Chronic Posterior Cruciate Ligament Injuries Research Articles

The use of ultrasonography as an effective screening tool for chronic posterior cruciate ligament injuries

PurposeWe aimed to explore the applicability and validity of ultrasonography for diagnosing chronic posterior cruciate ligament (PCL) injuries.MethodsPCL thickness was measured at 2 cm proximal to the tibia insertion site. Using the same ultrasonography image, the angle tangent to the PCL from the tibia insertion site was also measured. These data were analyzed by plotting the receiver operating curve (ROC), and the sensitivity and specificity were calculated according to the optimal cut-off point. Ultrasonography data from the PCLinjured knee were compared with those from the contralateral uninjured knee of the same patient.ResultsTwelve men and six women, with a mean age of 28.8 ± 14.0 years, were included in this study. The mean time from injury to medical examination was 10.0 ± 6.7 months. The mean thickness of the PCL was 8.1 ± 1.9 mm on the affected side and 5.8 ± 1.2 mm on the uninjured side, with the affected side being significantly thicker. ROC analysis revealed that the optimal cut-off value for the thickness of chronic PCL injuries was 6.5 mm (sensitivity 83.3%, specificity 77.8%, area under the curve [AUC] = 0.87). The optimal cut-off value for the angle was 20° (sensitivity 88.9%, specificity 94.4%, AUC = 0.96).ConclusionUltrasonography is useful as a screening tool for chronic PCL injuries. The optimal cut-off point was 6.5 mm for thickness and 20° for angle.Level of evidenceIV.

Open Repair of Posterior Cruciate Ligament Femoral Peel-Off Lesion in Multiligamentous Knee Injuries Results in Good Outcomes

To identify posterior cruciate ligament (PCL) peel-off lesions, to separate these lesions from more common midsubstance tears, and to evaluate patient outcomes after primary open repair. Patients with acute femoral-side "peel off"-type lesions associated with multiligamentous injuries who underwent PCL repair were identified. Patients with chronic PCL injuries, midsubstance PCL tears, or PCL tibial avulsions were excluded from the study. A total of 11 patients were included in this study. All patients underwent open repair using a suture pullout technique. The mean follow-up period was 18 months. The mean Lysholm score at 12 months was 87. Mean knee range of motion (flexion) achieved at 12 months was 121°. No patient had grade 3 laxity on posterior stress testing at final follow-up. Our study showed good outcomes after primary repair of femoral PCL peel-off lesions. Level IV, therapeutic case series.

Supine lateral radiographs at 90° of knee flexion have a similar diagnostic accuracy for chronic posterior cruciate ligament injuries as stress radiographs.

This study aimed to evaluate whether supine lateral radiographs (SLRs) could replace stress radiographs for diagnosing chronic posterior cruciate ligament (PCL) injuries and identifying combined PCL injuries (defined as PCL injury with medial collateral ligament or posterolateral ligament complex injury). In this retrospective study, both SLRs at 30° and 90° of knee flexion (30/90 SLRs) and Telos stress radiographs of patients with chronic PCL injuries (n = 38) and only 30/90 SLRs of healthy controls (n = 84) were taken. Injured-to-normal differences on 30/90 SLRs and stress radiographs were assessed. Correlation analysis was performed to evaluate injured-to-normal differences on 30/90 SLRs and stress radiographs in patients with chronic PCL injury. Subgroup analysis was performed to compare injured-to-normal differences on 30/90 SLRs and stress radiographs between the isolated and combined PCL injury groups. Receiver operating characteristic curves based on 30/90 SLRs were calculated to determine the cut-off value for diagnosing chronic PCL injury and identifying combined PCL injury. Injured-to-normal differences on both 30 SLRs (3.1 ± 3.6 vs 1.6 ± 1.2, P = 0.019) and 90 SLRs (7.5 ± 3.5 vs 1.2 ± 1.0, P < 0.001) were significantly greater in patients with chronic PCL injuries than in healthy controls. Further, 90 SLRs had a highly accurate diagnostic value for chronic PCL injuries (area under the curve 0.958). The cut-off value for diagnosing chronic PCL injuries based on 90 SLRs was 3.0mm (sensitivity, 94.7%; specificity, 92.9%). Injured-to-normal differences on 30/90 SLRs were significantly correlated with those on stress radiographs. The correlation coefficients were 0.397 (P = 0.014) for 30 SLRs and 0.605 (P < 0.001) for 90 SLRs. The cut-off value for diagnosing combined PCL injuries based on 90 SLRs was 9.6mm (area under the curve 0.72). The diagnostic accuracy of 90 SLRs for chronic PCL injuries was similar to that of stress radiographs. Therefore, the 90 SLRs are reliable alternative method to assess the posterior knee laxity when the stress radiographs are not available. Level IV, case series.

Association of ACL Laxity Tests with Arthroscopic Findings in Chronic ACL and PCL Deficient Knees.

An anterior cruciate ligament (ACL) injury may be diagnosed by clinical examination and radiological investigation using magnetic resonance imaging or by arthroscopy. 1,2 Based on our experience, the ACL tear in concomitant chronic ACL and posterior cruciate ligament (PCL) deficient knees may produce knee laxity, which is more difficult to assess on clinical examination, which in turn may affect the management algorithm of the patient. Our hypothesis is that, in a concomitant chronic ACL and PCL injury, posterior capsular contracture and abnormal reattachment of torn ACL will result in less clinical and subjective laxity, preoperatively. The aim of this study is to review a cohort of patients who had undergone PCL reconstructive surgery and compare the preoperative clinical assessments with and without anesthesia with arthroscopic finding of ACL. This is to assess the accuracy and reliability of clinical ACL laxity tests in detecting ACL tear in chronic ACL and PCL injury.

Posterior Tibial Translation Measurements on Magnetic Resonance Imaging Improve Diagnostic Sensitivity for Chronic Posterior Cruciate Ligament Injuries and Graft Tears

Background: Magnetic resonance imaging (MRI) of the knee is a highly sensitive and specific method for diagnosing acute posterior cruciate ligament (PCL) tears, with a reported accuracy of 96% to 100%. In chronic and revision settings, these injuries may be missed on MRI because of the apparent continuity of nonfunctional PCL fibers. Posterior tibial translation (PTT) of the medial compartment has been identified as a potential secondary finding of PCL tear on routine MRI. Purpose/Hypothesis: The purpose of this study was to evaluate the sensitivity of PTT on MRI associated with PCL injuries and compare it with the sensitivity of a radiologist’s MRI interpretation with preoperative posterior knee stress radiographs as the gold standard. Our hypothesis was that the MRI measurement of PTT of the medial compartment would improve diagnostic sensitivity as compared with the diagnosis made by the interpreting radiologist’s evaluation of the continuity of the PCL fibers for chronic and postrecostruction graft injuries. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: Cases of patients who underwent a primary or revision PCL reconstruction, without anterior cruciate ligament injury, by a single surgeon between 2010 and 2016 were retrospectively analyzed. Measurements of medial and lateral compartment PTT were performed with the MRI of PCL-injured cases and controls without clinical or MRI evidence of ligamentous injury. The sensitivity of this technique was compared with the preoperative MRI diagnosis determined by review of the musculoskeletal radiologist’s report and confirmed by the gold standard of posterior knee stress radiographs. The sensitivity of medial compartment PTT was determined by receiver operator characteristic (ROC) analysis and compared with the MRI sensitivity for chronic PCL and PCL graft tears. Results: One hundred patients (80 males and 20 females) with a mean age of 31.1 years (range, 15-66 years) met the inclusion criteria: 57 acute primary tears, 32 chronic primary, and 11 PCL graft tears. MRI sensitivity was 100% for acute primary PCL tears, 62.5% for chronic primary PCL tears, and 18.1% for PCL graft tears. There were significant differences in medial compartment PTT on MRI for acute versus chronic injuries (P = .025) and acute versus graft injuries (P = .007). ROC curve analysis indicated that the most accurate cutoff point for the detection of chronic PCL tears was 2.0 mm of medial compartment PTT on MRI, with a sensitivity and specificity of 0.80 and 0.89, respectively. For PCL graft injuries, the ROC curve indicated that the most accurate medial compartment PTT cutoff for the detection of PCL graft failure was 3.6 mm (sensitivity, 0.92; specificity, 0.72). Conclusion: MRI evaluation of the PCL fibers had poor sensitivity for chronic PCL tears and PCL reconstruction graft tears. The sensitivity for diagnosing chronic PCL tears and PCL reconstruction graft failures was improved by measuring posteromedial tibial translation.

Quantifiable Imaging Biomarkers for Evaluation of the Posterior Cruciate Ligament Using 3-T Magnetic Resonance Imaging: A Feasibility Study.

Background:Quantitative magnetic resonance imaging (MRI) techniques, such as T2 and T2 star (T2*) mapping, have been used to evaluate ligamentous tissue in vitro and to identify significant changes in structural integrity of a healing ligament. These studies lay the foundation for a clinical study that uses quantitative mapping to evaluate ligaments in vivo, particularly the posterior cruciate ligament (PCL). To establish quantitative mapping as a clinical tool for identifying and evaluating chronic or acute PCL injuries, T2 and T2* values first must be determined for an asymptomatic population.Purpose:To quantify T2 and T2* mapping properties, including texture variables (entropy, variance, contrast, homogeneity), of the PCL in an asymptomatic population. It was hypothesized that biomarker values would be consistent throughout the ligament, as measured across 3 clinically relevant subregions (proximal, middle, and distal thirds) in the asymptomatic cohort.Study Design:Cross-sectional study; Level of evidence, 4.Methods:Unilateral knee MRI scans were acquired for 25 asymptomatic subjects with a 3.0-T MRI system using T2 and T2* mapping sequences in the sagittal plane. The PCL was manually segmented and divided into thirds (proximal, middle, and distal). Summary statistics for T2 and T2* values were calculated. Intra- and interrater reliability was assessed across 3 raters to 2 time points.Results:The asymptomatic PCL cohort had mean T2 values of 36.7, 29.2, and 29.6 ms in the distal, middle, and proximal regions, respectively. The distal PCL exhibited significantly higher mean, variance, and contrast and lower homogeneity of T2 values than the middle and proximal subregions (P < .05). T2* results exhibited substantial positive skew and were therefore presented as median and quartile (Q) values. Median T2* values were 7.3 ms (Q1-Q3, 6.8-8.9 ms), 7.3 ms (Q1-Q3, 7.0-8.5 ms), and 7.3 ms (Q1-Q3, 6.4-8.2 ms) in the distal, middle, and proximal subregions, respectively.Conclusion:This is the first study to identify T2 and T2* mapping values, and their texture variables, for the asymptomatic PCL. The distal third of the PCL had significantly greater T2 values than the proximal or middle thirds.Clinical Relevance:T2 and T2* values of the asymptomatic PCL can provide a baseline for comparison with acute and chronic PCL injuries in future studies.

Surgical Reconstruction in Chronic Posterior Cruciate Ligament Injuries of the Knee

Introduction: This is a cross-sectional study to evaluate the outcome of posterior cruciate ligament reconstruction in chronic injuries using ipsilateral Bone-patella tendon-Bone graft in nine patients, between January 2000 and January 2003 at our institution. Methods: Eight male and one female patient; their ages ranged from 18 to 36 years old. The surgery was done at an average of 17.2 months (range from 3 and 40 months) post injury. All patients were followed up for a minimum of two years period. The assessment was done at twelve and twenty-four months using Lysholm knee score, IKDC knee examination evaluation score and arthrometric measurement with KT-2000. Results: The result showed only moderate success in restoration of ligament stability with 73.4% satisfactory objective results. However, the functional improvement and patient satisfaction is only 55%. The incidences of degenerative changes were 89% at the time of operation. Conclusion: Surgical reconstruction of chronic Posterior Cruciate Ligament restored satisfactory stability of the knee but the functional outcome was only moderate.

Reconstruction for chronic grade-II posterior cruciate ligament deficiency in Malaysian military personnel.

To evaluate the outcome of reconstruction for chronic grade-II posterior cruciate ligament (PCL) deficiency in Malaysian military personnel. Medical records of 16 male military personnel aged 25 to 41 years who underwent reconstruction for chronic grade-II PCL deficiency using the quadruple hamstrings tendon by a single surgeon were reviewed. The mean time from injury to surgery was 43.6 (range, 3-104) months. 10 patients had grade-I (n=4), grade-III (n=2), and grade-IV (n=4) lesions of the medial femoral condyles. Seven patients had medial (n=6) and lateral (n=1) meniscus tears. At the 2-year follow-up, patients were asked to complete a questionnaire consisting of the Lysholm score, Tegner activity level, and International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form. Posterior drawer test, KT-2000 arthrometer test for posterior translation of the tibia, and military health grade (MHG) were assessed by an independent assessor. At the 2-year follow-up, the mean Lysholm score was 83; the score was excellent in 2 patients, good in 9, fair in 4, and poor in one. The mean IKDC subjective score was 74. The median Tegner activity level increased from 5.5 to 6. The posterior drawer test of 11 patients improved to grade I and the remaining 5 remained at grade II. The mean posterior translation of the tibia was 2.4 mm postoperatively; the posterior translation was normal in 8 patients, nearly normal in 7, and abnormal (≥ 6 mm) in one. The MHG improved in 14 patients and remained unchanged in 2. The latter 2 patients had no chondral lesion or meniscus injury. The first one was 40 years old with a postoperative IKDC score of 55 and a Tegner activity level of 2. The second one was 34 years old with a postoperative IKDC score of 65 and posterior translation of the tibia of 6 mm. Surgical reconstruction for chronic grade-II PCL injury achieved satisfactory outcome and may be appropriate for military personnel.

Recent Evolution of Cruciate Ligament Surgery of the Knee

Recent Evolution of Cruciate Ligament Surgery of the Knee

Combined Posterolateral Corner Reconstruction With Remnant Tensioning and Augmentation in Chronic Posterior Cruciate Ligament Injuries: Minimum 2-Year Follow-Up

To evaluate functional results and knee stability after tensioning of remnant posterior cruciate ligament (PCL) with anterolateral (AL) bundle reconstruction and posterolateral corner (PLC) reconstruction in chronic PCL and PLC injuries. Between March 2001 and March 2007, 95 patients with chronic PCL injuries combined with PLC injuries underwent tensioning of the remnant PCL with AL bundle reconstruction and PLC reconstruction. Among these 95 patients, 70 who were satisfied with our inclusion were reviewed. The mean follow-up period was 40.1 months (range, 24 to 96 months). Tensioning of remnant PCL fibers was performed by distal transfer of the posterior tibial attachment. The AL bundle of the PCL was reconstructed by use of the modified inlay technique. The PLC reconstructive procedure was performed with a single sling through fibular tunnel. Stability was measured on posterior stress radiographs and by use of a maximal manual displacement test performed with a KT-1000 arthrometer (MEDmetric, San Diego, CA). The International Knee Documentation Committee and Orthopädishe Arbeitsgruppe Knie scoring systems were used for clinical evaluation. Stress radiographs showed that the mean side-to-side difference (posterior tibial translation compared with that of the contralateral knee) was reduced from 10.3 ± 2.4 mm preoperatively to 2.2 ± 1.5 mm at the last follow-up (P < .001), whereas the KT-1000 tests showed that this difference was reduced from 8.4 ± 2.2 mm preoperatively to 2.0 ± 1.4 mm (P < .001). The final International Knee Documentation Committee objective score was A in 30 patients (42.8%), B in 34 (48.6%), and C in 6 (8.6%). The mean Orthopädishe Arbeitsgruppe Knie score improved from 63.5 ± 10.4 to 88.9 ± 7.6 (P < .001). Excellent posterior stability and relatively good clinical results were achieved with tensioning of the remnant PCL and AL bundle and PLC reconstruction by use of fibular tunnel for patients with chronic combined PCL-PLC injuries. Level IV, case series.

Magnetic resonance imaging study of alteration of tibiofemoral joint articulation after posterior cruciate ligament injury

Cadaveric studies have shown that the posterior cruciate ligament (PCL) is an important constraint to posterior translation of the tibia. Arthroscopic studies have shown that chronic PCL injuries predispose to articular cartilage lesions in the medial compartment and the patellofemoral joint. The aim of the present study was to investigate sagittal plane articulation of the tibiofemoral joint of subjects with an isolated PCL injury. Magnetic resonance was used to generate sagittal images of 10 healthy knees and 10 knees with isolated PCL injuries. The subjects performed a supine leg press against a 150 N load. Images were generated at 15° intervals as the knee flexed from 0 to 90°. The tibiofemoral contact and the flexion facet centre (FFC) were measured from the posterior tibial cortex. The contact pattern and FFC was significantly more anterior in the injured knee from 45 to 90° of knee flexion in the medial compartment compared to the healthy knee. The greatest difference between the mean TFC points of both groups occurred at 75 and 90°, the difference being 4 mm and 5 mm respectively. The greatest difference between the mean FFC of both groups occurred at 75° of flexion, which was 3 mm. There was no significant difference in the contact pattern and FFC between the injured and healthy knees in the lateral compartment. Our findings show that there is a significant difference in the medial compartment sagittal plane articulation of the tibiofemoral joint in subjects with an isolated PCL injury.

Lower-limb adaptation during squatting after isolated posterior cruciate ligament injuries

Background While many studies point out that posterior cruciate ligament plays an important role in squatting, not many, if any, have looked into knee kinematics or kinetics for isolated posterior cruciate ligament injuries. This study explores lower-limb adaptation during squatting for asymptomatic patients with isolated chronic posterior cruciate ligament injuries. Methods Thirteen research subjects or test participants with isolated chronic posterior cruciate ligament injuries were recruited to analyze the kinematics and kinetics on both sides of their hip, knees and ankle joints during squatting. We adopted ExpertVision™ motion analysis system and two Kistler force plates to record the three-dimensional trajectories of the reflective markers used and the ground reaction forces respectively. Findings The peak vertical ground reaction force exerted on the participants, their peak support moment and the knee-joint peak extension moment exhibited at their non-involved side are significantly greater than that at their involved side. We also find that the involved side's knee joint (extension moment) exhibits a reduced percentage on the peak support moment contributed by the individual joints, while the joints of the hip and ankle signify increased percentages. Interpretation In this study, the asymptomatic participants having isolated chronic posterior cruciate ligament injuries tend to shift their weight to their non-involved side, and part of their injured knee-joint load to their ipsilateral joints of the hip and ankle. The causes seem to be a habitual gravity center shift, insufficient muscle strength at the involved side, and a reduced mechanical efficiency in their extensor mechanism.

Does reconstruction of isolated chronic posterior cruciate ligament injuries restore normal knee function?

Isolated posterior laxity is most often cared for with conservative functional treatment. However, when there is pain or instability, surgical treatment can legitimately be proposed. The objective of this study was to assess the results of surgical treatment for chronic isolated posterior laxity. Surgical treatment of direct posterior laxity re-establishes sufficient anatomical integrity to stabilize and provide good function to the knee. This was a retrospective, continuous, single-operator study. Eleven operated patients were retained for this study, all followed up a mean 20.9 months, with a minimum follow-up of 1 year. Subjective and clinical assessments were carried out using the International Knee Documentation Score (IKDC) score. Surgical correction of posterior laxity was measured clinically and radiologically. The subjective IKDC score increased from 53 preoperatively to 68.5 at the last follow-up (P=0.006). For the objective IKDC score, all knees were classified C or D preoperatively; at the last follow-up, six were A or B and none D. All the knees had preoperative Clancy grade 2 or 3 laxity; after surgery, there were three. According to the IKDC laxity score, eight knees were classified A or B at the last follow-up. The radiographic workup noted a 48.6% (P=0.05) posterior laxity correction on the TELOS test. Posterior cruciate ligament reconstruction provides partial correction of posterior laxity. However, the subjective result remains insufficient, providing acceptable function for daily life activities but not sports activities. Level IV, retrospective study.

Role of high-resolution ultrasonography without and with real-time spatial compound imaging in evaluating the injured posterior cruciate ligament: preliminary study

This study sought to compare high-resolution ultrasonography (HRUS) without and with compound imaging in evaluating the injured posterior cruciate ligament (PCL). Thirteen patients with a magnetic resonance imaging (MRI) diagnosis of PCL lesions (ten acute and three chronic) and 20 healthy controls underwent conventional and compound HRUS performed by the same radiologist who was blinded to the subjects' case-control status. The PCL was scanned in a longitudinal direction in all cases. HRUS images were assessed for PCL thickness by two other radiologists blinded to the number and type of PCL injury. PCLs were classified as normal or injured, and the latter as having acute or chronic injuries. Inter-method reproducibility of measuring PCL thickness was assessed on conventional and compound HRUS images. Complete agreement in classifying normal or injured PCL and acute or chronic PCL injuries was achieved. PCL thickness in volunteers was 4.5+/-0.7 mm on conventional images and 4.6+/-0.7 mm on compound images. On conventional and compound HRUS images, the thickness of acutely injured PCL was 9.1+/-1.5 mm and 9.2+/-1.7 mm, respectively, and that of chronically injured PCL was 7+/-0.9 mm and 7+/-0.8 mm. Inter-method reproducibility of PCL thickness measurements on conventional vs. compound HRUS images was 98.6%. HRUS is a reliable technique for studying the PCL and detecting PCL injuries.

Characterization of spontaneous healing of chronic posterior cruciate ligament injury: Analysis of instability and magnetic resonance imaging

To explore the healing process of the injured posterior cruciate ligament (PCL) by evaluating instability measurements and magnetic resonance imaging (MRI) findings. A retrospective cross-sectional study of 46 cases of complete PCL tear who obtained MRI more than two months after injury. A total of 13 cases (28%) showed nearly normal PCL contour, 20 cases (44%) showed continuity but deformed PCL contour, and 13 cases (28%) showed discontinuity. The duration from injury to MRI was not directly correlated with continuity. However, the group that obtained MRI more than six months after injury showed more continuity than the group that obtained MRI within six months of the injury (P < 0.01). The group with nearly normal continuity showed better stability results in the KT-1000 arthrometer and stress radiographs than the group with discontinuity (P < 0.05). The presence of other combined ligament injuries had a negative effect on regaining PCL continuity (P <0.05). More than two-thirds (72%) of chronic PCL injury cases showed ligamentous continuity on MRI, especially when the injury had occurred more than six months before. Stability may improve as continuity is regained. The presence of other combined ligament injuries appears to prohibit spontaneous PCL healing.

Arthroscopic Femoral Tensioning and Posterior Cruciate Ligament Reconstruction in Chronic Posterior Cruciate Ligament Injury

Abstract For the new arthroscopic femoral tensioning and posterior cruciate ligament (PCL) reconstruction in chronic PCL injury, we make a transtibial tunnel, using the posterior trans-septal portal, while preserving the remnant bundle of the original PCL and meniscofemoral ligament. Also, to preserve the remnant femoral fibers of the PCL and provide femoral tensioning, we manipulate the suture hook with No.1 PDS by hand so that the sharp tip penetrates the remnants of the PCL near the femoral attachment site. After pulling the sutures previously placed at the remnant PCL fibers, the notchplasty osteotome is advanced to the femoral footprint of the PCL to a depth of 1 to 2 mm from the shallow to the deep direction. Then the remnant PCL fibers are detached from the medial femoral condyle, which the authors call the artificial femoral “peel-off” tear. We drill the femoral tunnel using the outside-in technique in the anatomic place of PCL footprint, which is located 1 to 2 mm from the edge of the articular cartilage. This procedure significantly contributes to the posterior stability and proprioception of the knee joint, the remnant femoral fibers and meniscofemoral fibers are preserved to be healed with a graft and subsequently form an integrated structure.

Tensioning of Remnant Posterior Cruciate Ligament and Reconstruction of Anterolateral Bundle in Chronic Posterior Cruciate Ligament Injury

Posterior cruciate ligament (PCL) injuries have potential for intrinsic healing and several magnetic resonance imaging studies have reported that the PCL healed with continuity but also with residual laxity. The goal of our study was to introduce a new method and investigate the outcome of tensioning of the remnant PCL and reconstruction of the anterolateral (AL) bundle of the PCL using modified inlay technique. Therapeutic study. Forty-nine patients who underwent tensioning of the remnant PCL and reconstruction of the AL bundle of the PCL were evaluated 45.7 months (range, 24 to 78 months) on average after surgery. Tensioning was performed by distal transfer of the tibial attachment. The AL bundle of the PCL was reconstructed with 4 bundles of hamstring tendon (34 cases), bone-patellar tendon-bone graft (7 cases), or Achilles tendon allograft (8 cases), arthroscopically at the femoral tunnel and by the modified inlay technique through a posteromedial approach in the supine position. In 35 patients who had a combined posterolateral rotatory instability, the posterolateral corner reconstruction was performed. Stability was assessed by stress radiographs with the Telos device and maximal manual testing with KT-1000 arthrometer. The clinical results were assessed by IKDC and OAK scores. Physical examination was performed using the posterior drawer test, varus stress test, posterolateral drawer test, and dial test in 30 degrees and 90 degrees flexion. The average side-to-side difference of posterior tibial translation on posterior stress radiographs decreased from 10.4 +/- 2.1 mm to 2.2 +/- 1.0 mm. The average side-to-side difference in maximal manual test with the KT-1000 arthrometer also decreased from 8.2 +/- 1.5 mm to 1.9 +/- 1.0 mm. The final IKDC score was A in 10 (20.4%), B in 33 (67.3%), and C in 6 (12.2%) patients. The average OAK score improved from 63.3 +/- 8.3 to 91 +/- 7.3. Good clinical results and very good posterior stability were achieved with tensioning of the remnant PCL and reconstruction of the AL bundle using the modified inlay technique in chronic PCL injuries. With this technique, the surgeon can operate without changing the patient's position during surgery. Level IV, therapeutic study.

The accuracy of magnetic resonance imaging in diagnosing chronic posterior cruciate ligament injury

Magnetic resonance imaging (MRI) is widely believed to be highly accurate in diagnosing injuries of the posterior cruciate ligament (PCL). The aim of this study was to determine the accuracy of MRI in diagnosing chronic PCL injury. MRI was performed on 10 knees with a clinical and arthroscopic diagnosis of a PCL injury sustained at least 6 months previously. Seven experienced musculoskeletal radiologists subsequently reviewed the scans. Their accuracy in diagnosing a PCL injury was 57% (40–80%). Thus, although MRI may be reliable in diagnosing acute PCL injury, MRI is not so reliable in evaluating chronic injuries. We postulate that, in the case of a chronic PCL injury, healing in continuity may occur, producing an intact but lax ligament. As demonstrated by our study, MRI may then be less accurate. This should be borne in mind when assessing the MRI scans of a suspected chronic PCL injury.

Stress radiography for quantifying posterior cruciate ligament deficiency

Purpose: The objective of this study was to evaluate the efficacy of different stress radiography techniques in quantifying a posterior cruciate ligament (PCL) lesion. Type of Study: Prospective serial study. Methods: Sixty patients with subacute or chronic PCL injuries, confirmed using magnetic resonance imaging (MRI) or arthroscopic evaluation, were enrolled in this study. The patients underwent a KT-2000 (Medmetric, San Diego, CA) examination and a series of stress radiographs that included a radiographic posterior drawer test with Telos (Telos, Weterstadt, Germany) at 90° and 25° of knee flexion, an active radiograph at 90° of knee flexion, and an axial view radiograph. Results: Stress radiography performed with Telos showed an average posterior tibial displacement of 11.54 ± 4.93 mm and 7.97 ± 3.16 mm at 90° and 25°, respectively. The active radiographs showed an average posterior tibial displacement of 11.48 ± 5.14 mm. Conclusions: Stress radiographs were shown to be superior to arthrometric evaluation in quantifying posterior tibial translation. The techniques performed with the knee at 90° of knee flexion allowed for greater posterior tibial displacement and, consequently, an easier quantification of the degree of ligament insufficiency. Stress radiographs performed through hamstring contraction gave the same results as those performed with Telos at 90° of knee flexion.

Arthroscopic evaluation of articular cartilage lesions in posterior cruciate ligament—Deficient knees

Purpose: The goal of this study was to gain more information on the likelihood of developing cartilage lesions in posterior cruciate ligament (PCL)-deficient knees. Type of Study: Retrospective clinical study. Methods: Standardized arthroscopy records of 181 patients with a nonsurgically treated acute or chronic PCL injury were analyzed with respect to cartilage degeneration. Subgroups with different duration of PCL insufficiency, the influence of isolated PCL or combined PCL/posterolateral instability, and the grade of posterior laxity was analyzed. Results: PCL insufficiency significantly increased the risk of developing medial femoral condyle and patellar cartilage degeneration over time. Of patients whose PCL deficiency was present for more than 5 years, 77.8% showed degenerative cartilage lesions of the medial femoral condyle and 46.7% showed cartilage degeneration of the patella. After 1 year of PCL insufficiency, the number of medial femoral cartilage lesions increased threefold (13.6% v 39.1%). With the presence of combined PCL/posterolateral insufficiency the amount of medial femoral degeneration was significantly increased (36.6% v 60.6%). Conclusions: We found that PCL insufficiency is not a benign injury with respect to the development of degenerative articular cartilage lesions. The early and continuous increase in cartilage degeneration at the medial femoral condyle and the patella should be considered when discussing operative versus conservative treatment for a PCL-deficient knee. The rapid development of medial arthritis should also be considered during decision making, particularly in patients with combined PCL/posterolateral instability or those who underwent previous partial medial menisectomy.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 19, No 3 (March), 2003: pp 262–268