Reconstruction of the posterior cruciate ligament. Indications and results.

©2004 British Editorial Society of Bone and Joint Surgery doi:10.1302/0301-620X.86B4. 15010 $2.00 J Bone Joint Surg [Br] 2004;86-B:480-91. Renewed interest in injuries to the posterior cruciate ligament (PCL) and its associated structures has resulted in an increasing number of reports on the anatomy, biomechanics, diagnosis and treatment. However, set against our knowledge of the management of injuries to the anterior cruciate ligament, that of injuries to the PCL is less clear. There are many reasons for this. Injuries to the PCL are much less common; an individual surgeon will see very few each year and his experience will be limited. Acute cases are often missed, either from lack of experience of the original examiner or because the patient does not realise the severity of the injury and does not seek medical help at the acute stage. Attempts at treatment in the past have produced relatively poor results and the indications for surgery are unclear. With increasing knowledge the situation is improving. Methods of diagnosis from clinical examination and special investigations are becoming more widely known and these, together with a high index of suspicion, should lead to the identification of a greater number of these injuries. Until recently, the natural history of isolated PCL injuries was unclear. The literature contained many retrospective studies with small numbers of cases and a varied aetiology. Their conclusions led to confusion. More recent prospective papers have aided clarification. The importance of the posterolateral corner in relation to PCL injuries has been increasingly understood both from original biomechanical studies and clinical observation. Without attention to injuries to this site the treatment of rupture of the PCL may be compromised and failure almost inevitable. Injuries to the PCL may be associated with multiple damage to other ligaments of the knee including dislocation. The management of complex injuries is beyond the scope of this review, but the basic principles will be described including the importance of injury to the PCL. Early surgical treatment has been advocated by most experienced surgeons, but few comparative studies of conservative versus operative treatment are available. While there have been many reports of methods of reconstruction of the PCL and associated structures, few long term results are available. Future knowledge and understanding will depend on prospective studies on specific forms of treatment allowing the surgeon to make an objective assessment and be armed with accurate information to provide the best treatment.