Posterior Cruciate Ligament Injury Differential Diagnoses

  • Author: Charles S Peterson, MD; Chief Editor: Craig C Young, MD   more...
 
Updated: Jan 12, 2010
 
 

Differential Diagnoses

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Contributor Information and Disclosures
Author

Charles S Peterson, MD  Consulting Staff, Arizona Sports Medicine Center; Instructor in Family Medicine, Mayo Clinic College of Medicine; Clinical Instructor, Midwestern University Medical School

Charles S Peterson, MD is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, and American Medical Society for Sports Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Thomas Agesen, MD  Assistant Clinical Professor, Department of Physical Medicine and Rehabilitation, UMDNJ, New Jersey Medical School; Consulting Staff, Mountainside Hospital, Summit Overlook Hospital

Thomas Agesen, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American College of Sports Medicine, and Physiatric Association of Spine, Sports and Occupational Rehabilitation

Disclosure: Nothing to disclose.

Janos P Ertl, MD  Assistant Professor, Department of Orthopedic Surgery, Indiana University School of Medicine; Chief of Orthopedic Surgery, Wishard Hospital

Janos P Ertl, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Association, Hungarian Medical Association of America, and Sierra Sacramento Valley Medical Society

Disclosure: Nothing to disclose.

Gyorgy Kovacs, MD  Consulting Surgeon, Department of Orthopedic Surgery, GOC Clinic

Disclosure: Nothing to disclose.

Specialty Editor Board

Gerard A Malanga, MD  Director of Pain Management, Overlook Hospital; Director of PM&R Sports Medicine Fellowship, Atlantic Health; Clinical Professor, Department of Physical Medicine and Rehabilitation, UMDNJ-New Jersey Medical School; Clinical Chief, Rehabilitation Medicine and Electrodiagnosis, St Michael's Medical Center; Fellow, American College of Sports Medicine

Gerard A Malanga, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Physical Medicine and Rehabilitation, American College of Sports Medicine, North American Spine Society, and Physiatric Association of Spine, Sports and Occupational Rehabilitation

Disclosure: Cephalon Honoraria Speaking and teaching; Endo Honoraria Speaking and teaching; Forest Labs Honoraria Speaking and teaching

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Russell D White, MD  Professor of Medicine, Department of Community and Family Medicine, University of Missouri-Kansas City School of Medicine, Truman Medical Center Lakewood

Disclosure: Nothing to disclose.

Jon B Whitehurst, MD  Clinical Instructor of Surgery, University of Illinois College of Medicine; Partner and Executive Board Member, Rockford Orthopedic Associates; Orthopedic Chairman, Rockford Memorial Hospital

Jon B Whitehurst, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America

Disclosure: Nothing to disclose.

Chief Editor

Craig C Young, MD  Professor, Departments of Orthopedic Surgery and Community and Family Medicine, Medical Director of Sports Medicine, Sports Medicine Fellowship Director, Medical College of Wisconsin

Craig C Young, MD is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Medical Society for Sports Medicine, and Phi Beta Kappa

Disclosure: Nothing to disclose.

References

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A normal lateral radiograph of a knee. In a normal knee, a line drawn along the posterior femoral condyle will not intersect the posterior tibial condyle.
A lateral radiograph of a knee with a posterior cruciate ligament injury. Note that the same line as in the above image will bisect the posterior tibial condyle due to a posterior sag and an incompetent posterior cruciate ligament.
The posterior tibial sag sign. The photo on the left demonstrates the clinical finding of the posterior tibial sag sign. A line drawn parallel to the patella accentuates the posterior tibial sag. The photo on the right demonstrates the quadriceps active drawer test described by Daniels. With the knee in 70-90° of flexion, the extensor mechanism is contracted, pulling the tibia anteriorly into a reduced position.
A close-up view of a posterior tibial sag with an incompetent posterior cruciate ligament.
This MRI of the knee shows a torn posterior cruciate ligament.
This MRI (coronal section) shows a posterior cruciate ligament tear.
This transverse MRI shows edema to the torn posterior cruciate ligament.
A view of the broad origin of the posterior cruciate ligament (PCL) on the medial femoral condyle of a left knee. The anterior cruciate ligament has been removed for surgical reconstruction.
An additional view of the posterior cruciate ligament broad origin and insertion in a knee pending anterior cruciate ligament reconstruction.
A right knee pending posterior cruciate ligament (PCL) reconstruction. A minimal notchplasty is completed. Two guide pins are advanced into the medial femoral condyle for tunnel placement to reconstruct the 2 bundles of the PCL.
The 2 tunnels are created by reaming from outside in; 8- to 9-mm tunnels are made depending on patient size and the graft that will be used.
Two red Robinson catheters are advanced through the femoral tunnels.
The catheters have premade holes, which are used for suture retrieval.
The catheters are advanced and threaded out the posterior knee. In this case, a posterior tibial onlay graft from an Achilles tendon allograft is used. The 2 bundles are secured to the catheters and advanced into the joint through the tunnels.
The 2 Achilles tendon bundles are secured with a baseball whipstitch, are threaded through the catheter holes, and are advanced into the femoral condyle tunnels.
Additional view of the placement and advancement of the Achilles allograft.
Completion and seating of the femoral allograft reconstruction. The 2 bundles are secured or stabilized by suturing over a post and washer. Note the reestablishment of the broad surface area for the reconstructed posterior cruciate ligament origin.
Completion of the tibial onlay, 2-bundle Achilles tendon allograft/posterior cruciate ligament (PCL) reconstruction. The bony calcaneus remnant is secured to the posterior tibia with 1 or 2 interfragmentary compression screws into a trough into the posterior tibia at the level of the PCL insertion. Care is taken to not penetrate the anterior tibial cortex with these screws. Note the intact original anterior cruciate ligament.
 
 
 
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