Posterior cruciate ligament injury: Diagnosis, treatments and rehabilitation strategies / 中国组织工程研究

BACKGROUND: With the increasing cases of posterior cruciate ligament injury, there are endless protocols for diagnosing and treating posterior cruciate ligament injury. However, there are few reviews of the integrity of posterior cruciate ligament. OBJECTIVE: To complete a comprehensive review of posterior cruciate ligament injury in terms of anatomy, clinical manifestations, auxiliary examination, treatment methods and rehabilitation strategies. METHODS: The PubMed, Ovid, CKNI, and WanFang databases were retrieved using the key words of “posterior cruciate ligament, PCL, anatom*, diagnos*, treatments, surger*, rehabilitation.” A total of 223 articles were searched. After removal of repetitive and ineligible literature, 65 articles were included for review. RESULTS AND CONCLUSION: Missed diagnosis and misdiagnosis of posterior cruciate ligament injury certainly exist. Posterior cruciate ligament injuries are mostly caused by traffic injuries and sports injuries, and are accompanied by other structural injuries to a certain degree. A full understanding of patient’s medical history, accurate physical examination methods, and sophisticated auxiliary examinations can help to correctly identify injuries to the posterior cruciate ligament and the surrounding structures, so as to formulate a reasonable diagnosis and treatment protocol. Research suggests that patients with posterior cruciate ligament injury should be subjected to reconstruction of the posterior cruciate ligament as soon as possible to reduce the risk of further degeneration. At present, there are still large disagreements on the diagnosis, treatment methods, and rehabilitation strategies of posterior cruciate ligament injury. So, a large number of rigorous randomized controlled trials are urgently needed to select the most suitable diagnosis and treatment methods.

Repair and Kennedy LAD Augmentation to Posterior Cruciate Ligament Injury / 대한정형외과학회잡지

The significance of the posterior cruciate ligament (PCL) in the stability of the knee and the necessity for surgical repair of its tears are still controversial. The purpose of this study is to present the short term results of surgical repair and Kennedy LAD augmentation for 15 cases with PCL injury. In 14 patients (15 knees), the torn PCL was repaired with pullout suture technique and Kennedy LAD augmentation was done from june 1993 to june 1994. The follow-up period ranged from 12 months to 25 months (average, 18months). The main causes of injuries were traffic accidents in 12. Thirteen of the patients were men and one was a woman, ranging in age from 17 to 52 years(average, 35 years). 10 knees were acute injury and repaired at average 9 days after injury. There were 11 cases that had combined injuries(4 ACL injuries, 4 meniscus injuries, 3 MCL injuries etc). In eight knees, the tear was in mid substance area and in five it was near femoral attach site and in two it was near tibial attach site. Postoperative results were evaluated by roentgenographic evaluation of posterior sagging and Lysholm knee score. 11 knee were stable but 4 knees were unstable posteriorly during postoperative follow-up period. 3 chronic injuried knees were included in 4 posteriorly unstable knees. There are 7 combined knee injuries in 11 stable knees and no combined injuries in unstable knees and average Lysholm knee score was 89.7 in stable knees and 90 in unstable knees and there was no significant difference between two groups. On the based of this study, surgical repair with pollout suture technique and augmentation with Kennedy LAD in acute PCL injury is a one of the good method for preventing posterior sagging but more longer follow-up period and more cases must be needed to accept this method.

The Prevention of Posterior Displacement of Tibia During Treatment of Posterior Cruciate Ligament Injury Using Modified Quengel Hinge / 대한정형외과학회잡지

In the treatment of posterior cruciate ligament injury, posterior displacerrient of tibia might be occured because of the direction of gravity due to weight of lower leg. To prevent this problem several methods have been introduced, but not settled yet. Therfore the author tried to solve this problem by applying Quengel brace that was firstly described by Mommsen in 1922 and perfected by Jordan using the correction of flexion contracture of the knee in hemophiliacs. But owing to the development of some problems in original hinge for prevention of posterior displacement of tibia after posterior cruciate ligament injury, we modified the design of the hinge that more effective anterior traction force should be operated on tibia. The authors applied Quengel brace including original and modified hinge to 21 cases of posterior cruciate ligament injury between June 1983 and May 1986. The followings were obtained. 1. By modification of the hinge, more effective anterior traction force operated on tibia without pressure sore or joint narrowing. 2. On clinical application of modified Quengel brace, posterior displacement of tibia were prevented effectively.

Surgical Treatment of Posterior Cruciate Ligament Injury / 대한정형외과학회잡지

It is generally accepted that integrity of the posterior cruciate ligament plays a major role in knee stability. The potential disability resulting from disruption of the posterior cruciate ligament is sufficient to warrant aggressive operative management when the lesion is discovered. From August 1980 to July 1982, the authors treated the 8 cases of the posterior cruciate ligament injury at the department of orthopedic surgery, Chung Ang university hospital; primary repair(2 cases), reconstruction using the medial head of the gastrocnemius muscle(6 cases). In the operative procedure of reconstruction using gastrocnemius, we experienced the following obstacle and resolved it effectively. l. In the surgical approach, we choosed the separate incision on the anteromedial and posteromedial aspect of knee and satisfactory results were obtained. 2. In adequate length of the gastrocnemius tendon was resolved by releasing of gastrocnemius as closer to it's femoral condyle origin as possible or together with attached periosteum and bone chips, by fixation of gastrocnemius with pull through wire suture method. 3. In advancement of the gastrocnemius into the knee joint, we used No. 32 chest tube and achieved the smooth enterance. 4. Adequate position of the femoral condyle drill hole was achieved by using hip screw reamer and K-wire.