Posterior Cruciate Ligament Injuries: Rationale for Treatment

  • F. Margheritini
  • R. Rossi
  • F. Frascari
  • P. P. Mariani


Knee injuries are common and account for 15–50% of all sports injuries, 40% of which are ligamentous in nature [1]. Historically, the athletic population has been considered at risk for injuries involving the posterior cruciate ligament (PCL), but, interestingly, the reported incidence of these lesions is relatively low. However, PCL injuries are most likely underestimated due to the subtlety of their symptoms and physical exam findings. Although athletes can often function at a high level with an isolated PCL injury, combined injuries and severe isolated injuries with persistent symptomatic instability usually require surgical treatment. Indeed, isolated PCL injury, if left untreated, may result in disability years later, although the natural history of the PCL-deficient knee remains a matter of debate. Furthermore, clinical evidence that current reconstruction techniques significantly alter the stability and function of the PLC-deficient knee is lacking. This chapter provides an up-to-date overview of the basic science and clinical aspects of PCL injury, focusing on the athletic population.


Posterior Cruciate Ligament Posterior Cruciate Ligament Reconstruction Posterior Cruciate Ligament Injury Posterior Tibial Translation Normal Knee Kinematic 
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  1. 1.
    Parolie JM, Bergfeld JA (1986) Long-term results of nonoperative treatment of isolated posterior cruciate ligament injuries in the athlete. Am J Sports Med 14:35–38PubMedCrossRefGoogle Scholar
  2. 2.
    Fanelli GC (1993) Posterior cruciate ligament injuries in trauma patients. Arthroscopy 9:291–294PubMedCrossRefGoogle Scholar
  3. 3.
    Fowler PJ, Messieh SS (1987) Isolated posterior cruciate ligament injuries in athletes. Am J Sports Med 15:553–557PubMedCrossRefGoogle Scholar
  4. 4.
    Shino K, Horibe S, Nakata K et al (1995) Conservative treatment of isolated injuries to the posterior cruciate ligament in athletes. J Bone Joint Surg Br 77:895–900PubMedGoogle Scholar
  5. 5.
    Cooper DE (1999) Clinical evaluation of posterior cruciate ligament injuries. Sports Med Arthrosc Rev 7:248–252CrossRefGoogle Scholar
  6. 6.
    Arendt E, Dick R (1995) Knee injury patterns among men and women in collegiate basketball and soccer: NCAA data and review of literature. Am J Sports Med 23:694–701PubMedCrossRefGoogle Scholar
  7. 7.
    Myklebust G, Maehlum S, Engebretsen L et al (1997) Registration of cruciate ligament injuries in Norwegian top level team handball: a prospective study covering two seasons. Scand J Med Sci Sports 7:289–292PubMedCrossRefGoogle Scholar
  8. 8.
    Levy AS, Wetzler MJ, Lewars M et al (1997) Knee injuries in women collegiate rugby players. Am J Sports Med 25:360–362PubMedCrossRefGoogle Scholar
  9. 9.
    Jarret GJ, Orwin JF, Dick RW (1998) Injuries in collegiate wrestling. Am J Sports Med 26:674–680PubMedGoogle Scholar
  10. 10.
    Butler DL, Noyes FR, Grood ES (1980) Ligamentous restraints to anterior-posterior drawer in the human knee: a biomechanical study. J Bone Joint Surg Am 62:259–270PubMedGoogle Scholar
  11. 11.
    Veltri DM, Deng XH, Torzilli PA et al (1995) The role of the cruciate and posterolateral ligaments in stability of the knee: a biomechanical study. Am J Sports Med 23:436–443PubMedCrossRefGoogle Scholar
  12. 12.
    Grood ES, Stowers SF, Noyes FR (1988) Limits of movement in the human knee: effect of sectioning the posterior cruciate ligament and posterolateral structures. J Bone Joint Surg Am 70:88–97PubMedGoogle Scholar
  13. 13.
    Covey DC, Sapega AA (1994) Anatomy and function of the posterior cruciate ligament. Clin Sports Med 13:509–518PubMedGoogle Scholar
  14. 14.
    Kennedy JC, Hawkins RJ, Willis RB et al (1976) Tension studies of human knee ligaments: yield point, ultimate failure, and disruption of the cruciate and tibial collateral ligaments. J Bone Joint Surg Am 58:350–355PubMedGoogle Scholar
  15. 15.
    Prietto MP, Bain JR, Stonebrook SN et al (1988) Tensile strength of the human posterior cruciate ligament (PCL) [abstract]. Trans Orthop Res Soc 13:195Google Scholar
  16. 16.
    Harner CD, Xerogeanes JW, Livesay GA et al (1995) The human posterior cruciate ligament complex: an interdisciplinary study: ligament morphology and biomechanical evaluation. Am J Sports Med 23:736–745PubMedCrossRefGoogle Scholar
  17. 17.
    Gollehon DL, Torzilli PA, Warren RF (1987) The role of the posterolateral and cruciate ligaments in the stability of the human knee: a biomechanical study. J Bone Joint Surg Am 69:233–242PubMedGoogle Scholar
  18. 18.
    Harner CD, Janaushek MA, Ma CB et al (2000) The effect of knee flexion angle and application of an anterior tibial load at the time of graft fixation on the biomechanics of a posterior cruciate ligament-reconstructed knee. Am J Sports Med 28:460–5-3PubMedGoogle Scholar
  19. 19.
    Nielsen S, Helmig P (1984) The static stablilizing function of the popliteal tendon in the knee. Arch Orthop Trauma Surg 103:165–169PubMedCrossRefGoogle Scholar
  20. 20.
    Neilsen S, Helmig P (1986) Posterior instability of the knee joint: an experimental study. Arch Orthop Trauma Surg 105:121–125CrossRefGoogle Scholar
  21. 21.
    Neilsen S, Ovesen J, Rasmussen O (1985) The posterior cruciate ligament and rotatory knee instability. Arch Orthop Trauma Surg 104:53–56CrossRefGoogle Scholar
  22. 22.
    Vogrin TM, Hoher J, Aroen A et al (2000) Effects of sectioning the posterolateral structures on knee kinematics and in situ forces in the posterior cruciate ligament. Knee Surg Sports Traumatol Arthrosc 8:93–98PubMedCrossRefGoogle Scholar
  23. 23.
    Clancy Jr WG, Shelbourne KD, Zoellner GB et al (1983) Treatment of knee joint instability secondary to rupture of the posterior cruciate ligament: report of a new procedure. J Bone Joint Surg Am 65:310–322PubMedGoogle Scholar
  24. 24.
    Harner CD, Janaushek MA, Kanamori A et al (2000) Biomechanical analysis of a doublebundle posterior cruciate ligament reconstruction. Am J Sports Med 28:144–151PubMedGoogle Scholar
  25. 25.
    Berg EE (1999) Posterior cruciate ligament recession. Arthroscopy 15:644–647PubMedCrossRefGoogle Scholar
  26. 26.
    Berg EE (1995) Posterior cruciate ligament tibial inlay reconstruction. Arthroscopy 11:69–76PubMedCrossRefGoogle Scholar
  27. 27.
    Margheritini F, Mauro CS, Rihn JA et al (2004) Biomechanical comparison of tibial inlay versus transtibial techniques for posterior cruciate ligament reconstruction: analysis of knee kinematics and graft in situ forces. Am J Sports Med 32:587–593PubMedCrossRefGoogle Scholar
  28. 28.
    MacGillivray JD, Stein BE, Park M et al (2006) Comparison of tibial inlay versus transtibial techniques for isolated posterior cruciate ligament reconstruction: minimum 2-year followup. Arthroscopy 22(3):320–328PubMedCrossRefGoogle Scholar
  29. 29.
    Fanelli GC, Edson CJ (1995) Posterior cruciate ligament injuries in trauma patients: part II. Arthroscopy 11:526–597PubMedCrossRefGoogle Scholar
  30. 30.
    Wascher DC, Grauer JD, Markoff KL (1993) Biceps tendon tenodesis for posterolateral instability of the knee: an in vitro study. Am J Sports Med 21:400–406PubMedCrossRefGoogle Scholar
  31. 31.
    Harner CD, Vogrin TM, Hoher J et al (2000) Biomechanical analysis of a posterior cruciate ligament reconstruction: deficiency of the posterolateral structures as a cause of graft failure. Am J Sports Med 28:32–39PubMedGoogle Scholar

Copyright information

© Springer-Verlag Italia 2011

Authors and Affiliations

  • F. Margheritini
  • R. Rossi
  • F. Frascari
  • P. P. Mariani

There are no affiliations available

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