Evolving evidence in the treatment of primary and recurrent posterior cruciate ligament injuries, part 1: anatomy, biome
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Evolving evidence in the treatment of primary and recurrent posterior cruciate ligament injuries, part 1: anatomy, biomechanics and diagnostics Philipp W. Winkler1,2 · Bálint Zsidai3 · Nyaluma N. Wagala2 · Jonathan D. Hughes2 · Alexandra Horvath4 · Eric Hamrin Senorski5 · Kristian Samuelsson3,6 · Volker Musahl2 Received: 16 September 2020 / Accepted: 26 October 2020 © The Author(s) 2020
Abstract The posterior cruciate ligament (PCL) represents an intra-articular structure composed of two distinct bundles. Considering the anterior and posterior meniscofemoral ligaments, a total of four ligamentous fibre bundles of the posterior knee complex act synergistically to restrain posterior and rotatory tibial loads. Injury mechanisms associated with high-energy trauma and accompanying injury patterns may complicate the diagnostic evaluation and accuracy. Therefore, a thorough and systematic diagnostic workup is necessary to assess the severity of the PCL injury and to initiate an appropriate treatment approach. Since structural damage to the PCL occurs in more than one third of trauma patients experiencing acute knee injury with hemarthrosis, background knowledge for management of PCL injuries is important. In Part 1 of the evidence-based update on management of primary and recurrent PCL injuries, the anatomical, biomechanical, and diagnostic principles are presented. This paper aims to convey the anatomical and biomechanical knowledge needed for accurate diagnosis to facilitate subsequent decision-making in the treatment of PCL injuries. Level of evidence V. Keywords Posterior cruciate ligament · PCL · Revision · Knee · Anatomy · Biomechanics · Posterior stress radiograph · Diagnostic workup
* Philipp W. Winkler [email protected] 1
Department for Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
2
Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, 3200 S. Water St, Pittsburgh, PA 15203, USA
3
Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden
4
Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
5
Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
6
Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
Abbreviations ACL Anterior cruciate ligament ALB Anterolateral bundle AP Anterior–posterior DB Double bundle ICC Intraclass correlation coefficients IKDC International Knee Documentation Committee MCL Medial collateral ligament MFL Meniscofemoral ligaments MRI Magnetic resonance imaging PCL Posterior cruciate ligament PCL-R Posterior cruciate ligament reconstruction PLC Posterolateral corner PMB Posteromedial bundle PMC Posteromedial corner PTT Posterior tibial t
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