Skip to main content
SpringerLink
Log in

Incidence and long-term follow-up of isolated posterior cruciate ligament tears

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

Abstract

Purpose

Isolated posterior cruciate ligament (PCL) tears are an uncommon injury. The goals of this study are to (1) determine the population-based incidence of isolated PCL tears, (2) compare the occurrence of secondary meniscal tears or arthritis in patients with PCL deficiency to patients without PCL tears, and (3) evaluate factors associated with long-term sequelae among patients with PCL deficiency.

Methods

This retrospective study included a population-based incidence cohort of 48 patients with new-onset, isolated PCL tears between 1990 and 2010, as well as an age and sex-matched cohort of individuals without PCL tears. A chart review was performed to collect information related to the initial injury, treatment, and outcomes. Subjects were retrospectively followed to determine the development of subsequent meniscal tears, arthritis, or total knee arthroplasty (TKA).

Results

The age- and sex-adjusted annual incidence of isolated, complete PCL tears was 1.8 (95 % CI 1.3, 2.3) per 100,000. During a mean 12.2-year follow-up, patients with isolated PCL tears had a significantly higher likelihood (HR 6.2, 95 % CI 1.8, 21.2) of symptomatic arthritis compared to individuals without PCL tears. The likelihood of subsequent meniscal tears (HR 2.1, 95 % CI 0.4, 10.7) and TKA (HR 3.2, 95 % CI 0.5, 19.6) was more frequent among patients with PCL tears compared to subjects without PCL tears. Older age at injury was significantly associated with future arthritis (P = 0.003) and TKA (P = 0.02).

Conclusion

Isolated PCL tears remain a rare injury with an estimated annual incidence of 2 per 100,000 persons. Patients with isolated PCL tears have a significantly higher risk of symptomatic arthritis than patients without PCL tears. Older age at injury is associated with a higher risk of arthritis and the need for TKA. The results of this study can be used to educate patients about the natural history of isolated PCL tears and provide a baseline of expectations for the future development of arthritis and subsequent meniscal injury following isolated PCL injury.

Level of evidence

Retrospective comparative study, Level III.

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

Access this article

Log in via an institution

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

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Cosgarea A, Jay P (2001) Posterior cruciate ligament injuries: evaluation and management. J Am Acad Orthop Surg 9:297–307

    Article  CAS  PubMed  Google Scholar 

  2. Fanelli G, Edson C (1995) Posterior cruciate ligament injuries in trauma patients: part II. Arthroscopy 11:526–529

    Article  CAS  PubMed  Google Scholar 

  3. Gill T, DeFrate L, Wang C, Carey C, Zayontz S, Zarins B, Li G (2004) The effect of posterior cruciate ligament reconstrucion of patellofemoral contact pressures in the knee joint under simulated muscle loads. Am J Sports Med 1:109–115

    Article  Google Scholar 

  4. Keller P, Shelbourne D, McCarroll J, Rettig A (1993) Nonoperatively treated isolated posterior cruciate ligament injuries. Am J Sports Med 21:132–136

    Article  CAS  PubMed  Google Scholar 

  5. Konsei S, Horibe S, Nakata K, Maeda A, Hamada M, Nakamura N (1995) Conservative treatment of isolated injuries to the posterior cruciate ligament in athletes. J Bone Joint Surg Br 77:895–900

    Google Scholar 

  6. LaPrade C, Civitarese D, Rasmussen M, LaPrade R (2015) Emerging updates on the posterior cruciate ligament. Am J Sports Med 43:3077–3092

    Article  PubMed  Google Scholar 

  7. Li G, Gill T, DeFrate L, Zayontz S, Glatt V, Zarins B (2002) Biomechanical consequences of PCL deficiency in the knee under simulated muscle loads—an in vitro experimental study. J Orthop Res 4:887–892

    Article  Google Scholar 

  8. Majewski M, Susanne H, Klaus S (2006) Epidemiology of athletic knee injuries: a 10-year study. Knee 13:184–188

    Article  CAS  PubMed  Google Scholar 

  9. Mariani P, Margheritini F, Christel P, Bellelli A (2005) Evaluation of posterior cruciate ligament healing: a study using magnetic resonance imaging and stress radiography. Arthroscopy 21:1354–1361

    Article  PubMed  Google Scholar 

  10. Mehta V, Paxton L, Fornalski S, Csintalan R, Fithian D (2007) Reliability of the international knee documentation committee radiographic grading system. Am J Sports Med 35:933–935

    Article  PubMed  Google Scholar 

  11. Melbourne D, Tietjens B (1996) Long-term follow up of the untreated isolated posterior cruciate ligament deficient knee. Am J Sports Med 24:306–310

    Article  Google Scholar 

  12. Okazaki K, Takayama Y, Osaki K, Matsuo Y, Mizu-uchi H, Hamai S, Honda H, Iwamoto Y (2015) Subclinical cartilage degeneration in young athletes with posterior cruciate ligament injuries detected with T1p magnetic resonance imaging mapping. Knee Surg Sports Traumatol Arthrosc 23:3094–3100

    Article  PubMed  Google Scholar 

  13. Parolie J, Bergfeld J (1986) Long-term results of nonoperative treatment of isolated posterior cruciate ligament injuries in the athlete. Am J Sports Med 14:35–38

    Article  CAS  PubMed  Google Scholar 

  14. Patel D, Allen A, Warren R, Wickiewicz T, Simonian P (2007) The nonoperative treatment of acute, isolated (partial or complete) posterior cruciate ligament-deficient knees: an intermediate-term follow-up study. HSS J 3:137–146

    Article  PubMed  PubMed Central  Google Scholar 

  15. Pearsall A, Hollis J (2004) The effect of posterior cruciate ligament injury and reconstruction on meniscal strain. Am J Sports Med 32:1675–1680

    Article  PubMed  Google Scholar 

  16. Rocca WA, Yawn BP, St Sauver JL, Grossardt BR, Melton LJ (2012) History of the Rochester Epidemiology Project: half a century of medical records linkage in a US population. Mayo Clin Proc 87:1202–1213

    Article  PubMed  PubMed Central  Google Scholar 

  17. Schulz M, Russe K, Weilder A, Eichhorn H, Strobel M (2003) Epidemiology of posterior cruciate ligament injuries. Arch Orthop Trauma Surg 123:186–191

    Article  CAS  PubMed  Google Scholar 

  18. Shelbourne K, Clark M, Gray T (2013) Minimum 10-year follow-up of patients after an acute, isolated posterior cruciate ligament injury treated nonoperatively. Am J Sports Med 41:1526–1533

    Article  PubMed  Google Scholar 

  19. Shelbourne K, Davis T, Patel D (1999) The natural history of acute, isolated, nonoperatively treated posterior cruciate ligament injuries. A prospective study. Am J Sports Med 27:276–283

    Article  CAS  PubMed  Google Scholar 

  20. Shelbourne K, Muthukaruppan Y (2005) Subjective results of nonoperatively treated, acute, isolated posterior cruciate ligament injuries. Arthroscopy 21:457–461

    Article  PubMed  Google Scholar 

  21. St Sauver J, Grossardt B, Leibson C, Yawn B, Melton L, Rocca W (2012) Generalizability of epidemiological findings and public health decisions: an illustration from the Rochester Epidemiology Project. Mayo Clin Proc 87:151–160

    Article  PubMed  PubMed Central  Google Scholar 

  22. St Sauver J, Grossardt B, Yawn B et al (2012) Data resource profile: the Rochester Epidemiology Project (REP) medical records-linkage system. Int J Epidemiol 41:1614–1624

    Article  PubMed  PubMed Central  Google Scholar 

  23. St Sauver J, Grossardt B, Yawn B, Melton L, Rocca W (2011) Use of a medical records linkage system to enumerate a dynamic population over time: the Rochester Epidemiology Project. Am J Epidemiol 173:1059–1068

    Article  PubMed  PubMed Central  Google Scholar 

  24. Watsend A, Osestad T, Jakobsen R, Engebretsen L (2009) Clinical studies on posterior cruciate ligament tears have weak design. Knee Surg Sports Traumatol Arthrosc 17:140–149

    Article  PubMed  Google Scholar 

  25. Wind W, Bergfeld J, Parker R (2004) Evaluation and treatment of posterior cruciate ligament injuries: revisited. Am J Sports Med 32:1765–1775

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This study was made possible by the Rochester Epidemiology Project which is supported by the National Institute on Aging of the National Institutes of Health under award number R01AG034676. The findings and conclusions of this report are solely the responsibility of the authors and do not necessarily represent the official views of the National Institutes of Health.

Author information

Authors and Affiliations

  1. Departments of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    Thomas L. Sanders, Ayoosh Pareek, Ian J. Barrett, Hilal Maradit Kremers, Andrew J. Bryan, Michael J. Stuart, Bruce A. Levy & Aaron J. Krych

  2. Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    Hilal Maradit Kremers

Authors
  1. Thomas L. Sanders
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ayoosh Pareek
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ian J. Barrett
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hilal Maradit Kremers
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Andrew J. Bryan
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Michael J. Stuart
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Bruce A. Levy
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Aaron J. Krych
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Thomas L. Sanders.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sanders, T.L., Pareek, A., Barrett, I.J. et al. Incidence and long-term follow-up of isolated posterior cruciate ligament tears. Knee Surg Sports Traumatol Arthrosc 25, 3017–3023 (2017). https://doi.org/10.1007/s00167-016-4052-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-016-4052-y

Keywords

Search

Navigation