Revista de Medicina Desportiva (English) May 2018 | Page 29

SPAT
Sociedade Portuguesa de
Artroscopia e Traumatologia
Desportiva
Rev. Medicina Desportiva informa, 2018; 9(3):27-31
Isolated Posterior Cruciate
Ligament Injury
Dr. Francisco Requicha 1 , Dr. Marino Machado 1 , Dr. Diogo Chorão Constantino 1 , Dr. João Pedro Jorge 1 ,
Dr. Luís Branco Amaral 2
1
Resident physician of orthopedics and traumatology; 2 Head of service and director of the
musculoskeletal department of Central Lisbon Hospital Center. Lisbon.
ABSTRACT
The posterior cruciate ligament is a primary restraint to posterior tibial translation. It has a complex
anatomy, histology and geometry which gives it unique functions difficult to reproduce. The natural
history of the rupture remains unclear but, due to instability, important functional impairment and
early progression to arthritis may develop. The interest of the scientific community has grown in the
past decades. Although there are no level I published studies, algorithms have been developed to
help guide professionals in their decisions. This article describes the current concepts and controver-
sies of the injury, based on a revision of the available literature.
KEYWORDS
Posterior cruciate ligament, instability, reconstruction
Introduction
The posterior cruciate ligament
(PCL) acts in synergy with other knee
structures to ensure the normal
biomechanics and kinematics of this
articulation.
The studies described good results
with the initial methods of treat-
ment of this injury. 1,2 However, more
recent revision work has shown the
opposite. 1-6 The theme has been in
particular analysis in recent decades
and new concepts and methods of
evaluation and treatment have been
instituted. Several works on the indi-
cations have been published, timing
and kind of the treatment to be
instituted. It is important to analyze
the state of art in order to make the
best decisions.
the tibia, heading towards the central
pivot and eventually inserting itself
into the lateral face of the medial
femoral condyle. 7-12 It is composed of
two beams: one antero-lateral (AL)
and another posterior-medial (PM).
Initially it was thought that AL was
the main beam, however, studies have
shown that there is a co-dominance
relationship between the two. 14-17 Part
of the ligament has synovial cover
that gives it good vascularity and
consequent greater healing potential
than the anterior cruciate ligament
(ACL). 5,18 Its innervation is mostly
done by the tibial nerve. 19 Histo-
logically, its fibers have a complex
geometry and mechanoreceptors that
create unique properties in response
to stimuli and proprioceptive control.
Biomechanics
It is the primary stabilizer of the
posterior translation of the tibia
and the evidence in biomechanical
models suggests that the magnitude
of the instability is correlated with
the magnitude of the injury. 6,7,20
It also has a secondary role in the
control of rotation between the
0-120° flexion and resistance to
varus or valgus stress, although the
main stabilizers are the structures
of the posterolateral corner (PLC)
and posterolateral-medial (PMC). 21,22
When the lateral and medial sta-
bilizer structures are injured, ACL
Anatomy
The PCL has an oblique path from a
depression on the posterior side of
Figure 1 – Relationship between the posterior and anterior cruciate and collateral ligaments 60
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