Complete Posterior Cruciate Ligament Research Articles

Physical and Muscular Performance in a Professional Soccer Player with a Posterior Cruciate Ligament Injury Following an Isokinetic Exercise Program: A Case Report.

The comprehensive treatment for an athlete who sustains a complete posterior cruciate ligament (PCL) injury remains unclear. The purpose of this case report is to describe the effects of an isokinetic exercise program on muscle performance and physical function in a professional soccer player with a PCL injury. Case Report. A 23-year-old male professional soccer player injured his right knee (non-dominant) during a soccer match, with magnetic resonance imaging confirming a complete PCL rupture. The athlete completed 23 sessions of isokinetic treatment over nine weeks to improve physical function and muscle performance. The concentric mode was used to evaluate quadriceps and hamstrings performance isokinetically at angular velocities of 60 °/s, 120 °/s, and 300 °/s. The LEFS questionnaire was used to evaluate physical function. The assessment occurred before starting the treatment and at the end of nine weeks. An athlete with similar anthropometric characteristics was invited to participate and serve as a control, in order to better understand the athlete's assessment results. After nine weeks, peak torque normalized to body mass (PT/BM) improved to 4.0 N.m/kg for knee extensors (control: 3.6 Nm/kg) and 2.3 N.m/kg for knee flexors (control: 1.9 Nm/kg) at 60 °/s. This increase in PT was reflected in the hamstrings-to-quadriceps (H:Q) ratio post-treatment (57 %). At the end of treatment, the athlete returned to sports activities with 98.7 % restored physical function as measured by the LEFS (Score: 79 points). The results demonstrated that the isokinetic treatment improved knee functional capacity, with increased PT/BM for knee extensors and flexors and enhanced torque-holding capacity, indicating improved muscle performance. 5.

Concomitant Anatomic PCL and FCL Reconstructions With Partial Lateral Meniscectomy

Background: Fibular collateral ligament (FCL) injuries commonly present in a multiligament knee injury pattern. These injuries are associated with significant instability leading to altered tibiofemoral biomechanics and therefore require surgical intervention. Similarly, grade 3 posterior cruciate ligament (PCL) injuries may disrupt normal tibiofemoral and patellofemoral biomechanics and increase the risk of secondary osteoarthritis. Therefore, concomitant reconstruction of the FCL and PCL should be performed to decrease knee laxity and optimize functional outcomes. Indications: Early operative treatment is indicated for patients with combined grade 3 FCL injuries and complete PCL tears. Contraindications to this procedure include patients who have significant osteoarthritis, open knee dislocations, or medical comorbidities making them unfit for surgery. Technique Description: The fundamental idea behind this technique is a stepwise treatment starting with open aspects of the procedure and followed by arthroscopic work. The technique is initiated with a lateral approach, common peroneal neurolysis, fibular and femoral FCL reconstruction tunnel preparation, and a gracilis or semitendinosus tendon autograft harvest. After that, focus shifts to intra-articular work such as associated meniscal assessment and treatment, PCL femoral and tibial tunnel preparation, graft passage, and PCL femoral tunnel fixation. Final graft fixation order is as follows: anterolateral bundle of PCL, posteromedial bundle of PCL, and finally FCL. Results: Multiple studies have reported that an anatomic FCL reconstruction in the setting of multiligament injury results in improved patient outcomes. In a prospective study of 20 patients, LaPrade et al reported −0.4 mm difference in side-to-side lateral compartment gapping and significant postoperative improvement of symptom and functional scores at a minimum 2 year postoperative follow-up after anatomic reconstruction of the FCL. Similarly, Moulton et al reported significant improvement in the average Western Ontario and Lysholm scores at 2.7 years follow-up. LaPrade et al also reported significant improvement in function and objective outcome scores at 3 years’ follow-up from anatomic double-bundle PCL reconstruction. Discussion: Anatomic FCL and PCL reconstructions successfully restore near native knee objective stability and provide superior clinical outcomes when compared to nonanatomic-based FCL reconstructions that continue to be performed. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

Optimizing Asymmetric Native Knee Flexion Gap Balance Promotes Superior Outcomes in Primary Total Knee Arthroplasty.

Replicating native knee kinematics remains the ultimate goal of total knee arthroplasty (TKA). Technology, such as robotics, provides robust intraoperative data; however, no evidence-based targets currently exist for improved clinical outcomes. Furthermore, some surgeons target a rectangular flexion space in TKA unlike the native knee. This study evaluated the effect of in vivo flexion gap asymmetry on patient-reported outcome measures (PROMs) in contemporary TKA. In vivo tibiofemoral joint space dimensions were measured during 129 TKAs using a calibrated tension device before and after complete posterior cruciate ligament resection. PROMs were compared based on the final dimensions and the change in flexion gap dimensions at 90° of flexion: (1) equal laxity, (2) lateral laxity, and (3) medial laxity. Groups did not differ by demographics ( P ≥ 0.347), clinical follow-up ( P = 0.134), tibiofemoral alignment ( P = 0.498), or preoperative PROMs ( P ≥ 0.093). Mean follow-up for the cohort was 1.5 years (range, 1-3). Pain with climbing stairs, pain while standing upright, and knees "always feeling normal" scores were superior for patients with equal or lateral laxity compared with medial laxity ( P ≤ 0.064). Pain with level walking, University of California Los Angeles activity level, KOOS JR, and satisfaction scores also tended to be superior for patients with equal or lateral laxity, although it lacked statistical significance ( P ≥ 0.111). Results of this study suggest that patients with either an equally tensioned rectangular flexion space or with later-flexion lateral laxity after posterior cruciate ligament resection may achieve superior PROMs. Findings support the clinical benefit of facilitating posterolateral femoral roll back in flexion, which mimics native knee kinematics and further helps define targets for advanced technology.

UTE-T2* versus conventional T2* mapping to assess posterior cruciate ligament ultrastructure and integrity-an in-situ study.

BackgroundClinical-standard morphologic magnetic resonance imaging (MRI) is limited in the refined diagnosis of posterior cruciate ligament (PCL) injuries. Quantitative MRI sequences such as ultrashort echo-time (UTE)-T2* mapping or conventional T2* mapping have been theorized to quantify ligament (ultra-) structure and integrity beyond morphology. This study evaluates their diagnostic potential in identifying and differentiating partial and complete PCL injuries in a standardized graded injury model.MethodsTen human cadaveric knee joint specimens were imaged on a clinical 3.0 T MRI scanner using morphologic, conventional T2* mapping, and UTE-T2* mapping sequences before and after standardized arthroscopic partial and complete PCL transection. Following manual segmentation, quantitative T2* and underlying texture features (i.e., energy, homogeneity, and variance) were analyzed for each specimen and PCL condition, both for the entire PCL and its subregions. For statistical analysis, Friedman’s test followed by Dunn’s multiple comparison test was used against the level of significance of P≤0.01.ResultsFor the entire PCL, T2* was significantly increased as a function of injury when acquired with the UTE-T2* sequence [entire PCL: 11.1±3.1 ms (intact); 10.9±4.6 ms (partial); 14.3±4.9 ms (complete); P<0.001], but not when acquired with the conventional T2* sequence [entire PCL: 10.0±3.2 ms (intact); 11.4±6.2 ms (partial); 15.5±7.8 ms (complete); P=0.046]. The PCL subregions and texture variables showed variable changes indicative of injury-associated disorganization.ConclusionsIn contrast to the conventional T2* mapping, UTE-T2* mapping is more receptive in the detection of structural damage of the PCL and allows quantitative assessment of ligament (ultra-)structure and integrity that may help to improve diagnostic differentiation of distinct injury states. Once further substantiated beyond the in-situ setting, UTE-T2* mapping may refine diagnostic evaluation of PCL injuries and -possibly- monitor ligament healing, ageing, degeneration, and inflammation.

Sex Differences In Posterior Cruciate Ligament Injuries

BACKGROUND: Acute tears of the posterior cruciate ligament (PCL) have been more commonly reported in males than females, with males constituting between 60 and 84% of isolated and combined PCL injuries. However, there is a paucity of studies comparing the injury patterns between males and females. This study aimed to evaluate the differences in patterns of isolated PCL tears and associated injuries between males and females on magnetic resonance imaging (MRI). METHODS: Patients with PCL tears were identified through an institutional database. Two musculoskeletal imaging radiologists independently reviewed each case to describe injury patterns as well as the presence and severity of concurrent injuries. After applying exclusion criteria, male and female cohorts were compared for differences in injury patterns and the presence of concurrent injuries. Linear regression analysis was performed to assess for differences in injury patterns related to age. RESULTS: A search yielded 322 consecutive patients with PCL injury. After reviewing MRI exams and applying exclusion criteria, the cohorts included 79 patients (21 female and 58 male). Overall, females with PCL tears were more likely to sustain concurrent injuries to the posteromedial corner (71.4% vs. 25.9%, p &lt; 0.001), anterior cruciate ligament (14.3% vs. 0%, p = 0.003), partial injury to the medial collateral ligament (23.8% vs. 6.9%, p = 0.037), and lateral meniscus (38.1% vs. 3.5%, p &lt; 0.001). Comparison of patients with Grade 3 PCL injuries showed that this type of injury occurred at a greater age in females when compared to males (46.0±22.1 vs. 32.3±13.5, p=0.019). Regression analysis between age and injury pattern in patients with Grade 3 PCL tears revealed significant findings only in female patients, with a positive correlation between age and distal location of the PCL tear (R2 = 0.5937, p = 0.003). We also observed significant negative correlations between age and associated injuries of the ACL (R2 = 0.3623, p = 0.038), and lateral retinaculum (R2 = 0.3325, p = 0.049). CONCLUSION: We observed significant sex differences in the number and type of accompanying injuries with acute PCL injuries. Complete PCL injuries were found to occur at a greater age in females, with an age-dependent distribution of PCL injury location and number of accompanying injuries. Further studies are needed to understand the role of these findings in the treatment and outcomes after PCL injury.

Protruding anterior medial meniscus and posterior tibial translation as secondary signs of complete and partial posterior cruciate ligament tear.

To evaluate whether measurement of protruding anterior meniscus in the medial compartment (PAMM) and posterior tibial translation (PTT) can be used as a secondary sign of posterior cruciate ligament (PCL) tear for differential diagnosis of partial or complete tear. 21 cases with complete PCL tear, 35 cases with partial PCL tear, and 55 normal cases were reviewed in this retrospective study. PTT and PAMM were measured from the MR images associated with each case. Non-parametric data were evaluated using the Kruskal-Wallis test and the Mann-Whitney U-test with Bonferroni correction to compare differences among the three groups: complete tear, partial tear, and controls. There were significant differences in the median values of PAMM among the three groups, and with PAMM increasing as the grade of PCL injury increased. However, there were no significant differences in median PTT among the three groups. Median PAMM in the partial and complete tear groups was significantly higher than in subjects without PCL rupture (adjusted p-value <0.05). Although median PAMM in subjects in the complete tear group tended to be higher than in those with a partial tear, this difference was not statistically significant (adjusted p-values ≥0.418). PAMM is more useful finding than PTT and can predict PCL tear with or without posterior instability. However, PAMM cannot differentiate partial tear and complete tear of the PCL. PAMM is more useful finding than PTT and can predict PCL tear with or without posterior instability. However, PAMM cannot differentiate partial tear and complete tear of the PCL.

The effects of posterior cruciate ligament rupture on the biomechanical and histological characteristics of the medial collateral ligament: an animal study

BackgroundTo investigate the effect of complete rupture of the posterior cruciate ligament (PCL) on the biomechanics and histology of the medial collateral ligament (MCL).Materials and methodsSeventy-two male rabbits were randomly divided into two groups: the ruptured group was treated with complete PCL amputation, while the intact group was only subjected to PCL exposure without amputation. Eighteen rabbits were randomly sacrificed at 8, 16, 24, and 40 weeks after the operation, and their specimens were processed for mechanical tensile testing, nano-indentation experiments, hematoxylin-eosin (HE) staining, and picrosirius-polarization staining.ResultsThere was no significant difference in the length and maximum displacement of the MCL between the ruptured group and the intact group at each time point. The maximum load of the ruptured group was significantly smaller than that of the intact group at 40 W. The elastic modulus and micro-hardness of the ruptured group increased significantly at 24 W and decreased significantly at 40 W. At 16 W and 24 W after PCL rupture, the number of type I collagen fibers and type III collagen fibers in the MCL of the ruptured group was significantly increased compared with that of the intact group. While the type I collagen fibers of the ruptured group were significantly decreased compared with the intact group at 40 W, there was no significant difference in type III collagen fibers between the ruptured group and the intact group.ConclusionPCL rupture has no significant effect on the mechanical and histological properties of MCL in a short period of time under physiological loading, but the histological and mechanical properties of MCL decrease with time.

Outcomes of Non operative Treatment of Isolated, Acute Posterior Cruciate Ligament (PCL) Injury

1.1. Objectives: The aim of this study is to evaluate the results of non-operative treatment of acute, isolated PCL injury. 1.2. Study Design: Prospective Observational Study. 1.3. Setting: Orthopedics and spine unit, Hayatabad Medical Complex, Peshawar. 1.4. Method: 63 patients who had post traumatic PCL injury were recruited for our study). There were 23 partial PCL injuries and 40 total PCL injuries among the 63 knees. These 63 knees were subjected to a thorough subjective, objective, functional, and radiological examination. 1.5. Results: There was no discomfort in 38 knees (60%), mild pain in 14 knees (22%), and significant pain on exercise in 6 (9.5%) knees at the most recent follow-up examination (10 percent). In 54 knees (93%), there was no swelling, mild, intermittent swelling in three knees (5%), and moderate swelling on exertion in one knee (2 percent). Fifty-two patients (91%) experienced no giving way, whereas five patients (9%) complained of giving way on occasion, especially while walking downstairs. 1.6. Conclusion: We currently believe that patients with acute, isolated, complete PCL tears and up to 10 mm of posterior tibial translation (anterior border of tibial plateau flush with anterior surface of femoral condyles with knee in 90-degree flexion) can be treated non operatively and that the majority of patients can achieve a satisfactory functional result.

Promising clinical and magnetic resonance imaging results after internal bracing of acute posterior cruciate ligament lesions in multiple injured knees.

The purpose of this study was to evaluate the clinical and radiological outcomes of acute posterior cruciate ligament (PCL) lesions in multiple injured knees that were surgically treated with internal bracing. Acute complete PCL lesions in multiple injured knees with subsequent internal-bracing treatment within 21days between 2014 and 2016 were eligible for inclusion. At final follow-up, patients were assessed with Tegner, Lysholm, and IKDC scores. PCL stability and healing were verified with KT-2000, stress radiography and magnetic resonance imaging (MRI). Fourteen patients [mean age 37.4 (± 17.8; SD) years] were evaluated after a mean follow-up of 19.9 (± 7.7; SD) months. Thirteen patients suffered complete lesions of the PCL with concomitant ligamentous injuries (Schenck I: six cases, Schenck III M: five cases, Schenck IV N: one case, Schenck V: one case). Median Tegner, mean Lysholm and mean IKDC scores at follow-up were 4 (2-7; interquartile range), 69.1 (± 16.6; SD) and 68.9 (± 18.1; SD) respectively. Posterior translation averaged 5.8 (± 2.2; SD) mm with the KT 2000 and stress radiography showed a mean posterior tibial translation of 5.5 (± 4.1; SD) mm in the side to side comparison. MRI showed adequate PCL healing. Internal bracing as treatment for acute PCL ruptures in multiple injured knees showed adequate restoration of posterior tibial translation in a single-centre study including 14 cases. IV.

The Role of Diffusion-weighted Magnetic Resonance Imaging in the Evaluation of Anterior Cruciate and Posterior Cruciate Ligament Tears

Objective: The objective of our study was to determine the role of diffusion-weighted (DW) magnetic resonance imaging (MRI) in diagnosing and differentiating between complete and partial anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) tears and to compare it with conventional MRI sequences. Materials and Methods: We conducted a prospective study for a period of 2 years from October 2017 to October 2019 on 30 patients with clinically suspected ACL/PCL injuries of the knee. MRI of the knee joint was performed using conventional, and DW sequences and the findings on both the sequences were assessed independently and compared with the intraoperative or follow-up MRI findings. Results: As per operative and follow-up MRI findings, the sensitivity and specificity of conventional MRI were 60% and 33.33% with a positive and negative predictive value of 47.37% and 45.45%, respectively. On the other hand, the sensitivity and specificity of DW MRI were 70.00% and 33.33% with a positive and negative predictive value of 51.22% and 52.13%, respectively. P = 0.417 was statistically not significant. Conclusion: According to our study, adding DW sequence to conventional MR sequences yielded comparable results in diagnosis and differentiation between complete and partial ACL and PCL tears.

The Role of Complete Posterior Cruciate Ligament Release in Flexion Gap Balancing for Total Knee Arthroplasty

BackgroundThe sequence of posterior cruciate ligament (PCL) release in posterior-substituting designs, when performing gap balancing in total knee arthroplasty (TKA), is variable. We hypothesize that early complete PCL release during knee exposure will change the flexion balance to result in a uniform medial-lateral flexion gap symmetry at the time of implant placement. MethodsTen cadaveric knees were prepared for TKA using standard medial parapatellar approach. Medial and lateral flexion gaps were measured in the conditions of intact, partial (50%) resection, and full resection of PCL. Measurements were performed with both surgical navigation and a caliper. Flexion gap distances were reported for medial and lateral compartments in the 3 PCL conditions. ResultsMedial flexion gap increased after only complete release of the PCL (mean 3.94-5.05 mm). The lateral flexion gap increased as well (mean 4.17-4.67 mm). Complete PCL release resulted in a statistically significant increase in medial flexion gap compared to intact (P = .013) and partially released (P = .012) specimens. No significant differences were noted in lateral flexion gap change. Notable change in medial versus lateral gap (flexion gap symmetry) relationship occurred after just partial PCL release (P = .018). ConclusionAmong the 3 PCL states, changes in flexion gap distance were most conspicuous in the medial compartment. This suggests gap balancing performed with incomplete PCL release will not accurately reflect gap distance after eventual PCL removal, thus supporting the hypothesis. It is recommended that the PCL should be released to the fullest extent possible before ligament tensioning for femoral component rotation in posterior-stabilized TKA.

Double-Bundle Posterior Cruciate Ligament Reconstruction in 100 Patients at a Mean 3 Years’ Follow-up: Outcomes Were Comparable to Anterior Cruciate Ligament Reconstructions

Background: Historically, outcomes of posterior cruciate ligament (PCL) reconstructions have been less predictable and reported to yield inferior results when compared with those for anterior cruciate ligament (ACL) reconstructions. Purpose: To report on the outcomes of double-bundle PCL reconstructions (DB PCLRs) in isolated versus combined injuries and acute versus chronic PCL reconstructions. To compare the outcomes of isolated DB PCLR with isolated ACL reconstruction. Study Design: Cohort study; Level of evidence, 3. Methods: All patients who underwent a primary endoscopic DB PCLR for complete PCL tears (grade III) between May 2010 and March 2015 were reviewed. Patient-reported outcome scores (Tegner, Lysholm, WOMAC [Western Ontario and McMaster Universities Osteoarthritis Index], SF-12 [12-item Short Form Health Survey]) and objective posterior stress radiographs were collected preoperatively and at a minimum 2 years postoperatively. A cohort subanalysis was additionally performed between isolated and combined PCL reconstruction and acute versus chronic PCL reconstruction. Patients who underwent isolated ACL reconstructions over the same inclusion period (2010-2015) were selected as a comparison group. Results: One hundred patients who underwent DB PCLR were included in this study. There were 31 isolated PCL injuries, and 69 patients had concurrent combined PCL injuries requiring surgery. The mean follow-up for the PCL cohort was 2.9 years (range, 2-6 years). The median Tegner activity score improved from 2 to 5, Lysholm from 48 to 86, WOMAC from 35.5 to 5, and SF-12 Physical Component Summary from 34 to 54.8 (all P values <.001). The mean side-to-side difference in posterior tibial translation on kneeling stress radiographs improved from 11.0 ± 3.5 mm preoperatively to 1.6 ± 2.0 mm postoperatively (P < .001). There were no differences in postoperative functional scores between isolated PCL reconstructions and PCL-based multiligament reconstructions (all P values >.229). There was no significant difference in the reported outcome scores between acute and chronic reconstructions (all P values >.087) except for Tegner scores (P < .001) and patient satisfaction (P = .011) favoring acutely treated PCL injuries. There were no significant differences between patients who had an isolated DB PCLR and patients who underwent an isolated ACL reconstruction (n = 141) in postoperative outcome scores (all P values >.064). Conclusion: Significantly improved functional and objective outcomes were observed after anatomic DB PCLR at a mean 3 years’ follow-up, with low complication rates, regardless of concomitant ligamentous injury or timing to surgery. Additionally, contrary to previous reports, comparable subjective and functional clinical outcomes were achieved compared with an isolated ACL reconstruction control cohort.

The biomechanical and histological effects of posterior cruciate ligament rupture on the medial tibial plateau

BackgroundThe objective of this study was to investigate the biomechanical and histological effects of the posterior cruciate ligament (PCL) on the medial tibial plateau.MethodsA total of 12 cadaveric human knee specimens were collected and grouped as follows: the PCL intact group (n = 12), the anterolateral bundle rupture group (n = 6), the postmedial bundle rupture group (n = 6), and the PCL rupture group (n = 12). The strain on the anterior, middle, and posterior parts of the medial tibial plateau with an axial loading force at different flexion angles was measured and analyzed, respectively. Forty-eight rabbits were chosen for animal study: surgery was performed on the one side of each rabbit randomly (experimental group), while the other side was taken as control (control group). Every 12 rabbits were culled at each of the four selected time points to collect the medial tibial plateau for morphological and histological observation.ResultsThe PCL rupture, either partial or complete, may generate an abnormal load on all the parts of the medial tibial plateau with axial loading at all positions. Noticeable time-dependent degenerative histological changes of the medial tibial plateau were observed in the rabbit models of PCL rupture. Compared with the control group, all the PCL rupture groups exhibited a higher expression of the matrix metalloproteinase-7 (MMP-7) and the tissue inhibitors of metalloproteinase-1 (TIMP-1) at all the time points.ConclusionsEither partial or complete PCL rupture may generate an abnormal load on all the parts of the medial tibial plateau with axial loading at all the positions and may cause cartilage degeneration on the medial tibial plateau.

Incidence and long-term follow-up of isolated posterior cruciate ligament tears.

Isolated posterior cruciate ligament (PCL) tears are an uncommon injury. The goals of this study are to (1) determine the population-based incidence of isolated PCL tears, (2) compare the occurrence of secondary meniscal tears or arthritis in patients with PCL deficiency to patients without PCL tears, and (3) evaluate factors associated with long-term sequelae among patients with PCL deficiency. This retrospective study included a population-based incidence cohort of 48 patients with new-onset, isolated PCL tears between 1990 and 2010, as well as an age and sex-matched cohort of individuals without PCL tears. A chart review was performed to collect information related to the initial injury, treatment, and outcomes. Subjects were retrospectively followed to determine the development of subsequent meniscal tears, arthritis, or total knee arthroplasty (TKA). The age- and sex-adjusted annual incidence of isolated, complete PCL tears was 1.8 (95% CI 1.3, 2.3) per 100,000. During a mean 12.2-year follow-up, patients with isolated PCL tears had a significantly higher likelihood (HR 6.2, 95% CI 1.8, 21.2) of symptomatic arthritis compared to individuals without PCL tears. The likelihood of subsequent meniscal tears (HR 2.1, 95% CI 0.4, 10.7) and TKA (HR 3.2, 95% CI 0.5, 19.6) was more frequent among patients with PCL tears compared to subjects without PCL tears. Older age at injury was significantly associated with future arthritis (P=0.003) and TKA (P=0.02). Isolated PCL tears remain a rare injury with an estimated annual incidence of 2 per 100,000 persons. Patients with isolated PCL tears have a significantly higher risk of symptomatic arthritis than patients without PCL tears. Older age at injury is associated with a higher risk of arthritis and the need for TKA. The results of this study can be used to educate patients about the natural history of isolated PCL tears and provide a baseline of expectations for the future development of arthritis and subsequent meniscal injury following isolated PCL injury. Retrospective comparative study, Level III.

Isolated posterior cruciate ligament injuries: Results of arthroscopic management

Aim: Isolated posterior cruciate ligament (PCL) injuries are considered as benign and treated conservatively. Aim of this study is to determine the functional outcomes, efficacy of isolated PCL injuries treated by arthroscopic PCL reconstruction or fixation. Materials and Methods: A total of 24 patients, each with an isolated PCL injury, (17 with complete PCL tear and 7 with PCL avulsion fracture) were enrolled in this prospective study. Patients with complete tear underwent PCL reconstruction with hamstring tendon autograft and the patients with displaced avulsion fractures underwent arthroscopic fixation with suture bridge technique. The patients underwent regular follow-up postoperatively with clinical and radiographic evaluation. Follow-up examinations comprised the Lysholm knee score, International Knee Documentation Committee (IKDC) score. Results: Mean pre-operative lysholm score for 24 knees was 41; mean post-operative lysholm score was 90. 18 of 24 patients had excellent results, 4 patients had good results, and 2 patients had fare result at final assessment. In final IKDC ratings, 21 patients were assessed as normal or near normal (Grade A or B). Conclusions: The short-term follow-up showed good function after arthroscopic management in isolated PCL injuries. Hence, we recommend surgical intervention in isolated PCL injuries.

Kinematic Analysis of the Posterior Cruciate Ligament, Part 1

Background: The posterior cruciate ligament (PCL) is composed of 2 functional bundles and has an essential role in knee function and stability. There is, however, a limited understanding of the role of each individual bundle through the full range of knee flexion. Hypothesis: Both bundles provide restraint to posterior tibial translation across a full range of knee flexion. At higher angles of knee flexion (>90°), the intact PCL also imparts significant rotational stability. Study Design: Controlled laboratory study. Methods: Twenty matched-paired, human cadaveric knees (mean age, 55.2 years; range, 51-59 years; 6 male and 4 female pairs) were used to evaluate the kinematics of an intact, anterolateral bundle (ALB) sectioned, posteromedial bundle (PMB) sectioned, and complete PCL sectioned knee. A 6 degree of freedom robotic system was used to assess knee stability with an applied 134-N posterior tibial load, 5-N·m external and internal rotation torques, 10-N·m valgus and varus torques, and a coupled 100-N posterior tibial load and 5-N external rotation torque at 0°, 15°, 30°, 45°, 60°, 75°, 90°, 105°, and 120°. Results: All sectioned states had significant increases compared with intact in posterior translation, internal rotation, and external rotation at all tested flexion angles, with the exception of the ALB sectioned state at 75° of flexion for external rotation. The significant increases (mean ± standard deviation) in posterior translation during a 134-N posterior tibial load at 90° of flexion were 0.9 ± 0.6 mm, 2.6 ± 1.8 mm, and 11.7 ± 4.0 mm for the PMB, ALB, and complete PCL sectioned states, respectively, compared with the intact state. The largest significant increases in internal rotation were in the PMB and complete PCL sectioned states at 105° of flexion, 1.3° ± 1.0° and 2.8° ± 2.1°, respectively. Conclusion: Both the ALB and the PMB assume a significant role in resisting posterior tibial translation, at all flexion angles, suggesting a codominant relationship. The PCL provided a significant constraint to internal rotation beyond 90° of flexion. Clinical Relevance: This information broadens the understanding of native knee kinematics and provides a template for the evaluation of single- and double-bundle PCL reconstructions.

Effect of partial and complete posterior cruciate ligament transection on medial meniscus: A biomechanical evaluation in a cadaveric model

Background:The relationship between medial meniscus tear and posterior cruciate ligament (PCL) injury has not been exactly explained. We studied to investigate the biomechanical effect of partial and complete PCL transection on different parts of medial meniscus at different flexion angles under static loading conditions.Materials and Methods:Twelve fresh human cadaveric knee specimens were divided into four groups: PCL intact (PCL-I), anterolateral bundle transection (ALB-T), posteromedial bundle transection (PMB-T) and PCL complete transection (PCL-T) group. Strain on the anterior horn, body part and posterior horn of medial meniscus were measured under different axial compressive tibial loads (200-800 N) at 0°, 30°, 60° and 90° knee flexion in each groups respectively.Results:Compared with the PCL-I group, the PCL-T group had a higher strain on whole medial meniscus at 30°, 60° and 90° flexion in all loading conditions and at 0° flexion with 400, 600 and 800 N loads. In ALB-T group, strain on whole meniscus increased at 30°, 60° and 90° flexion under all loading conditions and at 0° flexion with 800 N only. PMB-T exihibited higher strain at 0° flexion with 400 N, 600 N and 800 N, while at 30° and 60° flexion with 800 N and at 90° flexion under all loading conditions.Conclusions:Partial PCL transection triggers strain concentration on medial meniscus and the effect is more pronounced with higher loading conditions at higher flexion angles.

Arthroscopic reconstruction of posterior cruciate ligament with ligament advanced reinforcement system Y-shape double bundles artificial ligament

Objective To study the operative techniques and clinical effect of arthroscopic reconstruction for posterior cruciate ligament (PCL) with ligament advanced reinforcement system (LARS)Y-shape double bundles artificial ligament. Methods From June 2006 to August 2010,14 patients (10 males and 4 females,at age range of 19-58 years,mean 38 years) with PCL ruptures were treated with LARS under arthroscopic observation.The injury causes included sports contusion in nine patients,traffic accidents in three and falling from height in two.Five patients were with left knee injury and three with right knee injury.The course of injury was 10-30 days (average 15.7 days).MRI indicated complete PCL ruptures in 14 patients and complete anterior cruciate ligament (ACL) ruptures in two.The combined injuries included medial meniscus injury in five patients,lateral meniscus injury in three and posterior acetabular wall fracture in one.The preoperative Lysholn score was (40 ± 7.9 ) points ( range,20-55 points).According to the international knee documentation committee (IKDC) grading,three patients were rated as grade C and 11 as grade D preoperatively.The operation was performed under arthroscopic observation.The ending point and tunnel of PCL of the femur and tibia were drilled with the help of a locator. Results All the patients obtained primary healing,with no complications such as infection,spontaneous rupture or laxity of graft postoperatively.The regular follow-up for all cases ranged from6-60 months ( average 20.5 months).The postoperative Lysholn score was ( 88 ± 3.6 ) points ( 84-93 points),with statistical difference in comparison with the preoperative score (P ＜ 0.05 ) The IKDCgrading was A in 10 patients and B in four 12 months postoperatively. Conclusions Arthroscopic reconstruction with LARS artificial ligaments can effectively recover the stability of the knees,avoid the complications brought by autologous tendon and prevent the allograft rejection complications induced by allogenic tendon graft.The treatment is characterized by simple procedures,minor wound and fast recovery. Key words: Knee joint; Posterior cruciate ligament; Arthroscopes; Artificial ligament

How We Manage the Multiple-Ligament Injured (Dislocated) Knee

Treating mulitligament knee dislocations can be difficult. Initial treatment should consist of immediate reduction and care for limb-threatening injuries. Physical examination, x-rays, and magnetic resonance imaging are often necessary to clearly define the injury pattern. Occasionally, a computed tomography scan is beneficial to better characterize fractures. Timing for definitive treatment of the multiligament knee injury depends on associated injuries at the time of injury, the integrity of the soft tissues, the vascular status of the limb, and the condition of the knee at presentation. In general, early surgery is indicated in patients with associated fractures, vascular compromise, and patellar or quadriceps tendon ruptures. We also tend to favor acute repair of lateral-sided injuries with or without graft augmentation. Medial collateral ligament (MCL) injuries can be treated with immobilization unless the MCL is displaced or if there is associated meniscal extrusion. The condition of the knee largely determines whether the cruciate ligaments should be acutely reconstructed or reconstructed in a staged procedure. We treat complete posterior cruciate ligament injuries with a double-bundle arthroscopic inlay technique. The decision to use allograft or autograft depends on the severity of the knee injury, the demands that will be placed on the knee, and patient wishes. The return to a high level of sports participation after this injury is challenging and usually takes at least 9 to 12 months.

Posterior cruciate ligament injuries in sports: treatment options

Lecture 4Diagnosis and management of posterior and cruciate ligament tears has advanced over the past two decades due to important understanding of the natural history of injury and basic science...