Posterior Cruciate Ligament Injury

Abstract

Posterior cruciate ligament (PCL) injuries are rare in pediatric populations, and there are relatively little data on the epidemiology, natural history, and optimal management of these injuries. Motor vehicle accidents and sporting events are the most common causes of PCL injuries in children. The most common mechanisms of injury include sustaining a direct blow to the anterior tibia or falling on the knee with the foot in a plantarflexed position. Less common mechanisms include knee hyperextension or hyperflexion. In pediatric populations, PCL injuries typically involve an avulsion fracture at either the femoral or tibial insertion sites, while mid-substance tears are less common. Pain and guarding may make initial examination both difficult and unreliable, and close follow up should be considered for proper diagnosis. PCL avulsion fractures are easily missed on radiographs, and MRI is recommended in acute cases. Nonoperative treatment is suggested for minimally displaced avulsion fractures and mid-substance tears; operative treatment is recommended for displaced avulsion fractures and in cases where conservative treatment has failed. Optimization of treatment is crucial in pediatric populations to preserve knee function and prevent long-term degenerative joint disease.