Skip to main content
SpringerLink
Log in

Nonoperative Treatment of Posterior Cruciate Ligament Injuries

  • Chapter
Posterior Cruciate Ligament Injuries

  • 255 Accesses

Abstract

The posterior cruciate ligament (PCL) injury is one of the most controversial areas in sports medicine.1 There is no consensus in the literature with respect to its incidence, natural history, and indications for conservative or surgical treatment. Unlike anterior cruciate ligament (ACL) reconstruction, the results of surgical reconstruction of the PCL are inconsistent, and there is little agreement among surgeons as to surgical techniques. Therefore, it is critical to identify those patients who can be treated nonoperatively and who will do as well, if not better, than the patients undergoing surgical reconstruction.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Miller MD. Management of the PCL-injured knee. Instructional Course Lecture 103, AOSSM annual meeting, Vancouver, 1998.

    Google Scholar 

  2. Rubinstein RA Jr, Shelbourne KD, McCarroll JR, VanMeter CD, Rettig AC. The accuracy of the clinical examination in the setting of posterior cruciate ligament injuries. Am J Sports Med 1994;22(4):550–557.

    Article  PubMed  Google Scholar 

  3. Fowler PJ, Messieh SS. Isolated posterior cruciate ligament injuries in athletes. Am J Sports Med 1987;15(6):553–557.

    Article  PubMed  CAS  Google Scholar 

  4. Kennedy JC, Grainger RW. The posterior cruciate ligament. J Trauma 1967;7(3):367–377.

    Article  PubMed  CAS  Google Scholar 

  5. McMaster WC. Isolated posterior cruciate ligament injury: literature review and case reports. J Trauma 1975;15(11):1025–1029.

    Article  PubMed  CAS  Google Scholar 

  6. Trickey EL. Injuries to the posterior cruciate ligament: diagnosis and treatment of early injuries and reconstruction of late instability. Clin Orthop 1980;147:76–81.

    PubMed  Google Scholar 

  7. Kannus P, Jarvinen M. Knee instabilities and their clinical examination. Finnish Sports Exerc Med 1985;4:79–89.

    Google Scholar 

  8. Mayer PJ, Micheli LJ. Avulsion of the femoral attachment of the posterior cruciate ligament in an eleven-year-old boy. Case report. J Bone Joint Surg 1979;61A(3):431–432.

    PubMed  CAS  Google Scholar 

  9. Sanders WE, Wilkins KE, Neidre A. Acute insufficiency of the posterior cruciate ligament in children. Two case reports. J Bone Joint Surg 1980;62A(1):129131.

    Google Scholar 

  10. Stanish WD, Rubinovich M, Armason T, Lapenskie G. Posterior cruciate ligament tears in wrestlers. Can J Appl Sport Sci 1986;11(4):173–177.

    PubMed  CAS  Google Scholar 

  11. Trickey EL. Rupture of the posterior cruciate ligament of the knee. J Bone Joint Surg 1968;50B(2):334–341.

    CAS  Google Scholar 

  12. Hughston JC, Bowden JA, Andrews JR, et al. Acute tears of the posterior cruciate ligament. Results of operative treatment. J Bone Joint Surg 1980;62A(3): 438–450.

    PubMed  CAS  Google Scholar 

  13. Andrews JR, Edwards JC, Satterwhite YE. Isolated posterior cruciate ligament injuries. History, mechanism of injury, physical findings and ancillary tests. Clin Sports Med 1994;13:519–530.

    PubMed  CAS  Google Scholar 

  14. Clancy WG. Repair and reconstruction of the posterior cruciate ligament. Instructional Course, AOSSM annual meeting, Traverse City, MI, 1989.

    Google Scholar 

  15. Clendenin MB, DeLee JC, Heckman JD. Interstitial tears of the posterior cruciate ligament of the knee. Orthopedics 1980;3:764–772.

    Google Scholar 

  16. Satku K, Chew CN, Seow H. Posterior cruciate ligament injuries. Acta Orthop Scand 1984;55(1):26–29.

    Article  PubMed  CAS  Google Scholar 

  17. Kannus P, Bergfeld J, Jarvinen M, et al. Injuries to the posterior cruciate ligament of the knee. Sports Med 1991;12(2):110–131.

    Article  PubMed  CAS  Google Scholar 

  18. Cain TE, Schwab GH. Performance of an athlete with straight posterior knee instability. Am J Sports Med 1981;9(4):203–208.

    Article  PubMed  CAS  Google Scholar 

  19. Clancy WG Jr, Shelbourne KD, Zoellner GB, et al. Treatment of knee joint instability secondary to rupture of the posterior cruciate ligament. Report of a new procedure. J Bone Joint Surg 1983;65A(3):310–322.

    PubMed  Google Scholar 

  20. Covey CD, Sapega AA. Injuries of the posterior cruciate ligament. J Bone Joint Surg 1993;75A(9):1376–1386.

    PubMed  CAS  Google Scholar 

  21. Parolie JM, Bergfeld JA. Long-term results of nonoperative treatment of isolated posterior cruciate ligament injuries in the athlete. Am J Sports Med 1986;14(1):35–38.

    Article  PubMed  CAS  Google Scholar 

  22. Shelbourne KD, Patel DV, Davis TJ. The natural history of acute, isolated, nonoperatively treated posterior cruciate ligament injuries: a prospective study. Paper presented at the AOSSM annual meeting. Vancouver, 1998.

    Google Scholar 

  23. Shino K, Horibe S, Nakata K, Maeda A, Hamada M, Nakamura N. Conservative treatment of isolated injuries to the posterior cruciate ligament in athletes. J Bone Joint Surg 1995;77B(6):895–900.

    CAS  Google Scholar 

  24. Veltri DM, Warren RE Anatomy, biomechanics, and physical findings in posterolateral knee instability. Clin Sports Med 1994;13(3):599–614.

    PubMed  CAS  Google Scholar 

  25. Fanelli GC, Edson CJ. Posterior cruciate ligament injuries in trauma patients: Part II. Arthroscopy 1995;11(5):526–529.

    Article  PubMed  CAS  Google Scholar 

  26. Shelbourne KD, Patel DV. Natural history of acute isolated nonoperatively treated posterior cruciate ligament injuries of the knee: a prospective study. Paper presented at the American Academy of the Orthopaedic Surgeons annual meeting, San Francisco, 1997.

    Google Scholar 

  27. Ritchie JR, Bergfeld JA, Kambic H, Manning T. Isolated sectioning of the medial and posteromedial capsular ligaments in the posterior cruciate ligamentdeficient knee. Influence on posterior tibial translation. Am J Sports Med 1998;26(3):389–394.

    PubMed  CAS  Google Scholar 

  28. Harner CD, Höher J. Evaluation and treatment of posterior cruciate ligament injuries. Am J Sports Med 1998;26(3):471–482.

    PubMed  CAS  Google Scholar 

  29. Cross MJ, Powell JF. Long-term followup of posterior cruciate ligament rupture: a study of 116 cases. Am J Sports Med 1984;12(4):292–297.

    Article  PubMed  CAS  Google Scholar 

  30. Huber FE, Irrgang JJ, Harner C, Lephart S. Intratester and intertester reliability of the KT-1000 arthrometer in the assessment of posterior laxity of the knee. Am J Sports Med 1997;25(4):479–485.

    Article  PubMed  CAS  Google Scholar 

  31. Eakin CL, Cannon WD Jr. Arthrometric evaluation of posterior cruciate ligament injuries. Am J Sports Med 1998;26(1):96–102.

    PubMed  CAS  Google Scholar 

  32. Staubli HU, Jakob RP. Posterior instability of the knee near extension. A clinical and stress radiographic analysis of acute injuries of the posterior cruciate ligament. J Bone Joint Surg 1990;72B(2):225–230.

    CAS  Google Scholar 

  33. Hewett TE, Noyes FR, Lee MD. Diagnosis of complete and partial posterior cruciate ligament ruptures. Stress radiography compared with KT-1000 arthrometer and posterior drawer testing. Am J Sports Med 1997;25(5):648655.

    Google Scholar 

  34. Sonin AH, Fitzgerald SW, Hoff FL, Friedman H, Bresler ME. MR imaging of the posterior cruciate ligament: normal, abnormal, and associated injury patterns. Radiographics 1995;15(3):551–561.

    PubMed  CAS  Google Scholar 

  35. Gross ML, Grover JS, Bassett LW, Seeger LL, Finerman GA. Magnetic resonance imaging of the posterior cruciate ligament. Clinical use to improve diagnostic accuracy. Am J Sports Med 1992;20(6):732–737.

    Article  PubMed  CAS  Google Scholar 

  36. Grover JS, Bassett LW, Gross ML, et al. Posterior cruciate ligament: MR imaging. Radiology 1990;174(2):527–530.

    PubMed  CAS  Google Scholar 

  37. Patten RM, Richardson ML, Zink-Brody G, Rolfe BA. Complete vs partialthickness tears of the posterior cruciate ligament: MR findings. J Comput Assist Tomogr 1994;18(5):793–799.

    Article  PubMed  CAS  Google Scholar 

  38. Bellelli A. Cicatrization of complete traumatic lesions of the posterior cruciate ligament. Magnetic resonance follow-up of 10 cases and a proposal for modification of Gross classification. Radiol Med (Torino) 1998;95(4):286–292.

    CAS  Google Scholar 

  39. Torg JS, Barton TM, Pavlov H, Stine R. Natural history of the posterior cruciate ligament-deficient knee. Clin Orthop 1989;246:208–216.

    PubMed  Google Scholar 

  40. Barton TM, Torg JS, Das M. Posterior cruciate ligament insufficiency. A review of the literature. Sports Med 1984;1:419–430.

    Article  PubMed  CAS  Google Scholar 

  41. Dandy DJ, Pusey RJ. The long-term results of unrepaired tears of the posterior cruciate ligament. J Bone Joint Surg 1982;64B(1):92–94.

    CAS  Google Scholar 

  42. Tietjens BB. Posterior cruciate ligament injuries. J Bone Joint Surg 1985;67B: 674.

    Google Scholar 

  43. Keller PM, Shelbourne KD, McCarroll JR, Rettig AC. Nonoperatively treated isolated posterior cruciate ligament injuries. Am J Sports Med 1993;21(1):132136.

    Google Scholar 

  44. Boynton MD, Tietjens BR. Long-term followup of the untreated isolated posterior cruciate ligament-deficient knee. Am J Sports Med 1996;24(3):306–310.

    Article  PubMed  CAS  Google Scholar 

  45. Dejour H, Walch G, Peyrot J, Eberhard P. The natural history of rupture of the posterior cruciate ligament. Rev Chir Orthop 1988;74(1):35–43.

    PubMed  CAS  Google Scholar 

  46. Bianchi M. Acute tears of the posterior cruciate ligament: clinical study and results of operative treatment in 27 cases. Am J Sports Med 1983;11(5):308–314.

    Article  PubMed  CAS  Google Scholar 

  47. Eriksson E, Haggmark T, Johnson RJ. Reconstruction of the posterior cruciate ligament. Orthopedics 1986;9(2):217–220.

    PubMed  CAS  Google Scholar 

  48. Loos WC, Fox JM, Blazina ME, Del Pizzo W, Friedman MJ. Acute posterior cruciate ligament injuries. Am J Sports Med 1981;9(2):86–92.

    Article  PubMed  CAS  Google Scholar 

  49. Moore HA, Larson RL. Posterior cruciate ligament injuries. Results of early surgical repair. Am J Sports Med 1980;8(2):68–78.

    Article  PubMed  CAS  Google Scholar 

  50. Strand T, Molster AO, Engesaeter LB, et al. Primary repair in posterior cruciate ligament injuries. Acta Orthop Scand 1984;55(5):545–547.

    Article  PubMed  CAS  Google Scholar 

  51. Morrison JB. The mechanics of the knee joint in relation to normal walking. J Biomech 1970;3(1):51–61.

    Article  PubMed  CAS  Google Scholar 

  52. Denham RA, Bishop RE. Mechanics of the knee and problems in reconstructive surgery. J Bone Joint Surg 1978;60B(3):345–352.

    Google Scholar 

  53. Morrison JB. Function of the knee joint in various activities. Biomed Eng 1969;4(12):573–580.

    PubMed  CAS  Google Scholar 

  54. Dahlkuits NJ, Mago P, Seedholm BB. Forces during squatting and rising from a deep squat. Eng Med 1982;11:69–79.

    Article  Google Scholar 

  55. Ericson MO, Nisell R. Tibiofemoral joint forces during ergometer cycling. Am J Sports Med 1986;14(4):285–290.

    Article  PubMed  CAS  Google Scholar 

  56. Chu DA. Rehabilitation of the lower extremity. Clin Sports Med 1995;14(1):205–222.

    PubMed  CAS  Google Scholar 

  57. Wilk KE. Rehabilitation of isolated and combined posterior cruciate ligament injuries. Clin Sports Med 1994;13(3):649–677.

    PubMed  CAS  Google Scholar 

  58. Lutz GE, Palmitier RA, An KN, Chao EY. Comparison of tibiofemoral joint forces during open-kinetic-chain and closed-kinetic-chain exercises. J Bone Joint Surg 1993;75A(5):732–739.

    PubMed  CAS  Google Scholar 

  59. Kaufman KR, An KN, Litchy WJ, Morrey BF, Chao EY. Dynamic joint forces during knee isokinetic exercise. Am J Sports Med 1991;19(3):305–316.

    Article  PubMed  CAS  Google Scholar 

  60. Pandy MG, Shelburne KB. Dependence of cruciate-ligament loading on muscle forces and external load. J Biomech 1997;30(10):1015–1024.

    Article  PubMed  CAS  Google Scholar 

  61. Wilk KE, Escamilla RF, Fleisig GS, Barrentine SW, Andrews JR, Boyd ML. A comparison of tibiofemoral joint forces and electromyographic activity during open and closed kinetic chain exercises. Am J Sports Med 1996;24(4):518–527.

    Article  PubMed  CAS  Google Scholar 

  62. Escamilla RF, Fleisig GS, Zheng N, Barrentine SW, Wilk KE, Andrews JR. Biomechanics of the knee during closed kinetic chain and open kinetic chain exercises. Med Sci Sports Exerc 1998;30(4):556–569.

    Article  PubMed  CAS  Google Scholar 

  63. Carlin GJ, Livesay GA, Harner CD, Ishibashi Y, Kim HS, Woo SL. In-situ forces in the human posterior cruciate ligament in response to posterior tibial loading. Ann Biomed Eng 1996;24(2):193–197.

    Article  PubMed  CAS  Google Scholar 

  64. Jurist KA, Otis JC. Anteroposterior tibiofemoral displacements during isometric extension efforts. The roles of external load and knee flexion angle. Am J Sports Med 1985;13(4):254–258.

    Article  PubMed  CAS  Google Scholar 

  65. Zheng N, Fleisig GS, Escamilla RF, Barrentine SW. An analytical model of the knee for estimation of internal forces during exercise. J Biomech 1998;31(10): 963–967.

    Article  PubMed  CAS  Google Scholar 

  66. Stuart MJ, Meglan DA, Lutz GE, Growney ES, An KN. Comparison of intersegmental tibiofemoral joint forces and muscle activity during various closed kinetic chain exercises. Am J Sports Med 1996;24(6):792–799.

    Article  PubMed  CAS  Google Scholar 

  67. O’Connor JJ. Can muscle co-contraction protect knee ligaments after injury or repair? J Bone Joint Surg 1993;75B(1):41–48.

    Google Scholar 

  68. Muller W. The Knee, Form, Function and Ligament Reconstruction. New York: Springer, 1983.

    Google Scholar 

  69. Skyhar MJ, Warren RF, Ortiz GJ, Schwartz E, Otis JC. The effects of sectioning of the posterior cruciate ligament and the posterolateral complex on the articular contact pressures within the knee. J Bone Joint Surg 1993;75A(5):694699.

    Google Scholar 

  70. Insall JN, Hood RW. Bone-block transfer of the medial head of the gastrocnemius for posterior cruciate insufficiency. J Bone Joint Surg 1982;64A(5):691699.

    Google Scholar 

  71. MacDonald P, Miniaci A, Fowler P, Marks P, Finlay B. A biomechanical analysis of joint contact forces in the posterior cruciate deficient knee. Knee Surg Sports Traumatol Arthrosc 1996;3(4):252–255.

    Article  PubMed  CAS  Google Scholar 

  72. Clancy WG. Repair and reconstruction of the posterior cruciate ligament. In: Chapman MW, ed. Operative Orthopaedics. Philadelphia: JB Lippincott, 1988:1651–1666.

    Google Scholar 

  73. Beynnon B, Yu J, Huston D, Fleming, et al. A sagittal plane model of the knee and cruciate ligaments with application of a sensitivity analysis. J Biomech Eng 1996;118 (2):227–239.

    Google Scholar 

  74. Yasuda K, Sasaki T. Exercise after anterior cruciate ligament reconstruction. The force exerted on the tibia by the separate isometric contractions of the quadriceps or the hamstrings. Clin Orthop 1987;220:275–283.

    PubMed  Google Scholar 

  75. Davies GJ. A Comparison of Isokinetics in Clinical Usage, 3rd ed. La Crosse, WI: S&S Publishers, 1987.

    Google Scholar 

  76. Daniel DM, Stone ML, Barnett P, et al. Use of the quadriceps active test to diagnose posterior cruciate ligament disruption and measure posterior laxity of the knee. J Bone Joint Surg 1988;70A(3):386–391.

    PubMed  CAS  Google Scholar 

  77. Mangine RE, Eifert-Mangine MA. Postoperative posterior cruciate ligament reconstruciton rehabilitation. In: Engle RP, ed. Knee Ligament Rehabilitation. New York: Churchill Livingstone, 1991:165–176.

    Google Scholar 

  78. Irrgang JJ. Rehabilitation for nonoperative and operative management of knee injuries. In: Fu FH, Harner CD, Vince KG, eds. Knee Surgery. Baltimore: Williams & Wilkins, 1994:485–502.

    Google Scholar 

  79. Wilk KE, Andrews JR. Current concepts in the treatment of anterior cruciate ligament disruptions. J Orthop Sports Phys Ther 1992;15:279–293.

    PubMed  CAS  Google Scholar 

  80. Spencer JD, Hayes KC, Alexander IJ. Knee joint effusion and quadriceps reflex inhibition in man. Arch Phys Med Rehabil 1984;65(4):171–177.

    PubMed  CAS  Google Scholar 

  81. Huegel M, Indelicato PA. Trends in rehabilitation following anterior cruciate ligament reconstruction. Clin Sports Med 1988;7(4):801–811.

    PubMed  CAS  Google Scholar 

  82. Degenhardt TC, Hughston JC. Chronic posterior cruciate instability: nonoperative management. Orthop Trans 1981;5:486–487.

    Google Scholar 

  83. Hirshman HP, Daniel MD, Miyasaka K. The fate of unoperated knee ligament injuries. In: Daniel DM, Akeson WH, O’Connor, eds. Knee Ligaments. Structure, Function, Injury and Repair. New York. Raven Press.

    Google Scholar 

  84. Lipscomb AB Jr, Anderson AF, Norwig ED, Hovis WD, Brown DL. Isolated posterior cruciate ligament reconstruction. Long-term results. Am J Sports Med 1993;21(4):490–496.

    Article  PubMed  Google Scholar 

  85. Dye SF, Chew MH. The use of scintigraphy to detect increased osseous metabolic activity about the knee. Instr Course Lect 1994;43:453–469.

    PubMed  CAS  Google Scholar 

Download references

Authors
  1. John A. Bergfeld
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Manuel Leyes
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Gary J. Calabrese
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Sports Injury Clinic and Arthroscopic Surgery, Department of Orthopaedic Surgery, Geisinger Medical Center, 17822-2130, Danville, Pennsylvania, USA

    Gregory C. Fanelli MD (Chief) (Chief)

Rights and permissions

Reprints and permissions

Copyright information

© 2001 Springer Science+Business Media New York

About this chapter

Cite this chapter

Bergfeld, J.A., Leyes, M., Calabrese, G.J. (2001). Nonoperative Treatment of Posterior Cruciate Ligament Injuries. In: Fanelli, G.C. (eds) Posterior Cruciate Ligament Injuries. Springer, New York, NY. https://doi.org/10.1007/978-0-387-21601-0_9

Download citation

  • DOI: https://doi.org/10.1007/978-0-387-21601-0_9

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4757-6216-7

  • Online ISBN: 978-0-387-21601-0

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics

Search

Navigation