Diagnostic and incidence of the rupture of the posterior cruciate ligament

Summary The purpose of this article is to evaluate the incidence and to give a general review of the examination of the posterior ligament complex. At least ca. 8–10 % of all severe ligament injuries concern the posterior cruciate ligament, which means, that an estimated 4000–5000 Germans suffer a PCL rupture every year. Motor-vehicle accidents are the most common cause of the injury, but sports-related traumas (football, skiing) have increased in recent years. The high number of high-energy mechanisms involved (up to 90 %), cause ligament ruptures often to be associated with other injuries, especially fractures of the femur and tibia head. In polytrauma patients PCL ruptures are frequently recognized very late, because the possibility of this kind of injury is often not considered during the clinical examination. The same holds for the diagnosis of monotrauma patients. The initial step in the evaluation is to obtain a thorough history (including the mechanism of injury) and to perform a physical examination. The instability after a PCL rupture may present as an ACL rupture, because the anterior drawer test seems to be positive. The anterior/posterior drawer test must be assessed with other evaluation procedures to distinguish between anterior und posterior instabilities. The posterior sag sign, the quadriceps active test or the reversed pivot-shift may indicate a PCL rupture. A correct roentgenogram can reveal an avulsion of the tibia and can prove posterior instability due to a posterior translation of the tibia. A quantitative examination (clinical or X-ray) of the instability and the indication of combined injury of the posterior cruciate ligament and the posterolateral complex are necessary for the therapeutic decision (operative/conservative). A rupture of the PCL may occur occasionally as a result of a luxation of the knee (reduced spontaneously) before the medical evaluation. A thorough neurovascular examination is essential. Magnetic resonance imaging can be important to the diagnosis of an acute injury, but it is not essential for the choice between operative and non-operative treatment. Arthroscopy has been found to have a high degree of accuracy in the diagnosis of ligament ruptures of the knee, but it is still an operative treatment, so that it can only be used if an operation of repair or reconstruction is planned anyway. Before operative treatment of chronic complex instability, potential osseous abnormalities (varus morphotype) must be revealed; in case of uncertainty, an X-ray control is necessary.      

Anterior and posterior cruciate ligament rupture after thermal treatment

Summary: This article reports the first published case of spontaneous, simultaneous rupture of both the anterior and posterior cruciate ligaments 3 months after radiofrequency thermal probe treatment. The patient had no previous traumatic injury to the knee. Simultaneous rupture occurred under minimal physiologic load. Clinical, radiologic, and surgical findings are presented.Arthroscopy: The Journal of Arthroscopic and Related surgery, Vol 16, No 7 (October), 2000: pp 732–736     

Isolated posterior cruciate ligament rupture presenting as a locked knee

Mechanical symptoms in the knee, especially locking, are most commonly associated with meniscal pathology. We present an atypical case of locking of the knee secondary to an isolated posterior cruciate ligament tear.     

Effect of posterior cruciate ligament rupture on biomechanical features of the medial femoral condyle

Objective: To investigate the biomechanical impact of rupture of the posterior cruciate ligament (PCL) and its various bundles on the medial femoral condyle. Methods: Twelve fresh human cadaveric knee specimens were divided into four groups: PCL intact, anterolateral band (ALB) rupture, posteromedial band (PMB) rupture and PCL complete rupture groups according to the purpose and order of testing. Strain in the middle of the medial femoral condyle was measured under different loads (200–800 N) at 0°, 30°, 60°, and 90° of knee flexion. Results: At 0° of knee flexion, compared with the PCL intact and ALB rupture groups, strain on the medial femoral condyle increased in the PMB rupture and PCL complete rupture groups under all loading conditions. There was no statistical difference between the PMB rupture and PCL complete rupture groups. At 30°, 60° and 90° of knee flexion, compared with the PCL intact group, increase in strain on the medial femoral condyle was noted in the ALB rupture group under higher loading conditions (600 N and 800 N) and PCL complete rupture group under all loading conditions. The PCL complete rupture group had higher strain on the medial femoral condyle than did the ALB rupture group under most loading conditions. Conclusion: At 0° of knee flexion, PMB rupture or PCL complete rupture can cause increase in strain on the medial femoral condyle. However, at 30°, 60° and 90° of knee flexion, ALB rupture or PCL complete rupture can cause increase in strain on the medial femoral condyle.     

Arthroscopic posterior cruciate ligament repair

This article presents a classic case of posterior cruciate ligament disruption, as an isolated entity, with avulsion of the cruciate from the tibia origin. The treatment is an arthroscopic technique for reimplantation of the posterior cruciate ligament, using the Instrument Maker staple for fixation to facilitate proper reduction of the posterior cruciate, and presents a follow-up with excellent range of motion and stability of the knee.     

Arthroscopic posterior cruciate ligament repair

Purpose: We present our technique of arthroscopic repair for femoral avulsion soft-tissue tears of the posterior cruciate ligament (PCL) and its results. Type of Study:Case series, retrospective review. Methods: We performed 13 arthroscopic repairs of the PCL and reviewed them retrospectively. Follow-up was available for 11 (85%) patients. Nonabsorbable monofilament sutures were placed through the loose fibers of the ligament and tied over a bone bridge. Patients were evaluated using magnetic resonance imaging, comparative stress views, and according to the scoring systems of Lysholm and Gillquist and the International Knee Documentation Committee (IKDC). Results: Mean follow-up was 51.4 months. IKDC scores revealed 4 (36.4%) patients with normal knee function, and 7 (63.6%) with nearly normal function. Average Lysholm and Gillquist score was 95.4 (90 to 100). All athletes returned to the same or a higher level of competition. Conclusions: Arthroscopic repair of the PCL in patients with a femoral avulsion is effective in reducing postoperative instability and improving functional outcome.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 18, No 7 (September), 2002: pp 695–702     

Aplasia of the anterior cruciate ligament with a compensating posterior cruciate ligament.

Aplasia of the anterior cruciate ligament is a rare condition and is usually associated with other abnormalities of the lower extremities. We report aplasia of the anterior cruciate ligament with a compensating posterior cruciate ligament in a 15-year-old boy.     

膝关节后交叉韧带断裂治疗临床分析

目的 对35例膝关节后交叉韧带断裂治疗进行临床分析,重点探讨了有关交叉韧带断裂的治疗问题。方法 经明确诊断后,分析采用胫骨附着处撕脱骨折复位固定手术治疗26例、早期髌韧带中1／3移植重建3例、单纯长腿石膏固定6例。结果 本组病例全部进行随访,随访时间13个月－5年,胫骨附着处撕脱骨折复位固定及髋韧带中1／3移植重建29例为优良、单纯长腿石膏固定6例为差。结论 后交叉韧带断裂后应该及时给予手术修复;膝后外侧手术入路,操作简单,暴露充分;少于3个月的陈旧性病例仍适应手术治疗。     

Avulsion of both posterior meniscal roots associated with acute rupture of the anterior cruciate ligament

A rare case of acute avulsion of both posterior meniscal roots concomitant with an acute anterior cruciate ligament (ACL) tear in a professional soccer player is described. While avulsion of the lateral meniscal root has been extensively reported in association with ACL injuries, medial root avulsion has never been reported in association with acute ACL. A review of the video documentation of the match accident revealed the exact mechanism of injury was a forceful external rotation of the standing limb.     

Instability after anterior cruciate ligament rupture

Manual tests and 2 external devices were used together with roentgen stereophotogrammetry (RSA) and an active weight-bearing radiographic method to measure the sagittal laxity in 11 knees with anterior-cruciate-ligament rupture. In 5 knees no ligament surgery had been performed (unstable knees) and in 6 knees a reconstruction had been performed one year before the examination (stable knees). There were positive correlations between all methods, including the manual tests when all knees, both stable and unstable, were analyzed together. However, the mean values of the total displacement differed between the methods, especially when comparing the weight-bearing radiographs with the three other methods. Some knees with substantial displacement during passive loading did not show any displacement when weight bearing; the measurements thus depended on both the ligamentous laxity and the patient's neuromuscular control of the joint. When the stable knees were analyzed separately, higher mean values were recorded with the external devices than with RSA using 180 N load. This could be explained by an error from soft tissue deformation which added to the skeletal displacement when the external devices were used.     

Diagnosis of rupture of the anterior cruciate ligament

Clinical examination has remained the key for diagnosis of meniscal and ligament lesions of the knee. Economical use of imaging techniques is based on adequate clinical examination. Standard radiographic examination is still a simple and valuable method. Magnetic resonance tomography has made great progress during the past few decades. For this reason, this article centers on this imaging modality.     

Epidemiology of posterior cruciate ligament injuries

BACKGROUND: The epidemiology of posterior cruciate ligament (PCL) injuries has not been well clarified. Isolated and combined PCL injuries are a frequently missed diagnosis. A better understanding of typical injury mechanisms may help in more accurate diagnosis of these injuries. METHODS: In this study the epidemiology of PCL insufficiency in 494 patients was retrospectively analysed. Stress-radiography was used to quantify posterior tibial displacement. RESULTS: The mean age at the time of injury was 27.5+/-9.9 years. Traffic accidents (45%) and athletic injuries (40%) were the most common injury causes. Motorcycle accidents (28%) and soccer-related injuries (25%) accounted for the main specific injury causes. The most common injury mechanisms were dashboard injuries (35%) and falls on the flexed knee with the foot in plantar flexion (24%). The mean side-to-side difference of posterior tibial displacement on posterior stress-radiographs in 90 degrees of flexion was 13.4+/-4.7 mm. According to the posterior displacement values, 232 (47%) patients had isolated PCL ruptures, while 262 (53%) patients with a posterior displacement of >12 mm were classified as having a combined posterior instability. There were significantly more combined PCL lesions due to vehicular trauma as compared with athletic trauma ( p<0.0001). CONCLUSIONS: In many PCL lesions, initiation of an adequate treatment regimen is delayed despite typical injury mechanisms and symptoms. In the future, a better understanding of the epidemiology of PCL injuries should enable us to diagnose the injury more reliably through a detailed history and a thorough physical and radiographic examination in the acute setting.