Diagnosing PCL Injuries: History, Physical Examination, Imaging Studies, Arthroscopic Evaluation

Verhulst, Fleur V; MacDonald, Peter

doi:10.1097/jsa.0000000000000251

Cited by 17 publications

(10 citation statements)

References 41 publications

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“…Force is required and a PCL tear is commonly known as a “dashboard injury” which occurs when the flexed knee hits a motor vehicle dashboard during a collision and is translated posteriorly, or during hyperflexion of the knee with the foot in plantar flexion, such as falling onto the flexed knee. 42 MCL injuries can occur in isolation or in combination with the ACL or PCL. The MCL originates at the medial epicondyle of the tibia deep to the pes anserine and inserts 5–7 cm below the joint line.…”

Section: Patient Evaluation and Imagingmentioning

confidence: 99%

Consensus Guidelines on Interventional Therapies for Knee Pain (STEP Guidelines) from the American Society of Pain and Neuroscience

Hunter¹,

Deer²,

Jones³

et al. 2022

JPR

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Knee pain is second only to the back as the most commonly reported area of pain in the human body. With an overall prevalence of 46.2%, its impact on disability, lost productivity, and cost on healthcare cannot be overlooked. Due to the pervasiveness of knee pain in the general population, there are no shortages of treatment options available for addressing the symptoms. Ranging from physical therapy and pharmacologic agents to interventional pain procedures to surgical options, practitioners have a wide array of options to choose from – unfortunately, there is no consensus on which treatments are “better” and when they should be offered in comparison to others. While it is generally accepted that less invasive treatments should be offered before more invasive ones, there is a lack of agreement on the order in which the less invasive are to be presented. In an effort to standardize the treatment of this extremely prevalent pathology, the authors present an all-encompassing set of guidelines on the treatment of knee pain based on an extensive literature search and data grading for each of the available alternative that will allow practitioners the ability to compare and contrast each option.

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Section: Patient Evaluation and Imagingmentioning

confidence: 99%

Consensus Guidelines on Interventional Therapies for Knee Pain (STEP Guidelines) from the American Society of Pain and Neuroscience

Hunter¹,

Deer²,

Jones³

et al. 2022

JPR

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show abstract

“…Another limitation centers on the use of MRI as the reference test. While MRI has been shown to accurately detect acute PCL-ruptures [ 7 , 41 – 47 ] a 100% accurate diagnosis of chronic PCL-injuries seems impossible [ 38 , 46 , 48 ]. However, all current PCL-deficient knees had to be classified as chronic as previously reported.…”

Section: Limitationsmentioning

confidence: 99%

“…This stems from a poor understanding of the PCL’s anatomic and biomechanical complexities and functional roles [ 1 , 2 ]. Although the PCL´s importance is currently acknowledged [ 3 – 5 ], PCL-rupture prevalence is still underestimated; likely due to subtle, often unspecific signs and symptoms accompanying the acute injury [ 6 , 7 ]. Thus, the estimated number of unidentified, chronic PCL-deficient knees is expected to be considerable [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

“…Clinical tests are the mainstay of primary PCL-diagnostics [ 2 , 6 , 9 , 10 ]. Clinicians commonly use the following clinical PCL-integrity tests: (1) posterior drawer test, (2) posterior sag sign, and/or (3) quadriceps active test [ 1 , 2 , 5 – 7 , 10 ]. However, each present with specific diagnostic weaknesses [ 2 , 11 – 13 ], meriting more precise clinical testing [ 1 , 11 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

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Clinical Accuracy of the Lateral-Anterior Drawer Test for Diagnosing Posterior Cruciate Ligament Rupture

et al. 2022

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Background Commonly used clinical posterior cruciate ligament (PCL) tests present with diagnostic weaknesses requiring alternative clinical tests. The Lateral-Anterior Drawer test (LAD-test) is a suggested alternative that previously demonstrated concurrent validity in situ. Further in vivo LAD-test clinical accuracy examination is required prior to any recommendation for clinical adoption. Thus, this case–control study aims to (1) investigate the LAD-test’s in vivo interrater and intra-rater reliability; (2) establish LAD-test concurrent validity against MRI as the reference standard; and (3) examine the correspondence between examiners’ professional working experience and LAD-test diagnostic accuracy. Methods Three examiners with different professional experience levels, blindfolded during testing, and blinded from subjects’ identity, medical history, and reference test outcome performed all LAD-testing twice per subject. Reliability analyses included percent agreement, Fleiss’ kappa and Cohen’s kappa coefficients with 95% Confidence Intervals (CIs) and prevalence-adjusted bias-adjusted kappa (PABAK) calculations. Validation parameters included sensitivity, specificity, likelihood ratios (LR + ; LR-), and predictive values (PPV; NPV) each accompanied by 95%CIs; each tester’s percent agreement with the MRI; and their Youden Index. Results The study sample was comprised of 31 subjects of which 14 had a history of unilateral full-thickness PCL-rupture. Their 14 contralateral knees and both knees of 17 healthy subjects served as controls. In vivo LAD-test performance did not produce any negative ramifications for the tested subjects. Interrater reliability was moderate (test-1: Fleiss’κ = 0.41; 95% CI 0.40;0.41; test-2:Fleiss’κ = 0.51; 95% CI 0.50;0.51). Pairwise examiner’s LAD-test outcome agreement ranged from 74 to 89%. Pairwise interrater reliability was fair-to-substantial (κ = 0.27 to κ = 0.65) with moderate-to-substantial PABAK (0.48–0.77). Intra-rater reliability was substantial-to-almost perfect (PABAK 0.65–0.97). Sensitivity and specificity ranged from 57 to 86% and 83 to 98%, respectively. The advanced and novice clinicians’ Youden Indexes were acceptable. The same examiners’ positive likelihood ratios revealed important and relative important effects, respectively. Positive predictive values were considerable for the advanced and novice clinicians, while negative predictive values were high for all examiners. Conclusion Overall, the study results suggested LAD-test practicability. In vivo LAD-test performance did not produce any negative ramifications for the tested subjects. In subjects presenting with a chronic PCL-deficiency (i.e., > 3 months since initial injury), the LAD-test’s clinical accuracy was comparable-to-superior to other commonly used clinical PCL-tests. Future studies to establish the LAD-test’s usefulness in isolation as well as in combination with other clinical tests for acute PCL-rupture diagnostics are warranted. Trial registration number DRKS00013268 (09. November 2017).

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“…

Posterior cruciate ligament (PCL) injury occurs far less often than anterior cruciate ligament (ACL) injury. [1][2][3][4][5][6][7][8] As such, diagnostic imaging for PCL injuries is not as standardized or as well characterized as for ACL injuries. As a result, PCL injuries are underdiagnosed, which may leave the PCL-deficient knee at risk for chronic instability and secondary osteoarthritis.

…”

mentioning

confidence: 99%

Imaging Review of the Posterior Cruciate Ligament

Cook

Wissman

2021

J Knee Surg

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Posterior cruciate ligament (PCL) injuries can often be missed on physical examination, especially in multiligament knee injuries. Therefore, a comprehensive approach to imaging the PCL should be implemented whenever history and examination findings indicate relative risk. Radiography, including a posterior-stress view, and magnetic resonance imaging, when available, provide consistently accurate diagnosis of PCL pathology and common knee comorbidities. Computed tomography and ultrasonography can be useful modalities with potential advantages with respect to availability and access, specific comorbidities, and/or cost-effectiveness.

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Diagnosing PCL Injuries: History, Physical Examination, Imaging Studies, Arthroscopic Evaluation

Cited by 17 publications

References 41 publications

Consensus Guidelines on Interventional Therapies for Knee Pain (STEP Guidelines) from the American Society of Pain and Neuroscience

Consensus Guidelines on Interventional Therapies for Knee Pain (STEP Guidelines) from the American Society of Pain and Neuroscience

Clinical Accuracy of the Lateral-Anterior Drawer Test for Diagnosing Posterior Cruciate Ligament Rupture

Imaging Review of the Posterior Cruciate Ligament

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