Physical Medicine and Rehabilitation for Posterior Cruciate Ligament Injury

Physical Medicine and Rehabilitation for Posterior Cruciate Ligament Injury

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The posterior cruciate ligament (PCL) courses from the posterior intercondylar area of the tibia to the medial condyle of the femur. It gives dynamic stability to the knee by preventing posterior displacement of the tibia on the femur. The PCL is an extrasynovial structure composed of a large anterolateral portion and a small posteromedial portion.

The PCL resists 85-100% of posteriorly directed forces at 30º and 90º of knee flexion. The 2 bands of the PCL, the anterolateral band and the posteromedial band, have different tension patterns. The anterolateral band is under great tension during knee flexion, whereas the posteromedial band is under more tension during knee extension.

Related Medscape Reference topics:

MRI for Posterior Cruciate Ligament Injuries

Posterior Cruciate Ligament Injury [Sports Medicine]

Posterior Cruciate Ligament Pathology

Related Medscape resource:

Resource Center Joint Disorders

Posterior cruciate ligament (PCL) injuries are usually the result of a direct blow to the anterior part of the tibia, with a hyperextension moment at the knee. Biomechanical studies have shown an increase in PCL force with knee flexion and the application of internal tibial torque, while other studies have shown that PCL-deficient knees have greater external tibial rotation. Several mechanisms have been implicated in PCL injury, including the following [1] :

Posterior translation of the proximal tibia

Dashboard injuries in motor vehicle accidents (the most common mechanisms)

Falling on a flexed knee (the most common injury in sports, particularly in wrestling and football)

Forced hyperflexion of the knee joint

A posterior force applied against a hyperextended knee with the foot fixed

Forced hyperextension of the knee

United States

There is a variable incidence of posterior cruciate ligament (PCL) injuries in the US population. In a retrospective study by Schulz and colleagues, 33% of the injuries were sports related. [1] As many as 20% of all knee ligament injuries consisted of PCL trauma.

International

International data about posterior cruciate ligament (PCL) injuries are limited. In Germany, approximately 8-10% of all severe ligament injuries involve the PCL, which means that annually, 4000-5000 members of the German population suffer a PCL rupture.

Chronic posterior cruciate ligament (PCL) deficiency can cause or predispose individuals to these pathologies: (1) medial compartment osteoarthritis of the knee, (2) increased risk for meniscal injury, and (3) patellofemoral osteoarthritis. [2]

In Schulz’s study, the mean age at which posterior cruciate ligament (PCL) injury occurred was 27.5 years ± 9.9 years. [1]

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Jawad Bhatti, MD Consulting Staff, Departments of Internal Medicine and Physical Medicine and Rehabilitation and Pain Management, Catahoula Parish District Hospital

Jawad Bhatti, MD is a member of the following medical societies: American Academy of Pain Medicine, American Academy of Physical Medicine and Rehabilitation, American College of Physicians-American Society of Internal Medicine

Disclosure: Nothing to disclose.

Stephen Kishner, MD, MHA Professor of Clinical Medicine, Physical Medicine and Rehabilitation Residency Program Director, Louisiana State University School of Medicine in New Orleans

Stephen Kishner, MD, MHA is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine

Disclosure: Nothing to disclose.

Mahmoud Sarmini, MD Assistant Professor, Department of Medicine, Section of Physical Medicine and Rehabilitation, Louisiana State University School of Medicine

Mahmoud Sarmini, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, International Society of Physical and Rehabilitation Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Patrick M Foye, MD Director of Coccyx Pain Center, Professor of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School; Co-Director of Musculoskeletal Fellowship, Co-Director of Back Pain Clinic, University Hospital

Patrick M Foye, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation

Disclosure: Nothing to disclose.

Consuelo T Lorenzo, MD Medical Director, Senior Products, Central North Region, Humana, Inc

Consuelo T Lorenzo, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation

Disclosure: Nothing to disclose.

Curtis W Slipman, MD Director, University of Pennsylvania Spine Center; Associate Professor, Department of Physical Medicine and Rehabilitation, University of Pennsylvania Medical Center

Curtis W Slipman, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, Association of Academic Physiatrists, International Association for the Study of Pain, North American Spine Society

Disclosure: Nothing to disclose.

Physical Medicine and Rehabilitation for Posterior Cruciate Ligament Injury

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