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Key Features

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  • Uncommon injury

  • Occurs when the individual falls on a flexed knee with the ankle in plantarflexion or with forced hyperflexion of the knee

  • Most common sports in which PCL injuries are sustained are football and hockey

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Clinical Findings

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  • Swelling and pain in the posterior and lateral knee

  • Increased pain with knee flexion

  • Examination begins with the uninjured knee and proceeds to the injured side

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Diagnosis

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  • Positive posterior drawer test is confirmatory

    • Performed with the patient supine, the knee flexed to 90 degrees, and the foot stabilized

    • Grading is based on the amount of translation

      • Grade 1 (mild) is up to 5 mm

      • Grade 2 (moderate) is 5–10 mm

      • Grade 3 (severe) is more than 10 mm; typically indicates that another ligament is injured in addition to the PCL and should alert the provider to an associated injury

  • Diagnostic imaging includes plain radiographs and MRI scan

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Treatment

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  • Isolated PCL injuries are almost universally treated nonoperatively

  • However, bony avulsions of the PCL off the femur or tibia generally requires surgical fixation

  • Ligamentous PCL injuries in isolation are remarkably well tolerated in athletes and can be treated with bracing and a progressive rehabilitation program

  • Combined injuries (PCL as well as other structures)

    • Complex and often require surgical stabilization

    • Surgical stabilization of these injuries is complicated

    • Return to sports at the previous level is uncertain

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