Diagnosis and Management of Articular Cartilage and Meniscus Pathology in the Posterior Cruciate Ligament-Injured Knee

2021 ◽  
Author(s):  
Michael A. Ewing ◽  
James P. Stannard ◽  
James L. Cook
Keyword(s):  
Posterior Cruciate Ligament ◽  
Comprehensive Evaluation ◽  
Cruciate Ligament ◽  
Treatment Options ◽  
Effective Means ◽  
Postoperative Management ◽  
Current Evidence ◽  
Meniscal Pathology ◽  
Injured Knee ◽  
Tissue Restoration

AbstractPosterior cruciate ligament (PCL) injuries commonly occur in association with participation in sporting or recreational activities or due to a direct trauma. Cartilage and meniscal lesions are prevalent in PCL-injured knees with increasing likelihood and severity based on extent and duration of trauma to the knee. As such, comprehensive diagnostics should be performed to ascertain all related pathology, and patients should be thoroughly educated regarding treatment options, likely sequelae including posttraumatic osteoarthritis, and associated outcomes. Treatments should address the joint as an organ, ensuring stability, alignment, and functional tissue restoration are optimized by the most efficient and effective means possible. Compliance with patient- and procedure-specific postoperative management protocols is critical for optimizing successful outcomes for these complex cases. The objectives of this review article are to highlight the likelihood and importance of osteochondral and meniscal pathology in the PCL-injured knee, and to provide the best current evidence regarding comprehensive evaluation and management for PCL-injured knees with cartilage and/or meniscal comorbidities.

Posterior Cruciate Ligament Reconstruction in the Multiple Ligament Injured Knee

2020 ◽  
Vol 33 (05) ◽  
pp. 421-430
Author(s):  
Michelle E. Kew ◽  
Mark D. Miller
Keyword(s):  
Posterior Cruciate Ligament ◽  
Knee Injury ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Knee Injuries ◽  
Surgical Reconstruction ◽  
Nonsurgical Management ◽  
Injured Knee ◽  
Tibial Inlay ◽  
Low Activity

AbstractMultiligamentous knee injuries are challenging to treat and diagnose. Posterior cruciate ligament (PCL) injuries are commonly found in the constellation of injuries included in a multiligamentous knee injury and are caused by a posteriorly directed force on the proximal tibia with relation to the femoral condyles. A thorough history and physical examination should be performed to evaluate for associated neurovascular injuries and associated ligamentous, chondral, or bony injuries. Nonsurgical management is reserved for patients who are critically ill or have very low activity demands. Surgical reconstruction is recommended for most patients with multiligamentous knee injuries. The PCL reconstruction can be undertaken with several different graft options and reconstruction techniques, including the transtibial, arthroscopic tibial inlay, and open tibial inlay approach. The literature has a paucity of data regarding outcomes among the various reconstructive options, so the optimal surgical technique has not been established.

Surgical Treatment of Avulsion Fracture of the Posterior Cruciate Ligament and Postoperative Management

2003 ◽  
Vol 54 (3) ◽  
pp. 516-519 ◽  
Author(s):  
Chong-Kuang Yang ◽  
Chung-Da Wu ◽  
Chi-Jui Chih ◽  
Kuan-Yih Wei ◽  
Chih-Chien Su ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Posterior Cruciate Ligament ◽  
Avulsion Fracture ◽  
Cruciate Ligament ◽  
Postoperative Management

Isometry of the Posterior Cruciate Ligament

1998 ◽  
Vol 26 (5) ◽  
pp. 663-668 ◽  
Author(s):  
Gerald J. Ortiz ◽  
Hans Schmotzer ◽  
Johanness Bernbeck ◽  
Scott Graham ◽  
James E. Tibone ◽  
...  
Keyword(s):  
Posterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Full Range ◽  
Surgical Reconstruction ◽  
Muscle Forces ◽  
Low Load ◽  
Fresh Frozen ◽  
Injured Knee ◽  
Gastrocnemius Muscles ◽  
Isometric Point

The effects of functional load and muscle force application on isometry of the posterior cruciate ligament were determined. Eight fresh-frozen cadaver knees were mounted in a custom-designed rig. A full range of motion and muscle forces were applied through the quadriceps, hamstring, and gastrocnemius tendons during a simulated static squat maneuver. The low-load isometric posterior cruciate ligament point was located 5.63 mm proximal and 0.18 mm anterior to the anatomic center of the posterior cruciate ligament origin on the femur. The high-load state, with no gastrocnemius and hamstring muscle forces applied, shifted the isometric point 6.32 mm proximal and 6.72 mm anterior (P 0.05). Loading the hamstring and gastrocnemius muscles also shifted the isometric point (P 0.05). This study indicated that the most isometric region of the posterior cruciate ligament femoral attachment changed significantly when functional loads and muscle forces were applied to the knee. This finding may have implications for both surgical reconstruction and rehabilitation of the posterior cruciate ligament-injured knee.

scholarly journals Does Posterior Cruciate Ligament Retention or Sacrifice in Total Knee Replacement Affect Proprioception? A Systematic Review

2021 ◽  
Vol 10 (16) ◽  
pp. 3470
Author(s):  
Marco Bravi ◽  
Fabio Santacaterina ◽  
Federica Bressi ◽  
Rocco Papalia ◽  
Stefano Campi ◽  
...  
Keyword(s):  
Systematic Review ◽  
Total Knee Replacement ◽  
Posterior Cruciate Ligament ◽  
Knee Replacement ◽  
Cruciate Ligament ◽  
Assessment Method ◽  
Human Motion ◽  
Current Evidence ◽  
Future Research ◽  
Total Knee

Background: Proprioception is an important part of the somatosensory system involved in human motion control, which is fundamental for activities of daily living, exercise, and sport-specific gestures. When total knee arthroplasty (TKA) is performed, the posterior cruciate ligament (PCL) can be retained, replaced, or discarded. The PCL seems to be responsible for maintaining the integrity of the joint position sense (JPS) and joint kinesthesia. The aim of this review was to assess the effect of PCL on knee joint proprioception in total knee replacement. Methods: This systematic review was conducted within five electronic databases: PubMed, Scopus, Web of Science, Cochrane, and PEDro with no data limit from inception to May 2021. Results: In total 10 publications were evaluated. The analysis was divided by proprioception assessment method: direct assessment (JPS, kinesthesia) and indirect assessment (balance). Conclusions: The current evidence suggest that the retention of the PCL does not substantially improve the joint proprioception after TKA. Due to the high heterogeneity of the studies in terms of design, proprioception outcomes, evaluation methods, further studies are needed to confirm the conclusions. In addition, future research should focus on the possible correlation between joint proprioception and walking function.

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