Current Reviews in Musculoskeletal Medicine

, Volume 11, Issue 3, pp 515–520 | Cite as

Clinical and radiologic evaluation of the posterior cruciate ligament-injured knee

  • Ahmad Badri
  • Guillem Gonzalez-Lomas
  • Laith Jazrawi
PCL Update (K Jones and M Alaia, section editors)
Part of the following topical collections:
  1. Topical Collection on PCL Update


Purpose of review

Accurate isolated PCL diagnosis continues to present a challenge. This article reviews the current literature regarding clinical and radiographic evaluation of PCL injuries.

Recent findings

A thorough history to understand the mechanism of injury should begin any evaluation. Several clinical tests have been shown to effectively assess PCL laxity, with the posterior drawer test possessing the highest sensitivity and specificity. Any thorough exam should compare the contralateral, uninjured leg. If a PCL or multi-ligament injury is suspected, plain radiographs should be performed to avoid missing a fracture or avulsion. An MRI represents the current gold standard for diagnosing ligament injuries in the knee and should always be obtained in these cases. Due to the significant incidence of nerve injuries (25%) and vascular injuries (18%) with knee dislocations, any suspicion of neurovascular compromise necessitates further studies.


A combination of a thorough clinical history and examination, followed by appropriate imaging optimizes PCL and multi-ligament injury evaluation.


Isolated posterior cruciate ligament Multi-ligament Clinical radiographic evaluation 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Human and animal rights and informed consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. 1.
    Kannus P, Bergfeld J, Järvinen M, Johnson RJ, Pope M, Renström P, et al. Injuries to the posterior cruciate ligament of the knee. Sports Med. 1991;12(2):110–31.CrossRefPubMedGoogle Scholar
  2. 2.
    • Medina O, Arom GA, Yeranosian MG, Petrigliano FA, McAllister DR. Vascular and nerve injury after knee dislocation: a systematic review. Clin Orthop Relat Res. 2014. a study of 862 patients with knee dislocations, 18% sustained vascular injuries and 25% had nerve injuries. Given the significant incidence of neurovascular injuries in this population, examiners should have a high suspicion and low tolerance to obtain advanced imaging if the exam is questionable.;472:2621–9.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Braun DT, Muffly MT, Altman GT. Irreducible posterolateral knee dislocation with entrapment of the adductor magnus tendon and medial skin dimpling. J Knee Surg. 2009;22(4):366–9.CrossRefPubMedGoogle Scholar
  4. 4.
    • Devitt BM, Whelan DB (2015) Posterior cruciate ligament injuries. A patients limited motion should not hinder the clinician from doing a comprehensive physical exam. If an exam cannot be completed accurately because of pain or stiffness than advanced imaging should be obtained and patient reexamined after better motion is achieved.
  5. 5.
    Rubenstein RA, Shelbourne KD, JR MC, CD VM, Rettig AC. The accuracy of the clinical examination in the setting of posterior cruciate ligament injuries. Am J Sports Med. 1994;22(4):550–7.CrossRefGoogle Scholar
  6. 6.
    Miller MD, Cooper DE, Fanelli GC, Harner CD, LaPrade R. Posterior cruciate ligament: current concepts. Instr Course Lect. 2002;51:347–51.PubMedGoogle Scholar
  7. 7.
    Sekiya JK, Whiddon DR, Zehms CT, Miller MD. A clinically relevant assessment of posterior cruciate ligament and posterolateral corner injuries. Evaluation of isolated and combined deficiency. J Bone Joint Surg Am. 2008;90(8):1621–7. Scholar
  8. 8.
    Daniel DM, Stone ML, Barnett P, et al. Use of the quadriceps active test to diagnose posterior cruciate-ligament disruption and measure posterior laxity of the knee. J Bone Joint Surg. 1988;70A:386–91.CrossRefGoogle Scholar
  9. 9.
    Hall FM, Hochman MG. Medial segond-type fracture: cortical avulsion off the medial tibial plateau associated with tears of the posterior cruciate ligament and medial meniscus. Skeletal Radio! 1997;26:553–5.CrossRefGoogle Scholar
  10. 10.
    Boynton M, Tietjens B. Long-term follow-up of the untreated isolated posterior cruciate ligament-deficient knee. Am J Sports Med. 1996;24:306 1.CrossRefGoogle Scholar
  11. 11.
    LaPrade RF, Heikes C, Bakker AJ, Jakobsen RB. The reproducibility and repeatability of varus stress radiographs in the assessment of isolated fibular collateral ligament and grade-III posterolateral knee injuries. An in vitro biomechanical study J Bone Joint Surg Am. 2008;90(10):2069–76.CrossRefGoogle Scholar
  12. 12.
    Jung T, Reinhardt C, Scheffler S, Weiler A. Stress radiography to measure posterior cruciate ligament insufficiency: a comparison of five different techniques. Knee Surg Sports Traumatol Arthrosc. 2006;14:1116–21.1.CrossRefPubMedGoogle Scholar
  13. 13.
    Peterson DC, Thain LMF, Fowler PJ (2001) Imaging of the posterior cruciate ligament.Google Scholar
  14. 14.
    Kode L, Lieberman JM, Motta AO, Wilber JH, Vasen A, Yagan R. Evaluation of tibial plateau fractures: efficacy of MR imaging compared with CT. Radiology. 1994;163:141–7.Google Scholar
  15. 15.
    Gardner MJ, Yacoubian S, Geller D, Suk M, Mintz D, Potter H, et al. The incidence of soft tissue injury in operative tibial plateau fractures. A magnetic resonance imaging analysis of 103 patients. J Orthop Trauma. 2005;19:79–84.CrossRefPubMedGoogle Scholar
  16. 16.
    Mui LW, Engelsohn E, Umans H. Comparison of CT and MRI in patients with tibial plateau fracture: can CT findings predict ligament tear or meniscal injury? Skelet Radiol. 2007;36(2):145–51.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Ahmad Badri
    • 1
  • Guillem Gonzalez-Lomas
    • 1
  • Laith Jazrawi
    • 1
  1. 1.Department of Orthopedics. Division of Sports MedicineNYU Langone HealthNew YorkUSA

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