Isolated Posterior Cruciate Ligament Injuries of the Knee

Abstract

Isolated injuries of the posterior cruciate ligament (PCL) are rare in comparison to other ligamentous knee injuries, resulting in a lack of evidence-based literature regarding their treatment. Although consensus exists regarding the nonoperative management of asymptomatic grade I injuries, the treatment of high-grade symptomatic PCL insufficiency remains a matter of debate. A variety of reconstructive procedures have been advocated on the basis of biomechanical data, however, the clinical benefit of these anatomic reconstructive techniques have yet to be conclusively proven in randomized trials. This article attempts to provide the treating physician with a concise overview of the etiology and diagnosis of isolated PCL injuries as well as an objective review of contemporary surgical treatment options and outcomes as reported in the current literature.

Multimodal and interdisciplinary management of an isolated partial tear of the posterior cruciate ligament: a case report

“…Another common injury mechanism is when the athlete falls onto a flexed knee with the foot in plantar flexion, the proximal tibia striking the ground first. 5 Unlike patients with isolated ACL tears, those with acute isolated PCL injuries do not typically report feeling or hearing a "pop." 12 An isolated PCL injury does not usually cause specific symptomatic complaints, 10 with knee pain, swelling, and stiffness often mild in severity.…”

“…5 It is essential to note the change in distance of step off between the medial tibial plateau and the medial femoral condyle (Fig 6). Normally, the plateau is approximately 1 cm anterior to the tibial condyle with the knee flexed at 90°.…”

“…6,12 Other PCL tests include the posterior sag sign (79%, sensitivity; 100%, specificity) and quadriceps active test (54%, sensitivity; 97%, specificity). 5 The reverse pivot shift test (26%, sensitivity; 95%, specificity) is also useful in ruling out a combined PCL injury. 4 Proper evaluation of the PCL is not complete without evaluation of other ligament structures.…”

“…This is largely due to the absence of randomized trials comparing treatment outcomes and few prospective studies outlining the true natural history of PCL injury. 5 Numerous authors note satisfactory to good short-term outcomes with nonsurgical management of isolated PCL tears. Parolie and Bergfield 17 found that 80% of patients that had greater than 100% strength of the uninvolved quadriceps were satisfied with their PCL-deficient knees.…”

“…4,5 Unlike the ACL and collateral ligaments, there is no general consensus on the treatment of isolated PCL injuries; nor is there a significant body of evidence to guide clinical management. 5 The literature suggests that knowledge and treatment of the PCL lag behind those of the ACL. 6 A review of the chiropractic literature reveals 1 citation describing 3 cases of isolated PCL injury.…”