Rupture of the Posterior Cruciate Ligament: Preoperative and Postoperative Assessment

Abstract

Posterior cruciate ligament (PCL) ruptures are not common, but reconstruction is increasing because PCL-deficient knees are prone to develop osteoarthritis. Preoperative MRI may confirm a total or partial disruption of PCL fibers. An overstretched PCL is often mistaken for an intact PCL while the knee is functionally PCL deficient, resulting in false-negative MRI reports. Posterior translation of the medial condyle is a useful indirect sign on imaging. Preoperative stress radiographs are used to quantify the degree of PCL deficiency, and posterior translation determines whether to treat conservatively or with surgery. Early postoperative imaging is performed to evaluate tunnel placement and fixation devices. Late postoperative imaging is performed to assess graft rupture, arthrofibrosis, or tunnel widening. Pre- and postoperative imaging plays an important part in planning and treating functionally PCL-deficient knees and PCL ruptures.

Keywords

PCL rupture - stress radiographs - postoperative imaging - CT - MRI

• References

• 1 Strobel MJ, Weiler A, Schulz MS, Russe K, Eichhorn HJ. Arthroscopic evaluation of articular cartilage lesions in posterior-cruciate-ligament-deficient knees. Arthroscopy 2003; 19 (3) 262-268
• 2 Arøen A, Sivertsen EA, Owesen C, Engebretsen L, Granan LP. An isolated rupture of the posterior cruciate ligament results in reduced preoperative knee function in comparison with an anterior cruciate ligament injury. Knee Surg Sports Traumatol Arthrosc 2013; 21 (5) 1017-1022
• 3 Logan M, Williams A, Lavelle J, Gedroyc W, Freeman M. The effect of posterior cruciate ligament deficiency on knee kinematics. Am J Sports Med 2004; 32 (8) 1915-1922
• 4 Amis AA, Gupte CM, Bull AMJ, Edwards A. Anatomy of the posterior cruciate ligament and the meniscofemoral ligaments. Knee Surg Sports Traumatol Arthrosc 2006; 14 (3) 257-263
• 5 Gupte CM, Smith A, McDermott ID, Bull AM, Thomas RD, Amis AA. Meniscofemoral ligaments revisited. Anatomical study, age correlation and clinical implications. J Bone Joint Surg Br 2002; 84 (6) 846-851
• 6 Li G, DeFrate LE, Sun H, Gill TJ. In vivo elongation of the anterior cruciate ligament and posterior cruciate ligament during knee flexion. Am J Sports Med 2004; 32 (6) 1415-1420
• 7 Fanelli GC, Beck JD, Edson CJ. Current concepts review: the posterior cruciate ligament. J Knee Surg 2010; 23 (2) 61-72
• 8 Schulz MS, Russe K, Weiler A, Eichhorn HJ, Strobel MJ. Epidemiology of posterior cruciate ligament injuries. Arch Orthop Trauma Surg 2003; 123 (4) 186-191
• 9 Harner CD, Höher J. Evaluation and treatment of posterior cruciate ligament injuries. Am J Sports Med 1998; 26 (3) 471-482
• 10 Túlio M, Caldas L, Ferreira G, Lopes S, Martins J, Massi R. Original article Posterior cruciate ligament injury : characteristics and associations of most frequent injuries. Rev Bras Ortop. 2013; 48: 427-431
• 11 Crawford R, Walley G, Bridgman S, Maffulli N. Magnetic resonance imaging versus arthroscopy in the diagnosis of knee pathology, concentrating on meniscal lesions and ACL tears: a systematic review. Br Med Bull 2007; 84: 5-23
• 12 Wind Jr WM, Bergfeld JA, Parker RD. Evaluation and treatment of posterior cruciate ligament injuries: revisited. Am J Sports Med 2004; 32 (7) 1765-1775
• 13 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
• 14 Rodriguez Jr W, Vinson EN, Helms CA, Toth AP. MRI appearance of posterior cruciate ligament tears. AJR Am J Roentgenol 2008; 191 (4) 1031
• 15 Cha JH, Chung HW, Kwon JW, Choi BK, Lee SH, Shin MJ. Longitudinal split of the posterior cruciate ligament: description of a new MR finding and evaluation of its potential clinical significance. Clin Radiol 2011; 66 (3) 269-274
• 16 Viana SL, Fernandes JL, Mendonça JL, Freitas FM. Diffuse intrasubstance signal abnormalities of the posterior cruciate ligament: the counterpart of the mucoid degeneration of the anterior cruciate ligament? A case series. JBR-BTR 2008; 91 (6) 245-248
• 17 Parkar AP, Vanhoenacker FM, Adriaensen ME. Bilateral mucoid degeneration of the posterior cruciate ligaments. JBR-BTR 2013; 96 (5) 298-300
• 18 Servant CT, Ramos JP, Thomas NP. The accuracy of magnetic resonance imaging in diagnosing chronic posterior cruciate ligament injury. Knee 2004; 11 (4) 265-270
• 19 Shelbourne KD, Clark M, Gray T. Minimum 10-year follow-up of patients after an acute, isolated posterior cruciate ligament injury treated nonoperatively. Am J Sports Med 2013; 41 (7) 1526-1533
• 20 Degnan AJ, Maldjian C, Adam RJ, Harner CD. Passive posterior tibial subluxation on routine knee MRI as a secondary sign of PCL tear. Radiol Res Pract 2014; 2014: 715439
• 21 Montgomery SR, Johnson JS, McAllister DR, Petrigliano FA. Surgical management of PCL injuries: indications, techniques, and outcomes. Curr Rev Musculoskelet Med 2013; 6 (2) 115-123
• 22 Dowd GSE. Reconstruction of the posterior cruciate ligament. Indications and results. J Bone Joint Surg Br 2004; 86 (4) 480-491
• 23 LaPrade CM, Civitarese DM, Rasmussen MT, LaPrade RF. Emerging updates on the posterior cruciate ligament: a review of the current literature. Am J Sports Med 2015; 43 (12) 3077-3092
• 24 Osti M, Krawinkel A, Benedetto KP. In vivo evaluation of femoral and tibial graft tunnel placement following all-inside arthroscopic tibial inlay reconstruction of the posterior cruciate ligament. Knee 2014; 21 (6) 1198-1202
• 25 Noyes FR, Barber-Westin SD. Posterior cruciate ligament revision reconstruction, part 1: causes of surgical failure in 52 consecutive operations. Am J Sports Med 2005; 33 (5) 646-654
• 26 Bellelli A, Adriani E, Margheritini F, Camillieri G, Della Rocca C, Mariani PP. Synovial healing in reconstructed cruciate ligaments. Our personal experience compared in single interventions and combined reconstructions [in Italian]. Radiol Med (Torino) 1999; 98 (6) 454-461
• 27 Amis AA, Jakob RP. Anterior cruciate ligament graft positioning, tensioning and twisting. Knee Surg Sports Traumatol Arthrosc 1998; 6 (Suppl. 01) S2-S12
• 28 Alcalá-Galiano A, Baeva M, Ismael M, Argüeso MJ. Imaging of posterior cruciate ligament (PCL) reconstruction: normal postsurgical appearance and complications. Skeletal Radiol 2014; 1659-1668
• 29 Narvy SJ, Pearl M, Vrla M, Yi A, Hatch III GFR. Anatomy of the femoral footprint of the posterior cruciate ligament: a systematic review. Arthroscopy 2015; 31 (2) 345-354
• 30 Lee YS, Ra HJ, Ahn JH, Ha JK, Kim JG. Posterior cruciate ligament tibial insertion anatomy and implications for tibial tunnel placement. Arthroscopy 2011; 27 (2) 182-187