Skip to main content


Log in

Posterior cruciate ligament lesions are mainly present as combined lesions even in sports injuries

  • KNEE
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope



To analyse 1000 consecutive patients, treated with isolated or combined posterior cruciate ligament (PCL) reconstruction in a single centre according to the epidemiological factors and differences in injury patterns depending on the activity during trauma.


Between 2004 and 2019, one thousand isolated and combined PCL reconstructions were performed. The medical charts and surgical reports of all patients were analysed regarding epidemiological factors. The PCL lesions were divided into isolated and combined lesions with at least one additional ligamentous injury. The influence of activity during accident and additional injury on the presence of isolated or combined lesions and injury patterns was calculated.


In 388 patients (38.8%), sporting activity was the main activity in PCL lesions, followed by traffic accidents in 350 patients (35.0%). Combined injuries were present in 227 patients (58.5%) with sports injuries and 251 patients (71.7%) with traffic accidents. Only during handball, an isolated PCL lesion (69.1%) was more common than a combined lesion. Highest rate of combined lesions was present in car accidents (91.7%). In all activities except skiing and biking, the most common additional peripheral injury was a tear of the posterolateral corner. In skiing and biking accidents, the most common additional peripheral lesion was a lesion of the medial collateral ligament. In patients with PCL lesion and additional fracture of the same lower extremity, a combined lesion was more common than an isolated lesion (p = 0.001).


Combined PCL lesions are more common than isolated lesions, even in sports injuries (except handball). Incidence and injury pattern vary depending on activity during trauma. Main additional peripheral lesion is a lesion of the posterolateral corner, except biking and skiing accidents where a medial lesion is more common.

Level of evidence

Level III.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others


  1. Amis AA, Bull AMJ, Gupte CM, Hijazi I, Race A, Robinson JR (2003) Biomechanics of the PCL and related structures: posterolateral, posteromedial and meniscofemoral ligaments. Knee Surg Sports Traumatol Arthrosc 11:271–281

    Article  CAS  Google Scholar 

  2. Dosher WB, Maxwell GT, Warth RJ, Harner CD (2019) Multiple Ligament Knee Injuries. Clin Sports Med 38:183–192

    Article  Google Scholar 

  3. Fanelli GC (1993) Posterior cruciate ligament injuries in trauma patients. Arthroscopy 9:291–294

    Article  CAS  Google Scholar 

  4. Fanelli GC, Giannotti BF, Edson CJ (1994) The posterior cruciate ligament arthroscopic evaluation and treatment. Arthroscopy 10:673–688

    Article  CAS  Google Scholar 

  5. Frosch K-H, Akoto R, Drenck T, Heitmann M, Pahl C, Preiss A (2016) Arthroscopic popliteus bypass graft for posterolateral instabilities of the knee: A new surgical technique. Oper Orthop Traumatol 28:193–203

    Article  Google Scholar 

  6. Grood ES, Stowers SF, Noyes FR (1988) Limits of movement in the human knee. Effect of sectioning the posterior cruciate ligament and posterolateral structures. J Bone Joint Surg Am 70:88–97

    Article  CAS  Google Scholar 

  7. Hsuan H-F, Lin Y-C, Chiu C-H, Ni Mhuircheartaigh J, Juan Y-H, Chan Y-S, Wu JS (2016) Posterior cruciate ligament tears in Taiwan: an analysis of 140 surgically treated cases. Clin Imaging 40:856–860

    Article  Google Scholar 

  8. LaPrade CM, Civitarese DM, Rasmussen MT, LaPrade RF (2015) Emerging updates on the posterior cruciate ligament: a review of the current literature. Am J Sports Med 43:3077–3092

    Article  Google Scholar 

  9. LaPrade RF, Wentorf FA, Fritts H, Gundry C, Hightower CD (2007) A Prospective magnetic resonance imaging study of the incidence of posterolateral and multiple ligament injuries in acute knee injuries presenting with a hemarthrosis. Arthroscopy 23:1341–1347

    Article  Google Scholar 

  10. Lind M, Jakobsen BW, Lund B, Hansen MS, Abdallah O, Christiansen SE (2009) Anatomical reconstruction of the medial collateral ligament and posteromedial corner of the knee in patients with chronic medial collateral ligament instability. Am J Sports Med 37:1116–1122

    Article  Google Scholar 

  11. Lind M, Nielsen TG, Behrndtz K (2017) Both isolated and multi-ligament posterior cruciate ligament reconstruction results in improved subjective outcome: results from the Danish Knee Ligament Reconstruction Registry. Knee Surg Sports Traumatol Arthrosc 26:1190–1196

    PubMed  Google Scholar 

  12. Lonner JH, Dupuy DE, Siliski JM (2000) Comparison of magnetic resonance imaging with operative findings in acute traumatic dislocations of the adult knee. J Orthop Trauma 14:183–186

    Article  CAS  Google Scholar 

  13. Medina O, Arom GA, Yeranosian MG, Petrigliano FA, McAllister DR (2014) Vascular and nerve injury after knee dislocation: a systematic review. Clin Orthop Relat Res 472:2621–2629

    Article  Google Scholar 

  14. Moatshe G, Dornan GJ, Løken S, Ludvigsen TC, LaPrade RF, Engebretsen L (2017) Demographics and injuries associated with knee dislocation: a prospective review of 303 patients. Orthop J Sports Med 5:232596711770652

    Article  Google Scholar 

  15. Nannaparaju M, Mortada S, Wiik A, Khan W, Alam M (2018) Posterolateral corner injuries: epidemiology, anatomy, biomechanics and diagnosis. Injury 49:1024–1031

    Article  CAS  Google Scholar 

  16. Owesen C, Sandven-Thrane S, Lind M, Forssblad M, Granan L-P, Årøen A (2017) Epidemiology of surgically treated posterior cruciate ligament injuries in Scandinavia. Knee Surg Sports Traumatol Arthrosc 25:2384–2391

    Article  Google Scholar 

  17. Preiss A, Giannakos A, Frosch K-H (2012) Minimally invasive augmentation of the medial collateral ligament with autologous hamstring tendons in chronic knee instability. Oper Orthop Traumatol 24:335–347

    Article  CAS  Google Scholar 

  18. Richter J, Schulz-Jahrsdörfer M, Schuster P (2017) Posterolaterale Rekonstruktion in modifizierter Larson-Technik. Arthroskopie 30:49–54

    Article  Google Scholar 

  19. Sanders TL, Pareek A, Barrett IJ, Kremers HM, Bryan AJ, Stuart MJ, Levy BA, Krych AJ (2017) Incidence and long-term follow-up of isolated posterior cruciate ligament tears. Knee Surg Sports Traumatol Arthrosc 25:3017–3023

    Article  Google Scholar 

  20. Schulz MS, Russe K, Weiler A, Eichhorn HJ, Strobel MJ (2003) Epidemiology of posterior cruciate ligament injuries. Arch Orthop Trauma Surg 123:186–191

    Article  CAS  Google Scholar 

  21. Schulz MS, Steenlage ES, Russe K, Strobel MJ (2007) Distribution of posterior tibial displacement in knees with posterior cruciate ligament tears. J Bone Joint Surg 89:332–338

    Article  Google Scholar 

  22. Stannard JP, Sheils TM, Lopez-Ben RR, McGwin G, Robinson JT, Volgas DA (2004) Vascular injuries in knee dislocations: the role of physical examination in determining the need for arteriography. J Bone Joint Surg Am 86:910–915

    Article  Google Scholar 

  23. Thompson SM, Salmon LJ, Waller A, Linklater J, Roe JP, Pinczewski LA (2016) Twenty-year outcome of a longitudinal prospective evaluation of isolated endoscopic anterior cruciate ligament reconstruction with patellar tendon or hamstring autograft. Am J Sports Med 44:3083–3094

    Article  Google Scholar 

  24. Wang S-H, Chien W-C, Chung C-H, Wang Y-C, Lin L-C, Pan R-Y (2018) Long-term results of posterior cruciate ligament tear with or without reconstruction: a nationwide, population-based cohort study. PLoS ONE 13:e0205118

    Article  Google Scholar 

  25. Wascher DC (2000) High-velocity knee dislocation with vascular injury. Treatment principles. Clin Sports Med 19:457–477

    Article  CAS  Google Scholar 

  26. Watanabe Y, Moriya H, Takahashi K, Yamagata M, Sonoda M, Shimada Y, Tamaki T (1993) Functional anatomy of the posterolateral structures of the knee. Arthroscopy 9:57–62

    Article  CAS  Google Scholar 

  27. Worley JR, Brimmo O, Nuelle CW, Cook JL, Stannard JP (2019) Incidence of concurrent peroneal nerve injury in multiligament knee injuries and outcomes after knee reconstruction. J Knee Surg 32:560–564

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations


Corresponding author

Correspondence to Michael Schlumberger.

Ethics declarations

Conflict of interest

The authors declare they have no conflict of interest.


The authors received no financial support for the research, authorship and/or publication of this article.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Schlumberger, M., Schuster, P., Eichinger, M. et al. Posterior cruciate ligament lesions are mainly present as combined lesions even in sports injuries. Knee Surg Sports Traumatol Arthrosc 28, 2091–2098 (2020).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: