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Posterior cruciate ligament nonoperative treatment

Dean Wang, Jessica Graziano, Riley J Williams, Kristofer J Jones
PURPOSE OF REVIEW: To review the current practices of nonoperative management of posterior cruciate ligament (PCL) injuries, the natural history of conservative care, and the latest PCL rehabilitation strategies. RECENT FINDINGS: PCL injuries often occur as part of a multiligamentous knee injury and occasionally occur in isolation. Although patients may be able to tolerate or compensate for a PCL-deficient knee, long-term outcomes after conservative care demonstrate a high rate of arthrosis in the medial and patellofemoral compartments resulting from altered knee kinematics and loads...
May 2, 2018: Current Reviews in Musculoskeletal Medicine
Christian Owesen, Eline Aas, Asbjørn Årøen
PURPOSE AND HYPOTHESIS: The main purpose of the study is to put focus on the costs related to treating posterior cruciate ligament (PCL) injuries and the possible implications of chosen treatment strategy to the respective institutions and society. METHODS: Costs of treating PCL injuries nonoperatively and for both single-bundle (SB) and double-bundle (DB) reconstruction were estimated. These costs were translated into equivalent quality-adjusted life years (QALY) given a threshold value of Euro (€) 70,000 per QALY...
July 14, 2017: Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA
Matthew R Prince, Michael J Stuart, Alexander H King, Paul L Sousa, Bruce A Levy
Posterior cruciate ligament (PCL) injuries account for nearly 20% of knee ligament injuries. PCL injuries can occur in isolation or, more commonly, in the setting of multiligamentous knee injuries. Isolated PCL disruptions are commonly treated nonoperatively; however, symptomatic grade III injuries, as well as PCL injuries found in multiligamentous injuries, are frequently treated surgically. Several reconstructive techniques exist for the treatment of PCL deficiency without a clear optimal approach. We describe our preferred operative technique to reconstruct the PCL using an all-inside arthroscopic approach with a quadrupled tibialis anterior or peroneus longus allograft with both tibial and femoral suspensory fixation...
October 2015: Arthroscopy Techniques
Mark P Smyth, Jason L Koh
Medial-sided knee injuries can result in pain, instability, and loss of function. Many clinical studies have been written on the treatment of medial-sided knee injuries; however, the vast majority are isolated case series of surgical or nonoperative treatment regimens, and only a few randomized prospective clinical trials can be found in the literature that compare different treatment modalities. Comparison of these treatments is challenging due to the variety of medial-sided structures that can be involved, the multiple different approaches to treatment, and the variability of how objective and subjective clinical outcomes are reported...
June 2015: Sports Medicine and Arthroscopy Review
Christopher M LaPrade, David M Civitarese, Matthew T Rasmussen, Robert F LaPrade
The posterior cruciate ligament (PCL) is recognized as an essential stabilizer of the knee. However, the complexity of the ligament has generated controversy about its definitive role and the recommended treatment after injury. A proper understanding of the functional role of the PCL is necessary to minimize residual instability, osteoarthritic progression, and failure of additional concomitant ligament graft reconstructions or meniscal repairs after treatment. Recent anatomic and biomechanical studies have elucidated the surgically relevant quantitative anatomy and confirmed the codominant role of the anterolateral and posteromedial bundles of the PCL...
December 2015: American Journal of Sports Medicine
Bob Yin, Jaipal Gandhi, Orr Limpisvasti, Karen Mohr, Neal S ElAttrache
BACKGROUND: Approximately 90% of current orthopaedic graduates are engaging in fellowship training, with sports medicine being the most commonly chosen specialty. The purpose of this study was to evaluate the impact of fellowship training on clinical decision-making by fellowship-trained sports medicine surgeons. METHODS: A survey was designed to assess the importance of fellowship on common clinical decisions made in the nonoperative and surgical treatment of knee, shoulder, and elbow disorders...
March 4, 2015: Journal of Bone and Joint Surgery. American Volume
Gerard G Adler
Posterior cruciate ligament (PCL) reconstructions are challenging surgeries. Recent advances have included double-bundle PCL, arthroscopic inlay, and all-inside techniques. This technical note presents an anatomic, single-bundle, all-inside PCL reconstruction with an anterior tibialis allograft GraftLink construct. The surgery was performed with FlipCutter guide pins and ACL TightRope RT. The case involved a 22-year-old woman with an isolated grade 3 PCL tear that had failed nonoperative treatment. The technique described is minimally invasive...
May 2013: Arthroscopy Techniques
Vincent Morelli, Crystal Bright, Ashley Fields
This article discusses athletic injuries of the anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), medial collateral ligament (MCL), and posterolateral corner. Best evidence to date validates that conservative management of ACL ruptures is a reasonable strategy. Current data also seem to advocate nonoperative management of PCL injuries. All isolated MCL injuries, regardless of grade, are usually treated with a brief period of immobilization and symptomatic management. Although the surgical literature often advocates surgical treatment of posterolateral corner injuries, there have been no randomized trials substantiating that these injuries are best treated surgically...
June 2013: Primary Care
Joshua L Hudgens, Blake P Gillette, Aaron J Krych, Michael J Stuart, Jedediah H May, Bruce A Levy
Controversy exists as to the superior graft source for posterior cruciate ligament (PCL) reconstruction. Allogeneic and autogeneic tissue have unique advantages and disadvantages, but little is known about the performance of one versus the other. This study is an evidence-based, systematic literature review comparing clinical and functional outcomes of allograft and autograft PCL reconstruction. A search was conducted via the Cochrane and MEDLINE databases for all relevant studies meeting the following inclusion criteria: (1) English language, (2) human subjects, (3) between the years 1980 and 2011, (4) minimum 24-month follow-up, (5) measures of clinical and functional outcomes, and (6) patients with isolated grade II/III PCL injuries who had failed nonoperative management and were deemed clinically and functionally unstable...
April 2013: Journal of Knee Surgery
Mininder S Kocher, Brett Shore, Adam Y Nasreddine, Benton E Heyworth
BACKGROUND: There is sparse literature regarding the outcomes of treatment for posterior cruciate ligament (PCL) injuries in pediatric and adolescent patients. PCL injuries are rare and are often treated conservatively. The purpose of this study was to review 2 separate cohorts of patients with pediatric and adolescent PCL injuries: those treated surgically with direct repair or ligament reconstruction and those managed nonoperatively. METHODS: Twenty-five patients 18 years or younger underwent treatment of 26 PCL injuries (1 bilateral) at a single institution between 1993 and 2009...
September 2012: Journal of Pediatric Orthopedics
Kyle S Jansson, Kerry E Costello, Luke O'Brien, Coen A Wijdicks, Robert F Laprade
PURPOSE: Currently there are many functional knee braces but very few designed to treat the posterior cruciate ligament (PCL). No PCL braces have been biomechanically validated to demonstrate that they provide stability with proper force distribution to the PCL-deficient knee. The purpose of this review was to evaluate the history and current state of PCL bracing and to identify areas where further progress is required to improve patient outcomes and treatment options. METHODS: A PubMed search was conducted with the terms "posterior cruciate ligament", "rehabilitation", "history", "knee", and "brace", and the relevant articles from 1967 to 2011 were analysed...
May 2013: Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA
Casey M Pierce, Luke O'Brien, Laurie Wohlt Griffin, Robert F Laprade
PURPOSE: Historically, the results of posterior cruciate ligament (PCL) reconstructions are not as favourable as anterior cruciate ligament (ACL) reconstructions, and it is well recognized that nonoperative treatment and postoperative rehabilitation for PCL injuries must be altered compared to those for ACL injuries. The purpose of this article was to review current peer-reviewed PCL rehabilitation programmes and to recommend a nonoperative and postoperative programme based on basic science and published outcomes studies...
May 2013: Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA
Kanu Goyal, Scott Tashman, Joon Ho Wang, Kang Li, Xudong Zhang, Christopher Harner
BACKGROUND: Most patients with isolated posterior cruciate ligament (PCL) injuries have minimal symptoms, and nonoperative treatment is recommended. However, over time, these patients can develop significant degenerative changes in their knees. Historically, PCL laxity is graded by nonweightbearing anteroposterior measuring techniques that do not reproduce the true, dynamic weightbearing conditions in the injured knee. The purpose of this study was to determine the patholaxity in patients with isolated PCL deficiency during functional weightbearing activities (running, walking, and stair ascent)...
April 2012: American Journal of Sports Medicine
Jin Hwan Ahn, Sang Hak Lee, Sang Hee Choi, Joon Ho Wang, Sung Won Jang
PURPOSE: The purpose of this study was to evaluate the clinical and magnetic resonance imaging (MRI) outcomes of nonoperative management of acute, isolated posterior cruciate ligament (PCL) injuries. METHODS: From February 2001 to January 2008, 49 consecutive patients with acute (<4 weeks), isolated PCL injuries underwent nonoperative treatment with cast immobilization and PCL braces. Of these patients, 38 who satisfied our inclusion criteria and could be followed up for a minimum of 24 months (median, 51 months) were enrolled in our study...
December 2011: Arthroscopy: the Journal of Arthroscopic & related Surgery
David R McAllister, Suleman M Hussain
Posterior cruciate ligament (PCL) injuries occur much less frequently than other ligament injuries of the knee such as anterior cruciate ligament injuries. There is general agreement for nonoperative treatment for lower grade injuries such as type I PCL injuries. However, for more severe injuries which may require surgery, there is no consensus on an optimal reconstruction method. Multiple arthroscopic and open techniques exist to reconstruct the PCL. Limited clinical outcomes data reveals good short-term clinical results with different reconstruction options...
December 2010: Sports Medicine and Arthroscopy Review
Emilio Lopez-Vidriero, David A Simon, Donald H Johnson
Compared with anterior cruciate ligament injuries, posterior cruciate ligament injuries are a rare event. The mechanisms are predictable and a thorough physical examination is mandatory to rule out or define combined injury patterns. Stress radiography and magnetic resonance imaging studies are very helpful adjuncts. Acute and chronic injuries require slightly different approaches. As our understanding of normal and pathologic knee joint kinematics develops, nonoperative rehabilitation goals and operative techniques continue to evolve...
December 2010: Sports Medicine and Arthroscopy Review
Patrick S Duffy, Ryan G Miyamoto
The medial collateral ligament (MCL) is the most frequently injured ligament in the knee, with mild-to-moderate tears often going unreported to physicians. Medial collateral ligament injuries can result from both contact and noncontact sporting activities. The mainstay of treatment is nonoperative; however, operative management of symptomatic grade II and grade III injuries is considered when laxity and instability persist. The timing of surgical repair in the setting of a multiligament knee injury remains an area of controversy among surgeons, with proponents of early reconstruction of the anterior and posterior cruciate ligaments and nonoperative management of the MCL versus proponents of delayed reconstruction following nonoperative treatment of the MCL...
June 2010: Physician and Sportsmedicine
David H Sohn, Sriram Balasubramanian, Constantine Demetropoulos, King Yang, Joseph Guettler, Kenneth A Jurist
Treatment of isolated posterior cruciate ligament (PCL) injuries is controversial. This is due in part to the discrepancy between clinical and biomechanical studies in the literature. Clinically, isolated PCL injuries are treated nonoperatively, and patients do well as long as they have adequate quadriceps function. Biomechanically, however, PCL injuries have been shown in cadavers to lead to altered kinematics and increased contact pressures. These studies, however, did not simulate weight-bearing muscle forces, which can compensate for the PCL deficiency...
May 2010: Orthopedics
Coen A Wijdicks, Chad J Griffith, Steinar Johansen, Lars Engebretsen, Robert F LaPrade
*The superficial medial collateral ligament and other medial knee stabilizers-i.e., the deep medial collateral ligament and the posterior oblique ligament-are the most commonly injured ligamentous structures of the knee. *The main structures of the medial aspect of the knee are the proximal and distal divisions of the superficial medial collateral ligament, the meniscofemoral and meniscotibial divisions of the deep medial collateral ligament, and the posterior oblique ligament. *Physical examination is the initial method of choice for the diagnosis of medial knee injuries through the application of a valgus load both at full knee extension and between 20 degrees and 30 degrees of knee flexion...
May 2010: Journal of Bone and Joint Surgery. American Volume
E A Morgan, R R Wroble
Posterior cruciate ligament (PCL) injuries are difficult to detect because patients rarely present with findings that suggest a severe ligament injury. The keys to diagnosis include learning the mechanism of injury and performing a posterior drawer test. A complete knee exam rules out associated injuries. Nonoperative treatment is indicated for low-grade, isolated PCL injuries, but patients should be monitored for any degenerative changes. Combined injuries, high-grade injuries, and avulsion fractures require surgery...
November 1997: Physician and Sportsmedicine
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