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PCL Lesion

  • Philippe LandreauEmail author
  • Jaleleddine Belhaj Ahmed

Abstract

Posterior cruciate ligament (PCL) injuries are less common than anterior cruciate ligament ruptures. The ligament consists of two distinct but inseparable bundles, anterolateral and posteromedial, with distinct footprints at both the femoral and tibial side. The PCL is sandwiched by the two meniscofemoral ligaments. The primary function of the PCL is to control posterior tibial displacement, and its secondary function is to assist with posterolateral stability and varus-valgus stress. The posterolateral structures (PLS) have an important synergistic relationship with the PCL to control posterior translation and external rotation. In football, injuries usually are a result of falling on a flexed knee with the foot in plantar flexion.

During the clinical examination, it is crucial to distinguish between PCL lesions that are isolated and those combined with other ligament injuries, especially the posterolateral laxity as the prognosis and treatment will differ vastly if this is present. The posterior sag test, the posterior drawer test, and the quadriceps active test are the main tests to detect a PCL rupture. In addition to the standard knee series, the MRI is the imaging study of choice for PCL ruptures.

Conservative treatment, based on a physiotherapy protocol, gives good results if the PCL rupture occurs as an isolated injury. The current consensus is that grade 1 and grade 2 should be treated conservatively. A combined acute lesion of the posterolateral structure must be diagnosed as the repair must be done within the first 3 weeks after the injury.

The general principles of the ligament reconstruction are based on the anatomical placement of the tunnels, use of a strong and large graft, graft tunnels avoiding sharp angulations, knowledge of the proximity of the popliteal vessels, tension and fixation of the anterolateral bundle between 70° and 90° of flexion, solid fixation of the transplant, as well as a suitable rehabilitation programme.

After conservative or surgical treatment, the rehabilitation must provide a maximum protection to the ligament and avoid any stressful activity, in a slower pace than for the ACL rehabilitation.

Keywords

Posterior cruciate ligament Conservative treatment Physiotherapy Epidemiology Surgery 

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Copyright information

© Springer International Publishing Switzerland 2015

Authors and Affiliations

  1. 1.Surgery DepartmentAspetar, Orthopaedic and Sports Medicine HospitalDohaQatar
  2. 2.Physiotherapy DepartmentAspetar, Orthopaedic and Sports Medicine HospitalDohaQatar

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