The nonoperative treatment of acute, isolated (partial or complete) posterior cruciate ligament-deficient knees: an intermediate-term follow-up study - PubMed (original) (raw)

The nonoperative treatment of acute, isolated (partial or complete) posterior cruciate ligament-deficient knees: an intermediate-term follow-up study

Dipak V Patel et al. HSS J. 2007 Sep.

Abstract

Fifty-seven consecutive patients (58 knees) with an acute, isolated, posterior cruciate ligament (PCL) injury were treated nonoperatively. Clinical, radiographic, and functional assessment was performed at a mean follow-up of 6.9 years (range 2 to 19.3 years) after the initial diagnosis. At the time of initial documentation of the injury, the posterior drawer test was grade A in 17 knees and grade B in 41 knees. The mean preinjury Tegner activity level was 7 (range 4 to 10). At latest follow-up, 38 knees had no pain, 14 had mild pain, and 6 had moderate pain on exertion. Fifty-four knees had no swelling, 3 had mild, intermittent swelling, and 1 had a moderate swelling on exertion. The posterior drawer test was grade A in 14 knees and grade B in 44 knees. The mean Lysholm-II knee score was 85.2 points (range 51 to 100 points) and the mean Tegner activity level was 6.6 (range 3 to 10). Based on Lysholm-II knee scoring system, the results were excellent in 23 knees (40%), good in 30 knees (52%), fair in 2 knees (3%), and poor in 3 knees (5%). No statistically significant correlation (p = 0.097) was seen between the grade of PCL laxity and Lysholm-II knee score. Plain radiographs showed mild (grade I) medial compartment osteoarthritis (OA) in 7 knees, and moderate (grade II) medial compartment OA in 3 knees. Mild patellofemoral OA was seen in 4 knees. We believe that most patients with acute, isolated PCL injuries do well with nonoperative treatment at a mean follow-up of 6.9 years. The level of evidence for this retrospective cohort study is level III.

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Figures

Fig. 1

Fig. 1

A 24-year-old athlete sustained an isolated grade B PCL injury while playing football. This was treated nonoperatively. At 16.5-years of follow-up, the plain radiograph of the right knee shows grade II (moderate) degenerative changes in the medial compartment

Fig. 2

Fig. 2

A 33-year-old male sustained an isolated grade B PCL tear in the right knee while skiing. At initial arthroscopic evaluation, grade III chondral injury was noted in the medial femoral condyle. Because of persistent knee symptoms, a radioisotope bone scan was performed at 32 months after the initial injury. The bone scan shows a moderate focal uptake of the radioactive isotope in the medial femorotibial compartment

Fig. 3

Fig. 3

Lysholm-II knee score vs length of follow-up

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