PCL rupture Flashcards
hx
28 yr old F, 3 wks after injuring knee, fell onto flexed knee, felt a pop, unable to play on, v swollen immediately, difficulty descending stairs, feels knee will give way
look
antalgic gait
effusion
affected leg sags posteriorly when examined from side with knees flexed
feel
patellar tap test for effusion
active and passive ROM
decreased ROM knee due to swelling in early stages
special tests
cruciate ligament test [post drawer positive, ant drawer, lachmanns neg, pivot test]
medial and lateral collateral ligaments [valgus and various tests]
meniscus exam [McMurrays test too painful to do]
DDx
PCL rupture
ACL rupture
Cartilage/ meniscus injury
why is PCL rupture likely?
unstable knee with positive post drawers test
why is ACL rupture unlikely?
post ant drawers/ pivot shift/ lachmanns
why is cartilage/ meniscal injury unlikely?
no symptoms of locking = cartilage injury
investigations
xray
MRI
Xray
outrule fracture
lateral xray = sag
MRI
Gold standard, high sensitivity and specificity for dx of PCL ruptures
Non-op tx
RICE
analgesia
physio strengthen quads
Don Joy brace
op tx
if ongoing instability, do PCL reconstruction
