Clinical and radiologic evaluation of the posterior cruciate ligament-injured knee
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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.
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.
KeywordsIsolated 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
- 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
- 4.• Devitt BM, Whelan DB (2015) Posterior cruciate ligament injuries. https://doi.org/10.1007/978-3-319-12072-0. 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.
- 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
- 13.Peterson DC, Thain LMF, Fowler PJ (2001) Imaging of the posterior cruciate ligament.Google Scholar
- 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