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Posterior cruciate ligament conservative treatment

João Luiz Ellera Gomes, Murilo Anderson Leie, Arthur de Freitas Soares, Márcio Balbinotti Ferrari, George Sánchez
The loss of knee extension, even if minimal, is disabling and considerably affects the individual's quality of life. This loss of extension can be a consequence of prior surgery, including a previous anterior cruciate ligament reconstruction. Although this loss of extension may be treated through an isolated arthroscopic procedure, a more severe case may warrant an invasive approach. In these cases, a posterior capsulotomy of the knee may be done if all conservative measures have been exhausted. This procedure has been proven to be safe and effective in the re-establishment of full extension in the setting of a minor flexion contracture of the knee...
October 2017: Arthroscopy Techniques
R S Khakha, S K Yasen, A J Wilson
BACKGROUND: Paediatric PCL injuries are rare but constitute a significant management challenge. We describe a novel approach to the surgical management of an 11-year-old boy who presented with persisting symptomatic instability following 18months of failed conservative therapy. METHODS: PCL reconstruction was performed using a physeal sparing, all-inside technique under fluoroscopic control. This avoids the potential for iatrogenic growth injury. A parentally donated hamstrings allograft was used to ensure adequate graft size, and reinforced using a non-elastic two millimetre braided suture...
January 14, 2018: Knee
Trevor J Carver, John B Schrock, Matthew J Kraeutler, Eric C McCarty
BACKGROUND: Previous studies have analyzed the treatment patterns used to manage injuries in National Collegiate Athletic Association (NCAA) Division I football players. HYPOTHESIS: Treatment patterns used to manage injuries in NCAA Division I football players will have changed over the study period. STUDY DESIGN: Descriptive epidemiology study. LEVEL OF EVIDENCE: Level 5. METHODS: The head orthopaedic team physicians for all 128 NCAA Division I football teams were asked to complete a survey containing questions regarding experience as team physician, medical coverage of the team, reimbursement issues, and treatment preferences for some of the most common injuries occurring in football players...
January 1, 2018: Sports Health
Yasukazu Yonetani, Yoshio Matsui, Yoshinari Tanaka, Shuji Horibe
Background: The posterior cruciate ligament (PCL) is a primary stabilizer of the knee in the posterior direction. However, PCL deficiency presents a clinical paradox because the outcome of PCL deficiency ranges from total disability to uninterrupted participation in competitive athletics. Purpose: To investigate whether posterior laxity (PL) and the flexion gap (FG) influence the results of the conservative treatment of isolated PCL injuries. Study Design: Case-control study; Level of evidence, 3...
November 2017: Orthopaedic Journal of Sports Medicine
Yannick Hurni, Vincenzo De Rosa, Jorge Gabriel Gonzalez, Mario Mendoza-Sagaon, Flurim Hamitaga, Giorgia Pellanda
Background  Posterior cruciate ligament (PCL) avulsion fracture of the tibial insertion is a very rare injury in children. In addition to performing an attentive clinical examination, radiologic studies are fundamental for its correct diagnosis and treatment. Its management may be either conservative or operative. So far, only a few cases treated conservatively have been reported in the pediatric population, with controversial results. Methods  We prospectively collected and reviewed clinical and radiographic data of an 11-year-old boy with avulsion fracture of the tibial insertion of the PCL...
July 2017: Surgery Journal
Eui-Chan Jang, Han-Jun Lee, Seong Hwan Kim, Yoon-Ho Kwak
Calcific periarthritis in the distal femur is a rare condition. Forty two year old Asian male visited to the outpatient clinic of orthopedic department with acute excruciating knee pain. The arthroscopic posterior cruciate ligament (PCL) reconstruction was performed 20 years ago with the bonepatellar tendon-bone (BPTB) autograft combined with Trevira (polyethylene terephthalate) artificial ligament. Severe tenderness was noted incidentally over the medial epicondyle area of the distal femur which the cancellous screw was inserted for PCL reconstruction, without any preceding trauma history or medial joint line tenderness due to degenerative change...
December 2017: Acta Orthopaedica et Traumatologica Turcica
K F Schüttler, E Ziring, S Ruchholtz, T Efe
Posterior cruciate ligament (PCL) injuries are still often overlooked and treatment of a ruptured PCL is inherently different in comparison to anterior cruciate ligaments (ACL). Conservative treatment is the first-line therapy for acute isolated PCL injuries leading to good clinical and biomechanical results. Injuries to the PCL combined with rupture of other stabilizing ligaments, such as the collateral ligaments or the posterolateral corner of the knee joint are treated surgically. The same is true for high grade chronic PCL insufficiency...
January 2017: Der Unfallchirurg
John J Elias, Neil T Soehnlen, Loredana M Guseila, Andrew J Cosgarea
BACKGROUND: The current study was performed to correlate anatomical parameters related to trochlear dysplasia, tibial tuberosity position, and patella alta with in vivo patellar tracking for subjects with recurrent patellar instability. METHODS: Eight subjects with recurrent patellar instability that failed conservative treatment were evaluated using computational reconstruction of in vivo knee motion. Computational models were created from dynamic CT scans of the knee during extension against gravity...
June 2016: Knee
Dhananjaya Sabat, Atul Jain, Vinod Kumar
PURPOSE: To retrospectively compare the clinical outcomes of displaced tibial-side posterior cruciate ligament (PCL) avulsion fractures treated with open reduction and screw fixation versus arthroscopic suture fixation. METHODS: From 2005 to 2013, all displaced PCL tibial-side avulsion fractures treated surgically-initially by an open posterior approach and later by arthroscopic-assisted suture fixation-were retrospectively reviewed. The cases with radiographic evidence of greater than 3 mm of displacement and/or grade II or III laxity on the posterior drawer test were included in the study group...
January 2016: Arthroscopy: the Journal of Arthroscopic & related Surgery
Fengyu Pan, Shan Hua, Zhuang Ma
BACKGROUND: The treatment of anterior cruciate ligament (ACL) rupture complicated with posterior lateral meniscus root (PLMR) tears remains controversial. The goal of this study was to evaluate clinical outcomes of PLMR tear refixation versus left untreated at the time of reconstruction. MATERIAL/METHODS: From August 2001 to January 2012, 31 patients who undergone repair of PLMR tears were evaluated and compared with a matched control group with untreated PLMR tears...
May 11, 2015: Medical Science Monitor: International Medical Journal of Experimental and Clinical Research
Ewa Kaminska, Tomasz Piontek, Marzena Wiernicka, Grazyna Cywinska-Wasilewska, Jacek Lewandowski, Dawid Lochynski
CONTEXT: The extent of knee extensor and flexor weakness after disruption of knee ligaments affects a rehabilitation output and functional recovery and may give prognostic information on a possible risk of development of knee osteoarthritis. OBJECTIVE: The hypothesis tested was whether patients with a multiple-ligament tear would have larger abnormalities in strength of the knee extensors and flexors than patients with an isolated-ligament rupture. DESIGN: Cross-sectional study, level III...
August 2015: Journal of Sport Rehabilitation
Naoya Orita, Masataka Deie, Noboru Shimada, Daisuke Iwaki, Makoto Asaeda, Kazuhiko Hirata, Mitsuo Ochi
PURPOSE: Most individuals with an isolated posterior cruciate ligament (PCL) injury do not complain of disability even if posterior instability is objectively revealed by a static physical examination, such as the posterior drawer test. This suggests it is insufficient to only evaluate posterior instability under static conditions. Therefore, we have investigated the effect of isolated PCL injury on the detailed kinematics of the knee in a dynamic environment such as during gait. METHODS: Eight unilateral PCL-deficient males and eight healthy control volunteers participated in this study...
November 2015: Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA
Rodrigo Salim, Fabricio Fogagnolo, Mauricio Kfuri
The integrity of posterior cruciate ligament (PCL) is essential for the normal kinematics of the knee. Injury to the PCL has adverse consequences, with worsening of functional performance and an increased risk to develop osteoarthritis. Conservative treatment is sometimes adopted, not only because it is an acceptable option for selected patients but also due to the lack of consensus in the orthopedic literature regarding the best surgical method. Hereby we describe a simplified technique for onlay PCL reconstruction pointing out possible advantages if compared with the traditional transtibial or inlay techniques...
August 2014: Journal of Knee Surgery
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
Wangdo Kim, Antonio P Veloso, Veronica E Vleck, Carlos Andrade, Sean S Kohles
BACKGROUND: Ligaments and cartilage contact contribute to the mechanical constraints in the knee joints. However, the precise influence of these structural components on joint movement, especially when the joint constraints are computed using inverse dynamics solutions, is not clear. METHODS: We present a mechanical characterization of the connections between the infinitesimal twist of the tibia and the femur due to restraining forces in the specific tissue components that are engaged and responsible for such motion...
March 2013: Journal of the American Podiatric Medical Association
Eric A White, Dakshesh B Patel, George R Matcuk, Deborah M Forrester, Ryan B Lundquist, George F Rick Hatch, C Thomas Vangsness, Christopher J Gottsegen
Injury to the ACL or PCL of the knee most commonly involves a tear of the collagenous fibers of the ligament. Less frequently, a cruciate ligament injury involves an avulsion fracture at the origin or insertion of the ligament, usually from the insertion site on the tibial surface. Avulsion fractures of the cruciate ligaments are important, as they can be identified on radiographs, allowing a specific diagnosis. Although more common in children, when they occur in adults, they are more commonly associated with other injuries...
October 2013: Emergency Radiology
Long-Jun Zhang, Jian-Liang Chen, Yong Xu, Shao-Bing Zhu
OBJECTIVE: To study the application of stress X-ray of knee joint for the diagnosis ot medial collateral ligament injury. METHODS: From January 2008 to June 2011, 46 patients with medial collateral ligament injury were reviewed. Among the patients, 32 patients were male and 14 patients were female, ranging in age from 28 to 72 years, with an average of (49.46 +/- 22.54) years. Left knee joint injuries occurred in 22 patients, and 24 patients had injuries in right knee joint...
November 2012: Zhongguo Gu Shang, China Journal of Orthopaedics and Traumatology
Matthew Fernandez, David Pugh
OBJECTIVE: The purpose of this case report is to describe the evaluation and conservative management of an isolated posterior cruciate ligament (PCL) tear. CLINICAL FEATURES: A 32-year-old man with a traumatic right knee injury after tripping was initially diagnosed with medial patellar retinaculum tear at a multidisciplinary clinic. The patient received physiotherapy but reinjured the knee after returning to the sports field 3 weeks later. Subsequent clinical testing and magnetic resonance imaging confirmed a grade II isolated PCL tear...
June 2012: Journal of Chiropractic Medicine
Michael D Rosenthal, Charles E Rainey, Angela Tognoni, Robert Worms
BACKGROUND: Posterior cruciate ligament injuries are increasingly recognized, the result of various sports activities, and while most athletes return to sports the development degenerative joint changes is common. OBJECTIVE: To provide a synopsis of the current best evidence regarding the recognition and treatment of posterior cruciate ligament injuries. DESIGN: Structured narrative review. METHODS: Keyword search of Medline, CINAHL, and PEDro databases for studies published in English from January 1975 to July 2011...
November 2012: Physical Therapy in Sport
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
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