Abstract

Lecture 4

Diagnosis and management of posterior and cruciate ligament tears has advanced over the past two decades due to important understanding of the natural history of injury and basic science principles. Despite the current advances, our understanding of posterior cruciate ligament (PCL) injury and treatment continues to lag behind that of the anterior cruciate ligament (ACL). In addition, there is still controversy regarding indications for surgical intervention, use of one versus two reconstructive graft bundles, location of the femoral tunnels and the ideal degree of graft tensioning.

The classic mechanism of injury to the PCL in sports due to a fall on a flexed knee with the foot in plantar flexion. A PCL injury can be partial or complete and it can be isolated or involve multiple ligaments.

The grading system is normal: A, B and C. Grade A is defined as partial tear and grade B as a complete PCL tear. Grade C PCL injuries are frequently associated with additional injury to the posterolateral corner or the medial aspect of the knee.

In general, acute isolated grade A and B PCL injuries can be treated non-operatively. In grade C injuries with associated ligament pathology, we recommend repairing or reconstructing all ligaments.