduetokneepain. 1 Upwardof60millionchildrenaged 6 to 18 years participate in organized sports each year in the US. 2 Parallelingthislevelofparticipationisasignificantnumberofsportsrelated injuries, with the knee being one of the most commonly injured joints: up to 54% of young athletes have knee pain annually. 3 There are anestimated2.5millionsports-relatedkneeinjuriesinadolescentseach year,and60%ofsports-relatedsurgeriesinhighschoolathletesinvolve the knee. [4][5][6] Certain sports are considered high risk, with football, soccer,andbasketballaccountingforthelargestproportionofsports-related kneeinjuriesintheUS. 7 Studiesinhighschoolathleteshaveconsistently foundthatadolescentgirlshaveasignificantlyhigherriskofseriousknee injury compared with boys. 7 Knee injuries can be broken down into 2 basic categories: those due to acute, traumatic events, and those due to cumulative, repetitive microtrauma, or so-called overuse injuries. The presenting history will typically guide the clinician in determining whether the patient is presenting with an acute or overuse injury. Although many acute knee injuries in children and adolescents are contusions and lacerations that are often self-limited, several conditions require specific identification in order to treat them properly and achieve ideal outcomes. 7 This article will review the diagnosis and management of acute knee injuries in children and adolescents, with a focus on specific conditions requiring the treating pediatrician's attention. Discussion General ConsiderationsIn the setting of acute knee trauma, there are a few keys to the physical examination. The knee should be inspected for obvious bony de-formity or opening of the skin. The presence of a knee effusion is one of the most significant physical findings. A knee effusion represents a hemarthrosis and is distinctly different from mere soft tissue swelling. In acute trauma, knee effusions are an indication of a likely severe injury, including fracture, tear to the meniscus, tear of a ligament, or a joint dislocation. Up to 70% of patients aged 9 to 14 years with traumatic effusion have had a serious intra-articular injury, with the 3 most common injuries being lateral patellar dislocation, anterior cruciate ligament (ACL) tears, and fracture. 8 Therefore, an acute traumatic effusion is an indication for radiography and possibly advanced imaging. The clinician must remember that up to 56% of patients presenting with a traumatic effusion may have no visible injury on plain radiographs, and advanced imaging may be indicated. 8 The clinician should assess weight-bearing status and examine gait where possible. If the patient cannot bear weight, it is important to ensure while lying supine that they can do a straight leg raise: demonstrating the ability to actively lift the straight leg off the examining table rules out that the patient has disrupted their extensor mechanism. A thorough neurovascular examination should be done of the leg distal to th...

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Current Concepts Review: The Posterior Cruciate Ligament

Cited by 84 publications

References 87 publications

Treatment of isolated lesions of the posterior cruciate ligament

Treatment of isolated lesions of the posterior cruciate ligament

TransMedial All-Inside Posterior Cruciate Ligament Reconstruction Using a Reinforced Tibial Inlay Graft

Acute Knee Injuries in Children and Adolescents

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