Subscribe to RSS
DOI: 10.1055/s-0030-1267466
© Thieme Medical Publishers
Current Concepts Review: The Posterior Cruciate Ligament
Publication History
Publication Date:
22 October 2010 (online)
ABSTRACT
Injuries to the posterior cruciate ligament (PCL) and methods of treatment of the injured PCL have historically been surrounded by controversy in the orthopedic community. The infrequent occurrence of PCL injuries and PCL-based, multiple ligament knee injuries has led to limitations in clinical studies and a subsequent lag in basic science and clinical research compared with that for other ligamentous injuries. In recent years, new studies have elucidated the biomechanical function and complex anatomy of the PCL leading to an increased interest in research, understanding, and treatment of these complex injuries. In addition to improved understanding of knee ligament structure and biomechanics, technical advancements in allograft tissue, surgical instrumentation, and graft tensioning and fixation methods and improved surgical techniques and postoperative rehabilitation methods have enhanced the results in PCL reconstruction and PCL-based, multiple ligament knee surgical outcomes.
KEYWORDS
Posterior cruciate ligament
REFERENCES
- 1 Fanelli G C, Edson C J. Posterior cruciate ligament injuries in trauma patients: part II. Arthroscopy. 1995; 11 526-529
- 2 Miller M D. Review of Orthopaedics. 4th ed. Philadelphia; Elsevier 2004
- 3 Cooper D E, Warren R F, Warner J JP. The posterior cruciate ligament and posterolateral structures of the knee: anatomy, functions, and patterns of injury. Instr Course Lect. 1991; 40 249-270
- 4 Van Dommelen B A, Fowler P J. Anatomy of the posterior cruciate ligament. A review. Am J Sports Med. 1989; 17 24-29
- 5 Edwards A, Bull A M, Amis A A. The attachments of the fiber bundles of the posterior cruciate ligament: an anatomic study. Arthroscopy. 2007; 23 284-290
- 6 Moorman III C T, Murphy Zane M S, Bansai S et al.. Tibial insertion of the posterior cruciate ligament: a sagittal plane analysis using gross, histologic, and radiographic methods. Arthroscopy. 2008; 24 269-275
- 7 Takahashi M, Matsubara T, Doi M, Suzuki D, Nagano A. Anatomical study of the femoral and tibial insertions of the anterolateral and posteromedial bundles of human posterior cruciate ligament. Knee Surg Sports Traumatol Arthrosc. 2006; 14 1055-1059
- 8 Girgis F G, Marshall J L, Monajem A. The cruciate ligaments of the knee joint. Anatomical, functional and experimental analysis. Clin Orthop Relat Res. 1975; 106 216-231
- 9 Sheps D M, Otto D, Fernhout M. The anatomic characteristics of the tibial insertion of the posterior cruciate ligament. Arthroscopy. 2005; 21 820-825
- 10 Fox R J, Harner C D, Sakane M, Carlin G J, Woo S L. Determination of the in situ forces in the human posterior cruciate ligament using robotic technology. A cadaveric study. Am J Sports Med. 1998; 26 395-401
- 11 Ortiz G J, Schmotzer H, Bernbeck J, Graham S, Tibone J E, Vangsness Jr C T. Isometry of the posterior cruciate ligament. Effects of functional load and muscle force application. Am J Sports Med. 1998; 26 663-668
- 12 Amis A A, Gupte C M, Bull A M, Edwards A. Anatomy of the posterior cruciate ligament and the meniscofemoral ligaments. Knee Surg Sports Traumatol Arthrosc. 2006; 14 257-263
- 13 Lopes Jr O V, Ferretti M, Shen W, Ekdahl M, Smolinski P, Fu F H. Topography of the femoral attachment of the posterior cruciate ligament. J Bone Joint Surg Am. 2008; 90 249-255
- 14 Gupte C M, Bull A M, Thomas R D, Amis A A. The meniscofemoral ligaments: secondary restraints to the posterior drawer. Analysis of anteroposterior and rotary laxity in the intact and posterior-cruciate-deficient knee. J Bone Joint Surg Br. 2003; 85 765-773
- 15 Heller L, Langman J. The menisco-femoral ligaments of the human knee. J Bone Joint Surg Br. 1964; 46 307-313
- 16 Harner C D, Xerogeanes J W, Livesay G A et al.. The human posterior cruciate ligament complex: an interdisciplinary study. Ligament morphology and biomechanical evaluation. Am J Sports Med. 1995; 23 736-745
- 17 Kusayama T, Harner C D, Carlin G J, Xerogeanes J W, Smith B A. Anatomical and biomechanical characteristics of human meniscofemoral ligaments. Knee Surg Sports Traumatol Arthrosc. 1994; 2 234-237
- 18 Vladimirov B. Arterial sources of blood supply of the knee-joint in man. Nauchni Tr Vissh Med Inst Sofiia. 1968; 47 1-10
- 19 Arnoczky S P, Rubin R M, Marshall J L. Microvasculature of the cruciate ligaments and its response to injury. An experimental study in dogs. J Bone Joint Surg Am. 1979; 61 1221-1229
- 20 Scapinelli R. Studies on the vasculature of the human knee joint. Acta Anat (Basel). 1968; 70 305-331
- 21 Kennedy J C, Alexander I J, Hayes K C. Nerve supply of the human knee and its functional importance. Am J Sports Med. 1982; 10 329-335
- 22 Katonis P G, Assimakopoulos A P, Agapitos M V, Exarchou E I. Mechanoreceptors in the posterior cruciate ligament. Histologic study on cadaver knees. Acta Orthop Scand. 1991; 62 276-278
- 23 Schultz R A, Miller D C, Kerr C S, Micheli L. Mechanoreceptors in human cruciate ligaments. A histological study. J Bone Joint Surg Am. 1984; 66 1072-1076
- 24 Safran M R, Allen A A, Lephart S M, Borsa P A, Fu F H, Harner C D. Proprioception in the posterior cruciate ligament deficient knee. Knee Surg Sports Traumatol Arthrosc. 1999; 7 310-317
- 25 Dejour H, Walch G, Peyrot J et al.. The natural history of rupture of the posterior cruciate ligament. Fr J Orthop Surg. 1988; 2 112-120
- 26 Gollehon D L, Torzilli P A, Warren R F. The role of the posterolateral and cruciate ligaments in the stability of the human knee. A biomechanical study. J Bone Joint Surg Am. 1987; 69 233-242
- 27 Butler D L, Noyes F R, Grood E S. Ligamentous restraints to anterior-posterior drawer in the human knee. A biomechanical study. J Bone Joint Surg Am. 1980; 62 259-270
- 28 Grood E S, Stowers S F, Noyes F R. Limits of movement in the human knee. Effect of sectioning the posterior cruciate ligament and posterolateral structures. J Bone Joint Surg Am. 1988; 70 88-97
- 29 Veltri D M, Deng X-H, Torzilli P A, Maynard M J, Warren R F. The role of the popliteofibular ligament in stability of the human knee. A biomechanical study. Am J Sports Med. 1996; 24 19-27
- 30 Gupte C M, Bull A MJ, Thomas R D, Amis A A. The meniscofemoral ligaments: secondary restraints to the posterior drawer. Analysis of anteroposterior and rotary laxity in the intact and posterior-cruciate-deficient knee. J Bone Joint Surg Br. 2003; 85 765-773
- 31 Ritchie J R, Bergfeld J A, Kambic H, Manning T. Isolated sectioning of the medial and posteromedial capsular ligaments in the posterior cruciate ligament-deficient knee. Influence on posterior tibial translation. Am J Sports Med. 1998; 26 389-394
- 32 Fox R J, Harner C D, Sakane M, Carlin G J, Woo S L. Determination of the in situ forces in the human posterior cruciate ligament using robotic technology. A cadaveric study. Am J Sports Med. 1998; 26 395-401
- 33 Kennedy J C, Grainger R W. The posterior cruciate ligament. J Trauma. 1967; 7 367-377
- 34 Race A, Amis A A. The mechanical properties of the two bundles of the human posterior cruciate ligament. J Biomech. 1994; 27 13-24
- 35 Brantigan O C, Voshell A F. The mechanics of the ligaments and menisci of the knee joint. J Bone Joint Surg. 1941; 23 44-66
- 36 Kanamori A, Vogrin T M, Yagi M et al.. Effects of PCL-deficiency on the soft tissues of the knee joint contact forces. Trans Orthop Res Soc. 2000; 25 485
- 37 Vogrin T M, Höher J, Arøen A, Woo S L, Harner C D. Effects of sectioning the posterolateral structures on knee kinematics and in situ forces in the posterior cruciate ligament. Knee Surg Sports Traumatol Arthrosc. 2000; 8 93-98
- 38 Covey D C, Sapega A A, Riffenburgh R H. The effects of sequential sectioning of defined posterior cruciate ligament fiber regions on translational knee motion. Am J Sports Med. 2008; 36 480-486
- 39 Race A, Amis A A. Loading of the two bundles of the posterior cruciate ligament: an analysis of bundle function in a-P drawer. J Biomech. 1996; 29 873-879
- 40 Covey D C, Sapega A A, Sherman G M. Testing for isometry during reconstruction of the posterior cruciate ligament. Anatomic and biomechanical considerations. Am J Sports Med. 1996; 24 740-746
- 41 Galloway M T, Grood E S, Mehalik J N, Levy M, Saddler S C, Noyes F R. Posterior cruciate ligament reconstruction. An in vitro study of femoral and tibial graft placement. Am J Sports Med. 1996; 24 437-445
- 42 Race A, Amis A A. PCL reconstruction. In vitro biomechanical comparison of “isometric” versus single and double-bundled “anatomic” grafts. J Bone Joint Surg Br. 1998; 80 173-179
- 43 Grood E S, Hefzy M S, Lindenfield T N. Factors affecting the region of most isometric femoral attachments. Part I: the posterior cruciate ligament. Am J Sports Med. 1989; 17 197-207
- 44 Burns II W C, Draganich L F, Pyevich M, Reider B. The effect of femoral tunnel position and graft tensioning technique on posterior laxity of the posterior cruciate ligament-reconstructed knee. Am J Sports Med. 1995; 23 424-430
- 45 Stone J D, Carlin G J, Ishibashi Y, Harner C D, Woo S L. Assessment of posterior cruciate ligament graft performance using robotic technology. Am J Sports Med. 1996; 24 824-828
- 46 Markolf K L, Jackson S R, McAllister D R. Single- versus double-bundle posterior cruciate ligament reconstruction: effects of femoral tunnel separation. Am J Sports Med. 2010; 38 1141-1146
- 47 Harner C D, Janaushek M A, Ma C B, Kanamori A, Vogrin T M, Woo S L. 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. 2000; 28 460-465
- 48 Markolf K L, Slauterbeck J R, Armstrong K L, Shapiro M S, Finerman G A. A biomechanical study of replacement of the posterior cruciate ligament with a graft. Part 1: isometry, pre-tension of the graft, and anterior-posterior laxity. J Bone Joint Surg Am. 1997; 79 375-380
- 49 Harner C D, Janaushek M A, Kanamori A, Yagi M, Vogrin T M, Woo S L. Biomechanical analysis of a double-bundle posterior cruciate ligament reconstruction. Am J Sports Med. 2000; 28 144-151
- 50 Bergfeld J A, Graham S M, Parker R D, Valdevit A D, Kambic H E. A biomechanical comparison of posterior cruciate ligament reconstructions using single- and double-bundle tibial inlay techniques. Am J Sports Med. 2005; 33 976-981
- 51 Harner C D, Vogrin T M, Höher J, Ma C B, Woo S L. Biomechanical analysis of a posterior cruciate ligament reconstruction. Deficiency of the posterolateral structures as a cause of graft failure. Am J Sports Med. 2000; 28 32-39
- 52 Johnson J C, Bach B R. Current concepts review, posterior cruciate ligament. Am J Knee Surg. 1990; 3 143-153
- 53 Clancy Jr W G, Shelbourne K D, Zoellner G B, Keene J S, Reider B, Rosenberg T D. Treatment of knee joint instability secondary to rupture of the posterior cruciate ligament. Report of a new procedure. J Bone Joint Surg Am. 1983; 65 310-322
- 54 Degenhardt T C, Hughston J C. Chronic posterior cruciate instability: nonoperative management. Orthop Trans. 1981; 5 486-487
- 55 Fanelli G C. Posterior cruciate ligament injuries in trauma patients. Arthroscopy. 1993; 9 291-294
- 56 Fanelli G C, Edson C, Foster J. PCL injuries in acute traumatic hemarthrosis of the knee. Presented at: AAOS Annual Meeting February 28, 1994 New Orleans, LA;
- 57 O'Donoghue D H. An analysis of end results of surgical treatment of major injuries to the ligaments of the knee. J Bone Joint Surg Am. 1955; 37 1-13, passim
- 58 Parolie J M, Bergfeld J A. Long-term results of nonoperative treatment of isolated posterior cruciate ligament injuries in the athlete. Am J Sports Med. 1986; 14 35-38
- 59 Schulz M S, Russe K, Weiler A, Eichhorn H J, Strobel M J. Epidemiology of posterior cruciate ligament injuries. Arch Orthop Trauma Surg. 2003; 123 186-191
- 60 Stanish W D, Rubinovich M, Armason T, Lapenskie G. Posterior cruciate ligament tears in wrestlers. Can J Appl Sport Sci. 1986; 11 173-177
- 61 Fowler P J, Messieh S S. Isolated posterior cruciate ligament injuries in athletes. Am J Sports Med. 1987; 15 553-557
- 62 Fanelli G C. PCL tears—who needs surgery. Presented at: AANA Annual Meeting April 1–4, 1993 Palm Desert, CA;
- 63 Fanelli G C. ACL/PCL reconstruction in the trauma patient. Presented at: AANA Annual Meeting February 1994 New Orleans, LA;
- 64 Fanelli G C, Edson C, Foster J, Rich J. Arthroscopically assisted combined anterior and posterior cruciate ligament reconstruction. Presented at: AAOS Annual Meeting February 28, 1994 New Orleans, LA;
- 65 DeLee J C, Drez Jr D, Miller M D. Orthopaedic Sports Medicine: Principles and Practice. 2nd ed. Philadelphia; Saunders 2003
- 66 McAllister D R, Petrigliano F A. Diagnosis and treatment of posterior cruciate ligament injuries. Curr Sports Med Rep. 2007; 6 293-299
- 67 Margheritini F, Mariani P P. Diagnostic evaluation of posterior cruciate ligament injuries. Knee Surg Sports Traumatol Arthrosc. 2003; 11 282-288
- 68 Daniel D M, Stone M L, Barnett P, Sachs R. Use of the quadriceps active test to diagnose posterior cruciate-ligament disruption and measure posterior laxity of the knee. J Bone Joint Surg Am. 1988; 70 386-391
- 69 Grood E S, Hefzy M S, Lindenfield T N. Factors affecting the region of most isometric femoral attachments. Part I: the posterior cruciate ligament. Am J Sports Med. 1989; 17 197-207
- 70 Baker Jr C L, Norwood L A, Hughston J C. Acute combined posterior cruciate and posterolateral instability of the knee. Am J Sports Med. 1984; 12 204-208
- 71 Jakob R P, Hassler H, Staubli H U. Experimental studies on the functional anatomy and the pathomechanism of the true and reversed pivot shift sign. Acta Orthop Scand. 1981; 5(Suppl) 18-32
- 72 Loos W C, Fox J M, Blazina M E, Del Pizzo W, Friedman M J. Acute posterior cruciate ligament injuries. Am J Sports Med. 1981; 9 86-92
- 73 Shelbourne K D, Benedict F, McCarroll J R, Rettig A C. Dynamic posterior shift test. An adjuvant in evaluation of posterior tibial subluxation. Am J Sports Med. 1989; 17 275-277
- 74 Daniel DM, Akeson W, O'Conner J Knee Ligaments—Structure, Function, Injury, and Repair. New York, NY; Raven 1990
- 75 Schulz M S, Steenlage E S, Russe K, Strobel M J. Distribution of posterior tibial displacement in knees with posterior cruciate ligament tears. J Bone Joint Surg Am. 2007; 89 332-338
- 76 Gross M L, Grover J S, Bassett L W, Seeger L L, Finerman G A. Magnetic resonance imaging of the posterior cruciate ligament. Clinical use to improve diagnostic accuracy. Am J Sports Med. 1992; 20 732-737
- 77 Boks S S, Vroegindeweij D, Koes B W, Hunink M G, Bierma-Zeinstra S M. Follow-up of posttraumatic ligamentous and meniscal knee lesions detected at MR imaging: systematic review. Radiology. 2006; 238 863-871
- 78 Servant C T, Ramos J P, Thomas N P. The accuracy of magnetic resonance imaging in diagnosing chronic posterior cruciate ligament injury. Knee. 2004; 11 265-270
- 79 Fanelli G C, Giannotti B F, Edson C J. The posterior cruciate ligament arthroscopic evaluation and treatment. Arthroscopy. 1994; 10 673-688
- 80 Shelbourne K D, Davis T J, Patel D V. The natural history of acute, isolated, nonoperatively treated posterior cruciate ligament injuries. A prospective study. Am J Sports Med. 1999; 27 276-283
- 81 Parolie J M, Bergfeld J A. Long-term results of nonoperative treatment of isolated posterior cruciate ligament injuries in the athlete. Am J Sports Med. 1986; 14 35-38
- 82 Boynton M D, Tietjens B R. Long-term follow-up of the untreated isolated posterior cruciate ligament-deficient knee. Am J Sports Med. 1996; 24 306-310
- 83 Keller P M, Shelbourne K D, McCarroll J R, Rettig A C. Nonoperatively treated isolated posterior cruciate ligament injuries. Am J Sports Med. 1993; 21 132-136
- 84 Fanelli G C, Giannotti B F, Edson C J. Arthroscopically assisted combined anterior and posterior cruciate ligament reconstruction. Arthroscopy. 1996; 12 5-14
- 85 Fanelli G C, Giannotti B F, Edson C J. Arthroscopically assisted combined posterior cruciate ligament/posterior lateral complex reconstruction. Arthroscopy. 1996; 12 521-530
- 86 Fanelli G C, Edson C J, Reinheimer K N, Beck J. Arthroscopic single bundle v double bundle posterior cruciate ligament reconstruction. Arthroscopy. 2008; 24(6, Suppl) e26
- 87 Fanelli G C, Beck J D, Edson C J. Double bundle posterior cruciate ligament reconstruction: surgical technique and results. Sports Med Arthrosc. 2010; 18 , In press
- 88 Fanelli G C, Edson C J. Arthroscopically assisted combined anterior and posterior cruciate ligament reconstruction in the multiple ligament injured knee: 2- to 10-year follow-up. Arthroscopy. 2002; 18 703-714
- 89 Fanelli G C, Edson C J. Combined posterior cruciate ligament-posterolateral reconstructions with Achilles tendon allograft and biceps femoris tendon tenodesis: 2- to 10-year follow-up. Arthroscopy. 2004; 20 339-345
- 90 Fanelli G C, Edson C J, Orcutt D R, Harris J D, Zijerdi D. Treatment of combined anterior cruciate-posterior cruciate ligament-medial-lateral side knee injuries. J Knee Surg. 2005; 18 240-248
-
91 Fanelli G C, Beck J D, Edson C J. Comparison of arthroscopic single and double bundle PCL reconstruction using allograft tissue in multiple ligament knee injuries: two to six year follow-up in ninety consecutive cases (Submitted).
- 92 Giffin J R, Haemmerle M J, Vogrin T M, Harner C D. Single- versus double-bundle PCL reconstruction: a biomechanical analysis. J Knee Surg. 2002; 15 114-120
- 93 Cooper D E, Stewart D. Posterior cruciate ligament reconstruction using single-bundle patella tendon graft with tibial inlay fixation: 2- to 10-year follow-up. Am J Sports Med. 2004; 32 346-360
- 94 Chen C H, Chen W J, Shih C H. Arthroscopic reconstruction of the posterior cruciate ligament with quadruple hamstring tendon graft: a double fixation method. J Trauma. 2002; 52 938-945
- 95 Garofalo R, Jolles B M, Moretti B, Siegrist O. Double-bundle transtibial posterior cruciate ligament reconstruction with a tendon-patellar bone-semitendinosus tendon autograft: clinical results with a minimum of 2 years' follow-up. Arthroscopy. 2006; 22 1331-1338, e1
- 96 Cain Jr E L, Clancy Jr W G. Posterior cruciate ligament reconstruction: two-bundle technique. J Knee Surg. 2002; 15 108-113
- 97 Nyland J, Hester P, Caborn D N. Double-bundle posterior cruciate ligament reconstruction with allograft tissue: 2-year postoperative outcomes. Knee Surg Sports Traumatol Arthrosc. 2002; 10 274-279
- 98 Wang C J, Chen H S, Huang T W. Outcome of arthroscopic single bundle reconstruction for complete posterior cruciate ligament tear. Injury. 2003; 34 747-751
- 99 Hatayama K, Higuchi H, Kimura M, Kobayashi Y, Asagumo H, Takagishi K. A comparison of arthroscopic single- and double-bundle posterior cruciate ligament reconstruction: review of 20 cases. Am J Orthop. 2006; 35 568-571
- 100 Lutz G E, Palmitier R A, An K N, Chao E YS. Comparison of tibiofemoral joint forces during open-kinetic-chain and closed-kinetic-chain exercises. J Bone Joint Surg Am. 1993; 75 732-739
- 101 Fanelli GC Posterior Cruciate Ligament Injuries: A Practical Guide to Management. New York, NY; Springer-Verlag 2001
- 102 Fanelli GC Posterior Cruciate Ligament Injuries: A Practical Guide to Management. New York, NY; Springer-Verlag 2004
- 103 Fanelli G C. Posterior cruciate ligament rehabilitation: how slow should we go?. Arthroscopy. 2008; 24 234-235
Gregory C FanelliM.D.
115 Woodbine Lane
Danville, PA 17821-5212