Posterior Cruciate Ligament (PCL) Injury

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

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)

Radiographs are often nondiagnostic but are required to diagnose any fractures

MRI is used to diagnose PCL and other associated injuries

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