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
. 2025 May 2;20(5):648-656.
doi: 10.26603/001c.134128. eCollection 2025.

Long-term Follow-up of Patients with Acute Posterior Cruciate Ligament Injury Treated Non-operatively with a Physiotherapy-led Exercise and Support Brace Intervention

Randi G Rasmussen  1 , Birgitte Blaabjerg  1 , Torsten G Nielsen  2 , Martin Lind  2   3
Affiliations

Long-term Follow-up of Patients with Acute Posterior Cruciate Ligament Injury Treated Non-operatively with a Physiotherapy-led Exercise and Support Brace Intervention

Randi G Rasmussen et al. Int J Sports Phys Ther. .

Abstract

Background: Posterior Cruciate Ligament (PCL) injuries can be treated non-operatively with a structured rehabilitation program or by surgical reconstruction. However, while the outcomes of surgically treated PCL injuries are well described, there is a paucity of large prospective studies reporting long-term outcomes of exercise interventions.

Purpose: The primary aim was to investigate long-term (after five years) patient-reported outcomes of a physiotherapy-led exercise and support brace intervention in patients with an acute PCL injury. The secondary aim was to report conversion to surgical PCL reconstruction.

Study design: Case series study, prospective.

Methods: Fifty patients with acute isolated or multiligament PCL injuries (presenting within eight weeks of injury) completed a 16-week exercise intervention, including 12 weeks in a PCL support brace. Patients were followed prospectively, and patient-reported outcomes were assessed using the International Knee Documentation Committee Subjective Knee Form (IKDC), the Knee injury and Osteoarthritis Outcome Score (KOOS) and the Tegner Activity Scale (TAS). In addition, conversion to surgery was retrospectively extracted from medical records.

Results: Thirty-six patients completed subjective questionnaires at the five-year follow-up. The mean IKDC score improved from 35 points at baseline to 79 points at the five-year follow-up. All mean KOOS subscale scores increased by a statistically significant amount from baseline to the five-year follow-up: Symptoms: 52/87 points; Pain 56/88 points; Activities of daily living 58/90 points; Sport/Recreation 17/75 points; Quality of life 23/73 points. The TAS improved from level 2 at baseline to level 5 at the five-year follow-up. Seven patients (14%) were converted to PCL surgical reconstruction. The median time from initiation of non-operative treatment to surgery was 13 months (range 10-14 months).

Conclusions: The physiotherapy-led exercise and brace intervention showed statistically significant improvements in patient-reported outcomes at long-term follow-up of five years, and the need for conversion to PCL reconstruction for isolated PCL injuries was low with a conversion rate of 7%.

Level of evidence: 3b.

Keywords: changes in patient-reported outcomes; non-operative treatment; physiotherapy; progressive exercises; self-reported outcome.

PubMed Disclaimer

Figures

A diagram of a flowchart Description automatically generated
Figure 1.. Patient flow diagram presenting lost to follow-up for the scheduled timepoints in the five-year follow-up period
A graph of different colored lines Description automatically generated
Figure 2.. Mean IKDC and KOOS scores from baseline to all follow-ups in patients with acute PCL injury treated with a standardized exercise and support brace intervention
Data are provided as means. Abbreviations: IKDC; The International Knee Documentation Committee: KOOS; The Knee injury and Osteoarthritis Outcome Score: Symp; Symptoms: ADL; Activities of Daily Living: Rec; Recreational: QoL; Quality of Life
A graph of injury injuries Description automatically generated
Figure 3.. Mean IKDC scores at baseline, one-, two- and five-year follow-up of patients divided into isolated PCL injury and multiligament PCL injury
Data are provided as means. Abbreviations: IKDC; The International Knee Documentation Committee: PCL; posterior cruciate ligament
A graph of different colored bars Description automatically generated
Figure 4.. Mean KOOS scores at baseline, one-, two-, and five-year follow-up of patients with isolated PCL injury
Data are provided as means. Abbreviations: KOOS; The Knee and Osteoarthritis Outcome Score: Symp; Symptoms: ADL; Activities of Daily Living: Rec; Recreational: QoL; Quality of Life.
A graph of different colored bars Description automatically generated
Figure 5.. Mean KOOS scores at baseline, one-, two-, and five-year follow-up of patients with multiligament PCL injury
Data are provided as mean. Abbreviations: KOOS; The Knee and Osteoarthritis Outcome Score: Symp; Symptoms: ADL; Activities of Daily Living: Rec; Recreational: QoL; Quality of Life.
A graph showing a number of injuries Description automatically generated
Figure 6.. Mean TAS scores at baseline, one-, two-, and five-year follow-up of patients with isolated PCL injury and multiligament PCL injury
Data are provided as mean.
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Evaluation and treatment of posterior cruciate ligament injuries. Harner C. D., Höher J. 1998Am J Sports Med. 26(3):471–482. doi: 10.1177/03635465980260032301. https://doi.org/10.1177/03635465980260032301 - DOI - DOI - PubMed
    1. Minimum 10-year follow-up of patients after an acute, isolated posterior cruciate ligament injury treated nonoperatively. Shelbourne K. D., Clark M., Gray T. 2013Am J Sports Med. doi: 10.1177/0363546513486771. https://doi.org/10.1177/0363546513486771 - DOI - DOI - PubMed
    1. Isolated posterior cruciate ligament tears: An update of management. Vaquero-Picado A., Rodríguez-Merchán E. C. 2017EFORT Open Rev. 2(4):89–96. doi: 10.1302/2058-5241.2.160009. https://doi.org/10.1302/2058-5241.2.160009 - DOI - DOI - PMC - PubMed
    1. The natural history of acute, isolated, nonoperatively treated posterior cruciate ligament injuries: A prospective study. Shelbourne K. D., Davis T. J., Patel D. V. 1999Am J Sports Med. 27(3):276–283. doi: 10.1177/03635465990270030201. - DOI - PubMed
    1. Isolated posterior cruciate ligament injuries in athletes. Fowler P. J., Messieh S. S. 1987Am J Sports Med. 15(6):553–557. doi: 10.1177/036354658701500606. https://doi.org/10.1177/036354658701500606 - DOI - DOI - PubMed

LinkOut - more resources