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Anatomy
- From the medial surface of the inter condylar notch to a groove in the posterior surface of the tibia below the level of the articular surface
- no truly isometric fibres but the most posterior portion has the least variation in length
- Most of the fibres of the PCL are lax in extension becoming taught in flexion limiting anterior displacement of the femur on the tibia in flexion
- average length of the PCL is 38mm
- diameter is 13mm with a width of 8mm
- Posterior menisco-femoral ligament of Wrisberg
- extends from the posterior horn of the lateral meniscus to the femur behind the PCL
- Anterior menisco-femoral ligament of Humphrey if present passes in front of the PCL
Mechanism of injury
- posterior directed force on a flexed knee
- forced hyperextension
- posterior rotatory force
Natural History
- Isolated PCL injuries rarely associated with meniscal pathology & result in little functional disability
- Increased shear forces transmitted to articular surfaces may lead to early degenerative arthritis
- At this time there is not sufficient evidence to prove the benefit of surgical reconstruction over non operative treatment
Treatment
Nonoperative
- 85 – 90% satisfactory results despite persistent laxity in the PCL
- Maintenance of quads strength emphasised, hamstring strengthening delayed
- Many are only slightly impaired & return to sport without reconstruction
Operative
- Indications
- bony avulsions
- fail conservative therapy
- multidirectional instability
- Options include:
- primary repair with augmentation with semitendinosus/ gracilis
- reconstruction with patellar tendon or achilles tendon auto- or allo-graft
Victorian Orthopaedic Registrar presentation
