Posterior Cruciate Ligament Injuries

Key Features

• 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

Clinical Findings

• 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

Diagnosis

• 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

Treatment

• 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