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Management of Posterior Cruciate Ligament Injuries: An Evidence-Based Review

Bedi, Asheesh MD; Musahl, Volker MD; Cowan, James B. MD

JAAOS - Journal of the American Academy of Orthopaedic Surgeons: May 2016 - Volume 24 - Issue 5 - p 277–289
doi: 10.5435/JAAOS-D-14-00326
Review Article
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Isolated injuries of the posterior cruciate ligament are uncommon, are often caused by a posteriorly directed force to the proximal tibia, and result in abnormal knee kinematics and function. A thorough clinical evaluation, including history, physical examination, and imaging, is required to rule out a concomitant structural knee injury. No clear prognostic factors predict outcomes, and ideal management remains uncertain. Nonsurgical management is advocated for isolated grade I or II posterior cruciate ligament injuries or for grade III injuries in patients with mild symptoms or low activity demands. Surgical management is reserved for high-demand athletes or patients in whom nonsurgical management has been unsuccessful. Although biomechanical studies have identified differences between single-bundle, double-bundle, transtibial, and tibial inlay reconstruction techniques, the optimal surgical technique has not been established. No high-quality evidence is available regarding immobilization, weight-bearing, bracing, or rehabilitation protocols for patients treated either nonsurgically or surgically. Additional long-term clinical studies with homogeneous patient populations are needed to identify the ideal management of these injuries.

From the Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI (Dr. Bedi and Dr. Cowan), and the Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA (Dr. Musahl).

Dr. Bedi or an immediate family member serves as a paid consultant to Smith & Nephew; has stock or stock options held in A3 Surgical; and serves as a board member, owner, officer, or committee member of the American Orthopaedic Society for Sports Medicine. Dr. Musahl or an immediate family member serves as a board member, owner, officer, or committee member of the American Orthopaedic Society for Sports Medicine. Neither Dr. Cowan nor any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article.

Received September 22, 2014

Accepted April 19, 2015

© 2016 by American Academy of Orthopaedic Surgeons
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