Posterior cruciate ligament tears: functional and postoperative rehabilitation (original) (raw)
Related papers
An evaluation of posterior cruciate ligament reconstruction surgery
BMC Musculoskeletal Disorders
Background: The nature of posterior cruciate ligament (PCL) injuries and the scarcity of data on this issue have made reports on clinical and epidemiological features of PCL injuries valuable. We aimed to report our experiences with PCL injuries in our region. Methods: Any patient who referred with a diagnosis of PCL rupture from 2004 to 2018 to our center, was included in this report. We evaluated pre-and postoperative outcomes and compared patients with isolated and combined (multi-ligament) PCL injuries. Results: Overall, 55 patients were included in our study. Majority of patients were men (87.2%). Mean age of patients was 28.12 ± 8.53 years old. Average follow-up period was 28.83 ± 20.62 months and mean duration between trauma and surgery was 27.8 ± 38.0 months. Most common cause of PCL injury was traffic accidents (70.9%) followed by sports injuries (5.5%). Majority of patients (69.1%) had combined PCL injuries. Majority of patients underwent single tibial-double femoral tunnel reconstruction (56.4%), followed by single tibialsingle femoral tunnel (34.5%) reconstruction. Allografts were used in 60% of patient. Average Cincinnati knee rating scale (CKRC) was 35.87 ± 11.4, which improved significantly after PCL reconstruction (79.45 ± 11.90, p < 0.001). Full range of motion only existed in 29.1% of patient prior to surgery, which improved after surgery (92.7%, p < 0.001). Three patients had postoperative arthrofibrosis and motion stiffness, 1 had deep vein thrombosis and 3 patients had infections. Those with isolated PCL injuries had higher pre-operative CKRS (42.05 ± 8.96 vs. 33.10 ± 11.45, p = 0.006) and lower pre-operative posterior drawer test (2.76 ± 0.43 vs. 3.1 ± 0.6, p = 0.042) compared to those with combined injuries. Conclusion: Today with advances in surgical techniques, considering treatment of collateral ligament injuries, use of stronger allografts and more secure fixation methods, better rehabilitation programs and early range of motion, results of reconstruction of the PCL has become very promising. Accordingly we recommend surgical treatment even for isolated PCL tears, with the goal to prevent functional deficit and to prevent degenerative arthritis.
Rehabilitation Protocol After Isolated Posterior Cruciate Ligament Reconstruction
Revista Brasileira de Ortopedia (English Edition), 2012
To create a rehabilitation protocol following reconstruction of the posterior cruciate ligament (PCL), through a literature review. The literature review was conducted in the Medline and Embase databases, to search for data on biomechanical concepts and analyses relating to the posterior cruciate ligament of the knee. The search strategy was set up using the following rules: problem or injury in association with anatomical location terms; or surgical intervention procedure in association with rehabilitation terms. We began the process in this manner and subsequently introduced restrictions on certain terms to improve the search specificity. To design the protocol, a table was created for better data assessment, based
Orthopaedics & Traumatology: Surgery & Research, 2010
Introduction: Reconstruction Surgery of the posterior cruciate ligament (PCL) has not yet been fully standardized, and associated rehabilitation protocols have not been clearly defined. The aim of this study is to report the results of a consecutive series of patients who underwent the same surgical technique for isolated PCL reconstruction and were submitted to the same specific rehabilitation protocol. A non-aggressive rehabilitation protocol which protects the graft from excess mechanical stress produces satisfying and reproducible clinical and laxity results in the knee. Materials and methods: Our series included 17 patients who underwent single bundle arthroscopic reconstruction of the PCL with an autologous quadriceps tendon graft and who followed the same non-aggressive rehabilitation protocol. All patients were followed up for an average of 30 months (range 12-60 months). The preoperative evaluation and the last follow-up included objective and subjective IKDC scores as well as the Tegner & Lysholm knee scales. The side to side laxity was measured radiologocially with the Telos stress testing device. A statistical analysis was performed to compare preoperative and postoperative results. Results: Preoperatively, no patients were classified as A or B on the IKDC objective score. At last follow-up visit, 88.2% of patients were classified as A or B. Average side to side anteroposterior laxity was 11.9 mm (range 8-18) in the preoperative evaluation and 3.8 mm (range 1-7) in the final follow-up (p = 0.01) The average subjective IKDC score was 37.7 before surgery and 74.7 at last follow-up (p < 0.01). The Tegner & Lysholm scores were significantly improved by surgery.
Isolated posterior cruciate ligament reconstruction: Long-term results
The American Journal of Sports Medicine, 1993
From 1973 to 1987, 28 patients seen at our institution sustained isolated posterior cruciate ligament tears. Of these 28 patients, 25 were reevaluated at an average followup of 7 years and 1 month after secondary recon struction of the posterior cruciate ligament using the semitendinosus and gracilis tendons alone or with an extraarticular procedure. Subjectively, 22 of 25 patients related no restrictions regarding activities of daily living, with 14 of 25 patients being able to return to their previous competitive level in sports. Objective evaluation after reconstruction re vealed no change in the preoperative and postoperative posterior drawer examination in 13 of 25 patients, a finding confirmed by KT-1000 arthrometer measure ments. Radiographic evaluation revealed degenerative changes predominantly involving the medial and patel lofemoral compartments in 15 of 25 patients. Despite optimistic subjective reporting, this long-term retrospective study reveals that this procedure in...
Posterior Cruciate Ligament : Injury , Diagnosis , and Management
2017
Posterior cruciate ligament (PCL) injuries represent a minority of isolated ligamentous injuries to the knee. However the sequelae of these injuries can have a significant negative impact on function leading to instability, pain, and arthritis. A thorough understanding of the anatomy, mechanism of injury, and, pathophysiological changes that can occur with impaired PCL function can help the clinician formulate a specific treatment algorithm.Up to this point, there has been no consensus on optimal treatment for these injuries. The vast majority of isolated PCL injuries are treated conservatively including grade I, grade II, and even some grade III tears. However, a myriad of operative options exist in grade III tears and concomitant knee ligamentous injuries. These include single-bundle (SB), doublebundle (DB), tibial inlay, and anteriomedial or anteriolateraltranstibial reconstruction techniques. This review will provide an introduction to PCL injuries, how they are diagnosed both o...
Management of Posterior Cruciate Ligament Injuries
Operative Techniques in Sports Medicine, 2009
Diagnosis and management of posterior cruciate ligament tears has advanced over the past 2 decades due to improved understanding of the natural history of injury and basic science principles. Despite the current advances, our understanding of posterior cruciate ligament injury and treatment continues to lag behind that of the anterior cruciate ligament. In addition, there is still controversy regarding indications for surgical intervention, use of 1 vs 2 reconstructive graft bundles, location of the femoral tunnels, and the ideal degree of graft tensioning. The purpose of this article is to present our diagnostic and surgical preferences. Oper Tech Sports Med 17:162-166
Arthroscopy: The Journal of Arthroscopic & Related Surgery, 2007
Purpose: The aim of our study was to analyze 20 patients who underwent secondary posterior cruciate ligament (PCL) reconstruction after previous isolated anterior cruciate ligament (ACL) reconstruction had been performed. Our analysis sought to assess ACL graft preservation or failure in these patients. A secondary aim of our study was to identify a testing protocol to be used before any surgery that would help diagnose PCL deficiency and avoid unneeded ACL reconstruction. Methods: A total of 180 PCL reconstructions were prospectively documented, and 20 patients (11%) were identified who underwent previous isolated ACL reconstruction. Cases were analyzed to determine the quantity of ACL graft failures that had occurred and the need for ACL graft removal due to a fixed posterior subluxation. Patient charts were thoroughly reviewed, so investigators could identify the number of patients with incorrect diagnosis (PCL involvement was overlooked or an intact ACL was replaced) and the number with incorrect management (isolated ACL reconstruction was performed even though PCL involvement was recognized). Results: A fixed posterior subluxation was present in 4 cases; this necessitated subsequent ACL graft resection in 2 patients to release subluxation prior to PCL reconstruction. In all, 7 ACL grafts failed because of overlooked posterolateral instability. In only 11 of 20 cases, the initial ACL graft could be preserved. ACL reconstruction was performed because of incorrect diagnosis in 16 patients and incorrect management in 4. Conclusions: A considerably high number of overlooked or underestimated PCL injuries led to isolated ACL reconstruction, which indicates that diagnostic difficulties still occur among orthopaedic surgeons who are not highly specialized. Beside persistent posterior laxity, a failed ACL graft was the main reason for a second operation, which required bicruciate ligament reconstruction. To avoid incorrect management and incorrect diagnosis, leading to isolated ACL reconstruction in PCL deficiency, we recommend that stress radiography be performed to detect eventual posterior instability. Level of Evidence: Level IV, therapeutic case series.
Posterior Cruciate Ligament: Current Concepts Review
The archives of bone and joint surgery, 2018
The posterior cruciate ligament (PCL) is the largest and strongest ligament in the human knee, and the primary posterior stabilizer. Recent anatomy and biomechanical studies have provided an improved understanding of PCL function. PCL injuries are typically combined with other ligamentous, meniscal and chondral injuries. Stress radiography has become an important and validated objective measure in surgical decision making and post-operative assessment. Isolated grade I or II PCL injuries can usually be treated non-operatively. However, when acute grade III PCL ruptures occur together with other ligamentous injury and/or repairable meniscal body/root tears, surgery is indicated. Anatomic single-bundle PCL reconstruction (SB-PCLR) typically restores the larger anterolateral bundle (ALB) and represents the most commonly performed procedure. Unfortunately, residual posterior and rotational tibial instability after SB-PCLR has led to the development of an anatomic double-bundle (DB) PCLR...