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 Revista de Medicina Desportiva informa may 2018 · 27