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For further information, see CMDT Part 41-06: Musculoskeletal Injuries of the Knee

Key Features

  • Usually follows an anterior trauma to the tibia, such as a dashboard injury during a motor vehicle accident

  • The knee may freely dislocate and reduce

  • One-third of multi-ligament injuries involving the PCL have neurovascular injuries

  • More than 70–90% of PCL injuries have associated injuries to the posterolateral corner, medial collateral ligament, and anterior cruciate ligament

Clinical Findings

  • Most patients with acute injuries have difficulty with ambulation

  • Patients with chronic PCL injuries

    • Can ambulate without gross instability but may complain of subjective “looseness”

    • Often report pain and dysfunction, especially with bending

  • Pain, swelling, pallor, and numbness in the affected extremity may suggest a knee dislocation with possible injury to the popliteal artery

  • Clinical examinations of PCL injuries include the sag sign (Table 41–7)

  • The PCL ligament can also be examined using the posterior drawer test (90% sensitivity and 99% specificity) (Table 41–7)

Diagnosis

  • Radiographs are often nondiagnostic but are required to diagnose any fractures

  • MRI is used to diagnose PCL and other associated injuries

Treatment

  • Isolated PCL injuries can be treated nonoperatively

  • Acute injuries are usually immobilized using a knee brace with the knee extension; the patient uses crutches for ambulation

  • Physical therapy can help achieve increased range of motion and improved ambulation

  • Many PCL injuries are associated with other injuries and may require operative reconstruction

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