PCL Injuries

Question 1

What are the most common causes of PCL injuries?

Answer 1

1) MVA; dashboard injury (45%)

2) Atheletics; hyperflexion with plantarflexed foot (40%)

Question 2

In the PCL deficient knee, where does DJD most commonly begin?

Answer 2

Medial and PF compartments

Question 3

What are common physical exam findings with a PCL tear?

Answer 3

1) Posterior drawer (most accurate)
2) Quadriceps active test; tibia reduces with quad contraction
3) Reverse pivot shift
4) Can be a part of combined injury with varus/valgus laxity at 0 degrees; or increased ER with dial test at 30 and 90 degrees

Question 4

What is becoming gold standard for diagnosing PCL tears?

Answer 4

Lateral stress view: flex knee to 70 degrees and apply posterior force; asymmetry btw knees indicates PCL disruption and difference of >12mm indicates associated PLC injury as well

Question 5

What is the primary treatment for PCL tears?

Answer 5

Quadriceps strengthening

Surgery for multi-ligametous knee injuries or bony avulsions with instability

Question 6

What is a surgical treatment that can address varus malignment and PCL deficiency in a PCL tear?

Answer 6

Opening wedge high tibial osteotomy
Increasing the tibial slope can help reduce posterior sag as well
PCL reconstruction is not option in varus malignment or if DJD has already set in

Question 7

What knee position is the PCL graft fixed in?

Answer 7

Single bundle: 90 degrees of flexion

Double bundle: anterolateral- 90 degrees flexion, posteromedial- extension

Question 8

What exercise should be avoided during PCL rehab?

Answer 8

Prone hamstring curls; pulls tibia posteriorly