The History of Posterior Cruciate Ligament Injury and Reconstruction

Abstract

This article provides a brief introduction in historical review of injuries to the posterior cruciate. The biomechanics and natural history and progression of surgical procedures are delineated and explained. Once considered the most important ligament in the knee, it is now understood the posterior cruciate ligament is but one of four major ligaments that work in concert to control the 6° of freedom of knee motion. PL not only provides primary restraint to the posterior drawer but is also an important secondary restraint to other motions, such as varus and valgus stresses and hyperextension. As clinicians have further studied the natural history of posterior cruciate injuries it is now understood that most isolated single ligament injuries that involve the posterior cruciate ligament can be successfully treated with rehabilitation and activity modification and not surgery. Complicating factors, which change the outcome of a nonoperative prognosis, are other associated ligament injuries, patella femoral arthrosis, and loss of meniscus and quadriceps weakness. When surgery is indicated, newer techniques, such as the transosseous double tunnel technique, the posterior tibial inlay technique, and associated extra-articular reconstructions, have improved the overall surgical results, particularly when assessing AP laxity.