Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2021 Mar;29(3):682-693.
doi: 10.1007/s00167-020-06337-2. Epub 2020 Oct 30.

Evolving evidence in the treatment of primary and recurrent posterior cruciate ligament injuries, part 2: surgical techniques, outcomes and rehabilitation

Philipp W Winkler  1   2 , Bálint Zsidai  3 , Nyaluma N Wagala  4 , Jonathan D Hughes  4 , Alexandra Horvath  5 , Eric Hamrin Senorski  6 , Kristian Samuelsson  3   7 , Volker Musahl  4
Affiliations
Review

Evolving evidence in the treatment of primary and recurrent posterior cruciate ligament injuries, part 2: surgical techniques, outcomes and rehabilitation

Philipp W Winkler et al. Knee Surg Sports Traumatol Arthrosc. 2021 Mar.

Abstract

Isolated and combined posterior cruciate ligament (PCL) injuries are associated with severe limitations in daily, professional, and sports activities as well as with devastating long-term effects for the knee joint. As the number of primary and recurrent PCL injuries increases, so does the body of literature, with high-quality evidence evolving in recent years. However, the debate about the ideal treatment approach such as; operative vs. non-operative; single-bundle vs. double-bundle reconstruction; transtibial vs. tibial inlay technique, continues. Ultimately, the goal in the treatment of PCL injuries is restoring native knee kinematics and preventing residual posterior and combined rotatory knee laxity through an individualized approach. Certain demographic, anatomical, and surgical risk factors for failures in operative treatment have been identified. Failures after PCL reconstruction are increasing, confronting the treating surgeon with challenges including the need for revision PCL reconstruction. Part 2 of the evidence-based update on the management of primary and recurrent PCL injuries will summarize the outcomes of operative and non-operative treatment including indications, surgical techniques, complications, and risk factors for recurrent PCL deficiency. This paper aims to support surgeons in decision-making for the treatment of PCL injuries by systematically evaluating underlying risk factors, thus preventing postoperative complications and recurrent knee laxity. LEVEL OF EVIDENCE: V.

Keywords: Double-bundle; Failure; Knee; PCL; Posterior cruciate ligament; Revision; Risk factors; Single-bundle; Tibial inlay; Transtibial.

PubMed Disclaimer

Conflict of interest statement

VM reports educational grants, consulting fees, and speaking fees from Smith & Nephew plc, educational grants from Arthrex, is a board member of the International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine (ISAKOS), and deputy editor-in-chief of Knee Surgery, Sports Traumatology, Arthroscopy (KSSTA). In addition, VM has a patent Quantified injury diagnostics-U.S. Patent No. 9,949,684, Issued on April 24, 2018 issued to University of Pittsburgh.

Figures

Fig. 1
Fig. 1
Schematic illustration of the transtibial and tibial inlay posterior cruciate ligament reconstruction techniques. Single-bundle (a) and double-bundle (b) transtibial technique (right knee, anterior view). Single-bundle (c) and double-bundle (d) tibial inlay technique (right knee, posterior view)
Fig. 2
Fig. 2
Posterior cruciate ligament graft failure. Patient with atraumatic PCL graft failure of the right knee. T2-weighted sagittal (a) and axial (b) MR images showing PCL graft failure and misplaced tibial tunnel (too anterior and too proximal). Note scarring of remnant PCL fibers imitating PCL continuity (white arrows). Arthroscopic images demonstrating graft failure (c), misplaced tibial tunnel (d), and revision PCL graft (e). Postoperative anterior–posterior (f) and lateral (g) radiographs demonstrating new anatomic tibial tunnel. white/black dashed lines, misplaced tibial tunnel; yellow dashed lines, new anatomic tibial tunnel; black arrow, new anatomic tibial tunnel during revision PCL reconstruction; *deficient PCL graft, ACL anterior cruciate ligament, MFC medial femoral condyle, MR magnetic resonance, PCL posterior cruciate ligament
Fig. 3
Fig. 3
Non-operative and postoperative treatment protocol for posterior cruciate ligament injuries. PCL posterior cruciate ligament, PT physical therapy, PTS posterior tibial support, ROM (ex/flex) range of motion (extension to flexion), w week
See this image and copyright information in PMC

References

    1. Aglietti P, Giron F, Losco M, Cuomo P, Ciardullo A, Mondanelli N. Comparison between single-and double-bundle anterior cruciate ligament reconstruction: a prospective, randomized, single-blinded clinical trial. Am J Sports Med. 2010;38:25–34. - PubMed
    1. Agolley D, Gabr A, Benjamin-Laing H, Haddad FS. Successful return to sports in athletes following non-operative management of acute isolated posterior cruciate ligament injuries: medium-term follow-up. Bone Jt J. 2017;99:774–778. - PubMed
    1. Ahn JH, Lee SH, Choi SH, Wang JH, Jang SW. Evaluation of clinical and magnetic resonance imaging results after treatment with casting and bracing for the acutely injured posterior cruciate ligament. Arthroscopy. 2011;27:1679–1687. - PubMed
    1. Ahrend M, Ateschrang A, Döbele S, Stöckle U, Grünwald L, Schröter S, et al. Return to sport after surgical treatment of a posterior cruciate ligament injury: a retrospective study of 60 patients. Orthopade. 2016;45:1027–1038. - PubMed
    1. Anderson CJ, Ziegler CG, Wijdicks CA, Engebretsen L, LaPrade RF. Arthroscopically pertinent anatomy of the anterolateral and posteromedial bundles of the posterior cruciate ligament. J Bone Jt Surg Am. 2012;94:1936–1945. - PubMed