Diagnostic and incidence of the rupture of the posterior cruciate ligament

Abstract

The purpose of this article is to evaluate the incidence and to give a general review of the examination of the posterior ligament complex. At least ca. 8-10 % of all severe ligament injuries concern the posterior cruciate ligament, which means, that an estimated 4,000-5,000 Germans suffer a PCL rupture every year. Motor-vehicle accidents are the most common cause of the injury, but sports-related traumas (football, skiing) have increased in recent years. The high number of high-energy mechanisms involved (up to 90 %), cause ligament ruptures often to be associated with other injuries, especially fractures of the femur and tibia head. In polytrauma patients PCL ruptures are frequently recognized very late, because the possibility of this kind of injury is often not considered during the clinical examination. The same holds for the diagnosis of monotrauma patients. The initial step in the evaluation is to obtain a thorough history (including the mechanism of injury) and to perform a physical examination. The instability after a PCL rupture may present as an ACL rupture, because the anterior drawer test seems to be positive. The anterior/posterior drawer test must be assessed with other evaluation procedures to distinguish between anterior und posterior instabilities. The posterior sag sign, the quadriceps active test or the reversed pivot-shift may indicate a PCL rupture. A correct roentgenogram can reveal an avulsion of the tibia and can prove posterior instability due to a posterior translation of the tibia. A quantitative examination (clinical or X-ray) of the instability and the indication of combined injury of the posterior cruciate ligament and the posterolateral complex are necessary for the therapeutic decision (operative/conservative). A rupture of the PCL may occur occasionally as a result of a luxation of the knee (reduced spontaneously) before the medical evaluation. A thorough neurovascular examination is essential. Magnetic resonance imaging can be important to the diagnosis of an acute injury, but it is not essential for the choice between operative and non-operative treatment. Arthroscopy has been found to have a high degree of accuracy in the diagnosis of ligament ruptures of the knee, but it is still an operative treatment, so that it can only be used if an operation of repair or reconstruction is planned anyway. Before operative treatment of chronic complex instability, potential osseous abnormalities (varus morphotype) must be revealed; in case of uncertainty, an X-ray control is necessary.

PCL Lesion

“…Patients injured in highenergy motor vehicle accidents suffer a higher incidence of additional life-threatening injuries, and therefore ligamentous knee injuries can be easily overlooked. A combined injury (PCL and PLS) is frequent, particularly in traffi c accidents, but can also occur in 50 % of athletic injuries [ 14 ].…”

Posterior cruciate ligament injuries

“…Hochstein et al (1999) reported that an estimated 4000-5000 Germans suffer PCL injuries each year with a mean age of 27.5 AE 9.9 years. In the context of the trauma setting, the most common causes are motor vehicle collisions followed by sporting injuries.…”

Die funktionelle Sonographie des hinteren Kreuzbandes - Eine neue Screeningmethode bei ligamentären Verletzungen des Kniegelenkes

“…Die hintere Kreuzbandverletzung ist eine häufig übersehene und komplexe Verletzung, was sich in einer umfangreichen Klassifikation nach Cooper zeigt [6]. So beträgt der Anteil chronischer dorsaler Instabilitäten im Patientengut verschiedener Autoren bis zu 70 % [7], und eine Serie operativ behandelter Instabilitäten zeigte im Mittel einen Abstand von 3,8 Jahren zum Unfallereignis (1 bis 8 Jahre) [3,7,8]. Die übersehene hintere Kreuzbandverletzung kann zu einer fixierten hinteren Schublade führen, wenn z.…”