Posterior Cruciate Ligament Injuries

The posterior cruciate ligament (PCL) is an intra-articular, extra-synovial ligament that provides stability to the knee joint. It acts as the primary restraint to posterior tibial translation and a secondary restraint to internal rotation. PCL tears are severe injuries with potential for long-lasting consequences to the knee joint. Most PCL injuries are also associated with high-energy trauma such as motor vehicle accidents and sports-related activities. The most common specific tests used to determine the integrity of the PCL during a physical exam are the posterior drawer test, quadriceps active test, dial test, and reversed pivot-shift test. Magnetic resonance imaging (MRI) is the most accurate diagnostic modality to identify acute isolated and combined PCL injuries. In most situations, an acute, isolated partial PCL injury (grade I or II) is treated with nonsurgical management, while surgical intervention is primarily reserved for symptomatic grade III complete ruptures of the ligament that fail to improve with initial conservative treatment. The two major arthroscopic PCL reconstruction techniques are the single-bundle (SB) PCL reconstruction and the double-bundle (DB) PCL reconstruction. Existing literature suggests a biomechanical and objective benefit to the DB technique without clear superiority of either technique in subjective clinical outcomes. Recent literature has supported the durability of both of these techniques. At 15 years follow-up from PCL reconstruction, the survival rates for Achilles tendon allograft are reported to be 82% for SB and 84% for DB. The primary goals of postoperative rehabilitation following PCL reconstruction are to strengthen the knee extensor mechanism, minimize posterior subluxation of the tibia, and gradually progress weight-bearing.