HSS Journal

, Volume 3, Issue 2, pp 137–146 | Cite as

The Nonoperative Treatment of Acute, Isolated (Partial or Complete) Posterior Cruciate Ligament-Deficient Knees: An Intermediate-term Follow-up Study

  • Dipak V. Patel
  • Answorth A. Allen
  • Russell F. Warren
  • Thomas L. Wickiewicz
  • Peter T. Simonian
Original Article

Abstract

Fifty-seven consecutive patients (58 knees) with an acute, isolated, posterior cruciate ligament (PCL) injury were treated nonoperatively. Clinical, radiographic, and functional assessment was performed at a mean follow-up of 6.9 years (range 2 to 19.3 years) after the initial diagnosis. At the time of initial documentation of the injury, the posterior drawer test was grade A in 17 knees and grade B in 41 knees. The mean preinjury Tegner activity level was 7 (range 4 to 10). At latest follow-up, 38 knees had no pain, 14 had mild pain, and 6 had moderate pain on exertion. Fifty-four knees had no swelling, 3 had mild, intermittent swelling, and 1 had a moderate swelling on exertion. The posterior drawer test was grade A in 14 knees and grade B in 44 knees. The mean Lysholm-II knee score was 85.2 points (range 51 to 100 points) and the mean Tegner activity level was 6.6 (range 3 to 10). Based on Lysholm-II knee scoring system, the results were excellent in 23 knees (40%), good in 30 knees (52%), fair in 2 knees (3%), and poor in 3 knees (5%). No statistically significant correlation (p = 0.097) was seen between the grade of PCL laxity and Lysholm-II knee score. Plain radiographs showed mild (grade I) medial compartment osteoarthritis (OA) in 7 knees, and moderate (grade II) medial compartment OA in 3 knees. Mild patellofemoral OA was seen in 4 knees. We believe that most patients with acute, isolated PCL injuries do well with nonoperative treatment at a mean follow-up of 6.9 years. The level of evidence for this retrospective cohort study is level III.

Key words

natural history acute/isolated posterior cruciate ligament injury nonoperative treatment 

References

  1. 1.
    O’Donoghue DH (1959) Surgical treatment of injuries to ligaments of the knee. JAMA 169(13):1423–1431Google Scholar
  2. 2.
    Clendenin MB, DeLee JC, Heckman JD (1980) Interstitial tears of the posterior cruciate ligament of the knee. Orthopedics 3:764–772Google Scholar
  3. 3.
    DeHaven KE (1980) Diagnosis of acute knee injuries with hemarthrosis. Am J Sports Med 8(1):9–14PubMedCrossRefGoogle Scholar
  4. 4.
    Lysholm J, Gillquist J (1981) Arthroscopic examination of the posterior cruciate ligament. J Bone Joint Surg [Am] 63-A(3):363–366Google Scholar
  5. 5.
    Hughston JC, Degenhardt TC (1982) Reconstruction of the posterior cruciate ligament. Clin Orthop Relat Res 164:59–77PubMedGoogle Scholar
  6. 6.
    Parolie JM, Bergfeld JA (1986) Long-term results of nonoperative treatment of isolated posterior cruciate ligament injuries in the athlete. Am J Sports Med 14(1):35–38PubMedCrossRefGoogle Scholar
  7. 7.
    Johnson JC, Bach BR Jr (1990) Posterior cruciate ligament [Current concepts review]. Am J Knee Surg 3:143–153Google Scholar
  8. 8.
    Fanelli GC, Giannotti BF, Edson CJ (1994) The posterior cruciate ligament arthroscopic evaluation and treatment [Current concepts review]. Arthroscopy 10(6):673–688PubMedCrossRefGoogle Scholar
  9. 9.
    Schulz MS, Russe K, Weiler A, et al. (2003) Epidemiology of posterior cruciate ligament injuries. Arch Orthop Trauma Surg 123(4):186–191PubMedGoogle Scholar
  10. 10.
    Clancy WG Jr, Sutherland TB (1994) Combined posterior cruciate ligament injuries. Clin Sports Med 13(3):629–647PubMedGoogle Scholar
  11. 11.
    Trickey EL (1968) Rupture of the posterior cruciate ligament of the knee. J Bone Joint Surg [Br] 50-B(2):334–341Google Scholar
  12. 12.
    Cross MJ, Powell JF (1984) Long-term followup of posterior cruciate ligament rupture: a study of 116 cases. Am J Sports Med 12(4):292–297PubMedCrossRefGoogle Scholar
  13. 13.
    Fowler PJ, Messieh SS (1987) Isolated posterior cruciate ligament injuries in athletes. Am J Sports Med 15(6):553–557PubMedCrossRefGoogle Scholar
  14. 14.
    Kennedy JC, Grainger RW (1967) The posterior cruciate ligament. J Trauma 7(3):367–377PubMedCrossRefGoogle Scholar
  15. 15.
    Hughston JC, Bowden JA, Andrews JR, et al. (1980) Acute tears of the posterior cruciate ligament. Results of operative treatment. J Bone Joint Surg [Am] 62-A(3):438–450Google Scholar
  16. 16.
    Trickey EL (1980) Injuries to the posterior cruciate ligament: diagnosis and treatment of early injuries and reconstruction of late instability. Clin Orthop Relat Res 147:76–81PubMedGoogle Scholar
  17. 17.
    Fleming RE Jr, Blatz DJ, McCarroll JR (1981) Posterior problems in the knee. Posterior cruciate insufficiency and posterolateral rotatory insufficiency. Am J Sports Med 9(2):107–113PubMedCrossRefGoogle Scholar
  18. 18.
    Loos WC, Fox JM, Blazina ME, et al. (1981) Acute posterior cruciate ligament injuries. Am J Sports Med 9(2):86–92PubMedCrossRefGoogle Scholar
  19. 19.
    Balkfors B (1982) The course of knee-ligament injuries. Acta Orthop Scand Suppl 198:1–99PubMedGoogle Scholar
  20. 20.
    Dandy DJ, Pusey RJ (1982) The long-term results of unrepaired tears of the posterior cruciate ligament. J Bone Joint Surg [Br] 64-B(1):92–94Google Scholar
  21. 21.
    Bianchi M (1983) Acute tears of the posterior cruciate ligament: clinical study and results of operative treatment in 27 cases. Am J Sports Med 11(5):308–314PubMedCrossRefGoogle Scholar
  22. 22.
    Clancy WG Jr, Shelbourne KD, Zoellner GB, et al. (1983) Treatment of knee joint instability secondary to rupture of the posterior cruciate ligament. Report of a new procedure. J Bone Joint Surg [Am] 65-A(3):310–322Google Scholar
  23. 23.
    Satku K, Chew CN, Seow H (1984) Posterior cruciate ligament injuries. Acta Orthop Scand 55(1):26–29PubMedCrossRefGoogle Scholar
  24. 24.
    Tibone JE, Antich TJ, Perry J, et al. (1988) Functional analysis of untreated and reconstructed posterior cruciate ligament injuries. Am J Sports Med 16(3):217–223PubMedCrossRefGoogle Scholar
  25. 25.
    Torg JS, Barton TM, Pavlov H, et al. (1989) Natural history of the posterior cruciate ligament-deficient knee. Clin Orthop Relat Res 246:208–216PubMedGoogle Scholar
  26. 26.
    Barrett GR, Savoie FH (1991) Operative management of acute PCL injuries with associated pathology: long-term results. Orthopedics 14(6):687–692PubMedGoogle Scholar
  27. 27.
    Whipple TL, Ellis FD (1991) Posterior cruciate ligament injuries. Clin Sports Med 10(3):515–527PubMedGoogle Scholar
  28. 28.
    Flandry FC, Wolfe MW, Martino JA, et al. (1996) The natural history of the posterior cruciate ligament-deficient knee. Orthop Trans 20:7Google Scholar
  29. 29.
    Longenecker SL, Hughston JC (1987) Long-term follow-up of isolated posterior cruciate injuries. Am J Sports Med 15:628Google Scholar
  30. 30.
    Dejour H, Walch G, Peyrot J, et al. (1988) The natural history of rupture of the posterior cruciate ligament. Fr J Orthop Surg 2:112–120Google Scholar
  31. 31.
    Keller PM, Shelbourne KD, McCarroll JR, et al. (1993) Nonoperatively treated isolated posterior cruciate ligament injuries. Am J Sports Med 21(1):132–136PubMedCrossRefGoogle Scholar
  32. 32.
    Shino K, Horibe S, Nakata K, et al. (1995) Conservative treatment of isolated injuries to the posterior cruciate ligament in athletes. J Bone Joint Surg [Br] 77–B(6):895–900Google Scholar
  33. 33.
    Boynton MD, Tietjens BR (1996) Long-term followup of the untreated isolated posterior cruciate ligament-deficient knee. Am J Sports Med 24(3):306–310PubMedCrossRefGoogle Scholar
  34. 34.
    Shelbourne KD, Davis TJ, Patel DV (1999) The natural history of acute, isolated, non-operatively treated posterior cruciate ligament injuries. A prospective study. Am J Sports Med 27(3):276–283PubMedGoogle Scholar
  35. 35.
    Iwamoto J, Takeda T, Suda Y, et al. (2004) Conservative treatment of isolated posterior cruciate ligament injury in professional baseball players: a report of two cases. Knee 11(1):41–44PubMedCrossRefGoogle Scholar
  36. 36.
    Toritsuka Y, Horibe S, Hiro-Oka A, et al. (2004) Conservative treatment for rugby football players with an acute isolated posterior cruciate ligament injury. Knee Surg Sports Traumatol Arthrosc 12(2):110–114PubMedCrossRefGoogle Scholar
  37. 37.
    Shelbourne KD, Muthukaruppan Y (2005) Subjective results of nonoperatively treated, acute, isolated posterior cruciate ligament injuries. Arthroscopy 21(4):457–461PubMedCrossRefGoogle Scholar
  38. 38.
    Tegner Y, Lysholm J (1985) Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res 198:43–49PubMedGoogle Scholar
  39. 39.
    Hefti F, Müller W, Jakob RP, et al. (1993) Evaluation of knee ligament injuries with the IKDC form. Knee Surg Sports Traumatol Arthrosc 1(3–4):226–234PubMedCrossRefGoogle Scholar
  40. 40.
    Lysholm J, Gillquist J (1982) Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale. Am J Sports Med 10(3):150–154PubMedCrossRefGoogle Scholar
  41. 41.
    Odensten M, Lysholm J, Gillquist J (1983) Long-term follow-up study of a distal iliotibial band transfer (DIT) for anterolateral knee instability. Clin Orthop Relat Res 176:129–135PubMedGoogle Scholar
  42. 42.
    Daniel DM, Stone ML, Barnett P, et al. (1988) Use of the quadriceps active test to diagnose posterior cruciate-ligament disruption and measure posterior laxity of the knee. J Bone Joint Surg [Am] 70-A(3):386–391Google Scholar
  43. 43.
    Jakob RP, Hassler H, Stäubli H-U (1981) Observations on rotatory instability of the lateral compartment of the knee. Experimental studies on the functional anatomy and pathomechanism of the true and reversed pivot shift sign. Acta Orthop Scand Suppl 191:1–32PubMedGoogle Scholar
  44. 44.
    Noyes FR, Barber-Westin SD, Grood ES (2001) Newer concepts in the treatment of posterior cruciate ligament ruptures. In: Insall JN, Scott WN (eds) Surgery of the knee, 3rd edn. Churchill Livingstone, Philadelphia pp 850–852Google Scholar
  45. 45.
    MacGillivray JD, Shubin Stein BE, Park M, et al. (2006) Comparison of tibial inlay versus transtibial techniques for isolated posterior cruciate ligament reconstruction: minimum 2-year follow-up. Arthroscopy 22(3):320–328PubMedCrossRefGoogle Scholar
  46. 46.
    Rosenberg TD, Paulos LE, Parker RD, et al. (1988) The forty-five-degree posteroanterior flexion weight-bearing radiograph of the knee. J Bone Joint Surg [Am] 70-A(10):1479–1483Google Scholar
  47. 47.
    Merchant AC, Mercer RL, Jacobsen RH, et al. (1974) Roentgenographic analysis of patellofemoral congruence. J Bone Joint Surg [Am] 56-A(7):1391–1396Google Scholar
  48. 48.
    Hughston JC, Norwood LA Jr (1980) The posterolateral drawer test and external rotational recurvatum test for posterolateral rotatory instability of the knee. Clin Orthop Relat Res 147:82–87PubMedGoogle Scholar
  49. 49.
    Rubinstein RA Jr, Shelbourne KD, McCarroll JR, et al. (1994) The accuracy of the clinical examination in the setting of posterior cruciate ligament injuries. Am J Sports Med 22(4):550–557PubMedCrossRefGoogle Scholar
  50. 50.
    Stäubli H-U, Jakob RP (1990) Posterior instability of the knee near extension. A clinical and stress radiographic analysis of acute injuries of the posterior cruciate ligament. J Bone Joint Surg [Br] 72-B(2):225–230Google Scholar
  51. 51.
    Hewett TE, Noyes FR, Lee MD (1997) Diagnosis of complete and partial posterior cruciate ligament ruptures. Stress radiography compared with KT-1000 arthrometer and posterior drawer testing. Am J Sports Med 25(5):648–655PubMedCrossRefGoogle Scholar
  52. 52.
    Geissler WB, Whipple TL (1993) Intraarticular abnormalities in association with posterior cruciate ligament injuries. Am J Sports Med 21(6):846–849PubMedCrossRefGoogle Scholar
  53. 53.
    Hamada M, Shino K, Mitsuoka T, et al. (2000) Chondral injury associated with acute isolated posterior cruciate ligament injury. Arthroscopy 16(1):59–63PubMedCrossRefGoogle Scholar
  54. 54.
    Strobel MJ, Weiler A, Schulz MS, et al. (2003) Arthroscopic evaluation of articular cartilage lesions in posterior-cruciate-ligament-deficient knees. Arthroscopy 19(3):262–268PubMedCrossRefGoogle Scholar
  55. 55.
    Skyhar MJ, Warren RF, Ortiz GJ, et al. (1993) The effects of sectioning of the posterior cruciate ligament and the posterolateral complex on the articular contact pressures within the knee. J Bone Joint Surg [Am] 75-A(5):694–699Google Scholar

Copyright information

© Hospital for Special Surgery 2007

Authors and Affiliations

  • Dipak V. Patel
    • 1
    • 2
    • 3
    • 7
  • Answorth A. Allen
    • 1
    • 4
    • 5
  • Russell F. Warren
    • 1
    • 4
    • 5
  • Thomas L. Wickiewicz
    • 1
    • 4
    • 5
  • Peter T. Simonian
    • 1
    • 6
  1. 1.Sports Medicine and Shoulder ServiceHospital for Special SurgeryNew YorkUSA
  2. 2.Department of Clinical Orthopaedics and Musculoskeletal ResearchSt. Joseph’s Hospital and Regional Medical CenterPatersonUSA
  3. 3.Seton Hall UniversitySouth OrangeUSA
  4. 4.Hospital for Special SurgeryNew YorkUSA
  5. 5.Clinical Orthopaedic SurgeryWeill Medical College of Cornell UniversityNew YorkUSA
  6. 6.Simonian Sports Medicine ClinicFresnoUSA
  7. 7.SecaucusUSA

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