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Objective To evaluate the effect of newly designed arthroscopic reconstruction of posterior cruciate ligament (PCL) using tibial tendon bolt. Methods The effects of embedded tendon pin were observed by X‐ray of knee joint. From October 2010 to September 2015, 51 PCL injury patients who met the inclusion criteria were enrolled in this retrospective study. The arthroscopically assisted reconstruction of the PCL with tibial tendon bolt was performed on all patients. Visual Analog Scale (VAS) pain score, Tegner activity score, Lysholm score, International Knee Documentation Committee (IKDC) assessment, posterior drawer test (PDT), and KT‐1000 activity score were evaluated preoperatively and at 1‐year postoperative and 3‐year postoperative. Results The preoperative, 1‐year postoperative, and 3‐year postoperative IKDC score (15.8% ± 14.8%, 89.6% ± 5.8%, and 86.8% ± 5.4%), Lysholm score (17.4 ± 10.7, 91.2 ± 2.8, and 88.2 ± 3.1), VAS score (5.8 ± 1.2, 1.3 ± 0.5, and 0.6 ± 0.5), Tegner activity score (1.2 ± 0.8, 8.1 ± 0.8, and 7.4 ± 0.8), and KT‐1000 score (15.6 ± 3.6, 4.5 ± 2.4, and 5.4 ± 1.8) were obtained. There were significant differences in these outcomes among preoperative, 1‐year postoperative, and 3‐year postoperative (all P, The application of tendon pin fixed by tibial inlay “8” shape tibial tunnel to reconstruct PCL was an effective, simple and safe surgical procedure for PCL injury.

Background To demonstrate and compare results obtained with the transtibial double-bundle posterior cruciate ligament (PCL) reconstruction technique using two types of autografts in isolated and combined PCL lesions. Methods Fifty-two patients with isolated or combined PCL injuries underwent double-bundle PCL reconstruction and were retrospectively evaluated. Among them, 34 were reconstructed using ipsilateral quadriceps and semitendinosus tendon grafts, and 18 were reconstructed using bilateral hamstring tendon grafts. The criteria for outcome evaluation were: objective International Knee Documentation Committee (IKDC) score, Lysholm score, posterior stability (posterior drawer test and KT-1000TM), and rate of complications, comparing the two types of grafts and comparing isolated PCL and combined lesions. The minimum follow-up was two years. Results Significant improvements were found in all evaluation methods between the pre- and postoperative periods (all P .05). The whole sample had the following results: objective IKDC score, 96.2% classified as A/B; Lysholm score, 98.1% rated as good or excellent; and KT-1000, 98.1% with a side-to-side difference of up to five millimeters (65.4% with 0 to two millimeters). The complication rate was 9.6%, with no differences between the graft type that was used (P = .585). No significant difference was observed when comparing the results between isolated PCL injuries and combined injuries (all P > .05). Conclusions The proposed PCL reconstruction technique presented satisfactory results in both isolated and combined PCL lesions, and there were no differences between different types of autografts used. Level of evidence Level III.

Quadriceps active (QA) test has been described and well known for the diagnosis of posterior cruciate ligament (PCL) deficiency. We describe a modification of the QA test to diagnose PCL deficiency. Pushed QA test consists of two components where the examiner pushes the proximal tibia posteriorly with the knee flexed

T2 mapping assesses tissue ultrastructure and composition, yet the association of imaging features and tissue functionality is oftentimes unclear. This study aimed to elucidate this association for the posterior cruciate ligament (PCL) across the micro- and macroscale and as a function of loading. Ten human cadaveric knee joints were imaged using a clinical 3.0T scanner and high-resolution morphologic and T2 mapping sequences. Emulating the posterior drawer test, the joints were imaged in the unloaded (δ0) and loaded (δ1) configurations. For the entire PCL, its subregions, and its osseous insertion sites, loading-induced changes were parameterized as summary statistics and texture variables, i.e., entropy, homogeneity, contrast, and variance. Histology confirmed structural integrity. Statistical analysis was based on parametric and non-parametric tests. Mean PCL length (37.8 ± 1.8 mm [δ0]; 44.0 ± 1.6 mm [δ1] [p < 0.01]), mean T2 (35.5 ± 2.0 ms [δ0]; 37.9 ± 1.3 ms [δ1] [p = 0.01]), and mean contrast values (4.0 ± 0.6 [δ0]; 4.9 ± 0.9 [δ1] [p = 0.01]) increased significantly under loading. Other texture features or ligamentous, osseous, and meniscal structures remained unaltered. Beyond providing normative T2 values across various scales and configurations, this study suggests that ligaments can be imaged morphologically and functionally based on joint loading and advanced MRI acquisition and post-processing techniques to assess ligament integrity and functionality in variable diagnostic contexts.

T2 mapping assesses tissue ultrastructure and composition, yet the association of imaging features and tissue functionality is oftentimes unclear. This study aimed to elucidate this association for the posterior cruciate ligament (PCL) across the micro- and macroscale and as a function of loading. Ten human cadaveric knee joints were imaged using a clinical 3.0T scanner and high-resolution morphologic and T2 mapping sequences. Emulating the posterior drawer test, the joints were imaged in the unloaded (δ0) and loaded (δ1) configurations. For the entire PCL, its subregions, and its osseous insertion sites, loading-induced changes were parameterized as summary statistics and texture variables, i.e., entropy, homogeneity, contrast, and variance. Histology confirmed structural integrity. Statistical analysis was based on parametric and non-parametric tests. Mean PCL length (37.8 ± 1.8 mm [δ0]; 44.0 ± 1.6 mm [δ1] [p < 0.01]), mean T2 (35.5 ± 2.0 ms [δ0]; 37.9 ± 1.3 ms [δ1] [p = 0.01]), and mean contrast values (4.0 ± 0.6 [δ0]; 4.9 ± 0.9 [δ1] [p = 0.01]) increased significantly under loading. Other texture features or ligamentous, osseous, and meniscal structures remained unaltered. Beyond providing normative T2 values across various scales and configurations, this study suggests that ligaments can be imaged morphologically and functionally based on joint loading and advanced MRI acquisition and post-processing techniques to assess ligament integrity and functionality in variable diagnostic contexts.

A 21-year-old man presented with left knee pain and instability that persisted three months after a road traffic accident. Physical examination revealed a positive posterior drawer test. Anterior drawer and pivot tests were negative. Magnetic resonance imaging of the knee demonstrated a complete tear of the posterior cruciate ligament (PCL). Recognition of the normal and injured appearances of the PCL is useful to aid the reader in the detection and characterisation of PCL injuries. Isolated acute PCL tears are usually managed conservatively. However, an active search for associated injuries is essential, as their presence may upstage the patients for surgical management.

Background: Posterior Cruciate Ligament (PCL) is the main posterior stabilizer of the knee. Injuries of the PCL are rare. Isolated PCL disruption most commonly occurs as avulsion at its tibial insertion as compared with its femoral origin or as a mid-substance tear. In PCL bony avulsion, fixation of the avulsed fragment with cancellous screw is a recommended procedure. Objective: To evaluate efficacy of Burk Schaffer’s approach in treatment of PCL tibial avulsion fracture with cancellous screw and evaluation of functional results according to Tegner Lysholm score. Material and Methods: We included 30 patients (Male 26 and Female 4) operated for isolated PCL avulsion from tibia during the period from 2015 to 2017. Patients were evaluated clinically by posterior drawer test, radiologically by X-ray and using functional scale of Tegner-Lysholm. MRI was advised for suspected other ligaments and meniscal injuries. All cases were operated with 4mm cannulated screw fixation by Burk and Schaffer approach. Results: Mean Tegner Lysholm score of 30 patients was 95.37 after 6 months of surgery, which was excellent. After 3 months 75% has grade 0 posterior drawer test, 12.5% has grade 1 and 12.5% has grade 2 laxity. Conclusion: Approach by Burk and Schaffer is safer and easier than the classical one. Open reduction and fixation with cannulated screw for tibial avulsion of PCL gives good functional outcome.

Introduction Posterior Cruciate Ligament (PCL) avulsion may mimics PCL rupture with positive posterior drawer test. Treatment of choice to PCL avulsion is vary from open surgery to arthroscopic surgery. PCL reconstruction with augmentation is a rare procedure to be performed in treating PCL avulsion case. This case reported and suggested an augmentation procedure in PCL avulsion case. This study aims is to evaluate the knee functional score using augmented PCL reconstruction on PCL avulsion using peroneus longus tendon. Presentation of case We report 3 cases, 1 male and 2 females. The result of physical examination, X-ray examination, and MRI of the knee showed a PCL avulsion. Posterior drawer test showed grade 2 result. We performed an augmented PCL reconstruction on PCL avulsion using peroneus longus tendon. Knee scoring (IKDC, Modified Cincinnati, Tegner-Lysholm) collected pre-operative and 2 years post-operative. The result of knee scoring was significant improved in post-operative compare to before surgery. Conclusion Augmented PCL reconstruction can be considered to be an alternative treatment of PCL avulsion because the procedure has excellent post-operative knee scoring result.

Background. PCL reconstruction is a successful method for enhancing the patient's quality of life but posterior knee laxity and knee stiffness have still occurred surgery. There is no study to evaluate knee laxity or loss of knee range of motion after surgery. Objectives. To assess the outcomes after PCL reconstruction, we: 1) evaluated the range of motion of the knee, 2) evaluated posterior knee laxity, and 3) determined the factors that influence laxity or the loss of range of motion after surgery. Methods. Articles that met the following criteria were enrolled in this review: 1) articles on peer-reviewed level 1 to 4 studies; 2) articles published in English; 3) articles on PCL reconstruction studies; 4) articles on isolated PCL rupture; 5) articles that describe laxity after surgery and 6) articles that describe the degree of range of motion after surgery. Results. Involving a total of 1711 patients. There was a loss of extension and flexion after PCL reconstruction (9.15% and 28.9%, respectively). Knee laxity was still observed at the final examination in the posterior drawer test, KT 1000/2000 test, and Telos radiographic view (64.8%, 42.8%, and 47.9%, respectively). In the subgroup analysis, there was no significant difference in laxity between allograft group vs autograft group using the KT 1000/2000 measurement (mean difference [MD] = -0.42, 95% confidence interval [-1.41, 0.56], p = 0.40), Single Bundle vs Double Bundle (DB) using the KT 1000/2000 measurement (MD = -0.003, 95% CI [-1.35, 1.29], p < 0.00001), and transtibial vs tibial inlay using the Telos radiograph measurement (MD = 0.03, 95% CI [-0.33, 0.39], p = 0.88), but DB significantly improved knee stability using the Telos radiographic measurement (MD = 0.69, 95% CI [0.29,1.09], p = 0.00008).Conclusion. This study demonstrates that the loss of range of motion or laxity is still a problem after PCL reconstruction.

Posterior Cruciate Ligament (PCL) avulsion may mimics PCL rupture with positive posterior drawer test. Treatment of choice to PCL avulsion is vary from open surgery to arthroscopic surgery. This study aims is to evaluate the knee functional score using augmented PCL reconstruction on PCL avulsion using peroneus longus tendon. Presentation of Case: We report 3 cases, 1 male and 2 females. The result of physical examination, X-ray examination, and MRI of the knee showed a PCL avulsion. Posterior drawer test showed grade 2 result. We performed an augmented PCL reconstruction on PCL avulsion using peroneus longus tendon. Knee scoring (IKDC, Modified Cincinnati, TegnerLysholm) collected pre-operative and 2 years post-operative. The result of knee scoring was significant improved in post-operative compare to before surgery. Discussions: The use of conventional screw on thin, small, and comminuted fragments cannot fix the bone and may causes bone fragmentation. Fixation technique using sutures produces unstable results and does not provide maximum pressure to fix the bone. Augmented PCL reconstruction surgery gives excellent result based on knee scoring system. Conclusion: Augmented PCL reconstruction can be considered to be an alternative treatment of PCL avulsion because the procedure has excellent post-operative knee scoring result.

Background: Tear of MCL of the knee is a frequent problem among knee ligaments injuries.Injuries to the MCL are usually caused by contact on the outside of the knee and are accompanied by sharp pain on the inside of the knee. Contrary to most other knee ligaments the medial collateral ligament (MCL) has an excellent ability to heal, being fairly large and well vascularised structure. The vast majority of isolated medial ligament injuries heal without significant long-term problems Objectives: is to compare between the early clinical examination, and assessment under general anesthesia (GA), and to find out the best methods to assess the MCL tear especially in suspected cases. Type of the study:Cross- sectional study. Methods: Fifty patients are collected from casualty & outpatient units from November/2014 to October/2016 with MCL injury in AL-Kindy teaching hospital.We decided to evaluate them under general anesthesia by valgus stress test at 30 degrees & 0 degrees to estimate the integrity of MCL, in addition to anterior &posterior Drawer test to evaluate anterior &posterior cruciate ligaments Results: : From the 50 patients we select, there were 21 patients seen in the examination to have MCL tear.1 of them were Grade I ( 4.8% ),14 of them were Grade II (66.7% ),&6 of them were Grade III (28.5%)Associated injuries with ACL injury were 5 patients, with PCL injury were 1 patient and with medial capsular injury were 2 patients. Follow up of case range from (2-10) weeks with an average of 6 weeks combined with physiotherapy programs. Conclusions: Diagnosis of MCL tear by valgus stress test under GA is the best method for the assessment of MCL tear in suspected cases.

To evaluate the clinical outcomes and graft maturation following posterior cruciate ligament reconstruction (PCLR) with preserved remnant and further analyze the correlated factors affecting graft maturation.Consecutive patients who underwent unilateral single-bundle PCLR with remnant preservation from January 2011 to October 2014 by the same senior doctor using tibialis anterior allografts and same surgical technique were included. At a follow-up of more than 2 years, range of motion (ROM) and posterior laxity assessed by posterior drawer test and the KT-1000 arthrometer were examined. Tegner, Lysholm, and International Knee Documentation Committee scores were evaluated. The graft maturation was assessed by a 3.0-T magnetic resonance imaging. Overall correlation analyses and multivariate regression analysis were performed to identify correlated factors of graft maturation, and then subgroups were divided and analyzed according to significant risk factor.Forty-three (84.3%) of 51 enrolled patients were successfully followed up (38.4 months, 24-54 months). All clinical scores improved significantly, and there were no complications. The results of KT-1000 difference revealed significant decline of posterior laxity (9.4 ± 1.5 vs 2.2 ± 1.5 mm; P.001). The MRI evaluation confirmed no ligament retears. Both correlation and regression analyses showed time from injury to surgery had a positive, statistically significant weak correlation with the signal intensity score (R = 0.38, P = .012; coefficient = 0.10; P = .036). Subgroup (group 1: time from injury to surgery3 months; group 2: 3-6 months; group 3: 6-12 months; group 4: ≥12 months) analysis showed there were no significant differences of clinical outcomes between subgroups, while MRI signal intensity was significantly lower in the group with shorter time from injury to surgery (P = .02).The remnant-preserved PCLR resulted in satisfactory clinical outcomes and graft maturation at a mean follow-up of 38.4 months. The time from injury to surgery showed a weak positive correlation with postoperative graft signal intensity on MRI.Level III, retrospective comparative study.

The authors present their experience with a posterior approach for fixation of posterior Cruciate ligament avulsion from the tibia. Avulsion usually occurs at the tibial insertion. The approach is easy, safe and demands no great technical prowess or instruments. Some minor modifications and technical tips for a safer exposure and a better fixation are highlighted. This is a reproducible method for achieving good stability in these avulsion fractures, where early intervention prevents significant late disability. A single 4-mm screw gives sufficient initial stabilization to allow supervised mobilization. A high index of suspicion should be maintained in all dashboard injuries presenting with femoral shaft fractures, especially when the patella is also fractured. The patients were objectively (posterior drawer test) and subjectively (Lysholm scale) reevaluated after a minimum follow up period of 12 post operative months.

BACKGROUND: Incidence of isolated posterior cruciate ligament (PCL) injury is lower than PCL rupture is associated with other knee injuries. Adjustable loop femoral cortical suspension device is commonly used for femoral graft fixation during PCL reconstruction. AIM: This study purpose is to describe the functional outcome of PCL reconstruction using an adjustable loop femoral cortical suspension device. METHODS: This study used prospective design with consecutive sampling. All patients underwent PCL reconstruction with adjustable loop femoral cortical suspension devices using peroneus longus tendon autograft. Patients were evaluated at 6 months after surgery using posterior drawer test and functional outcome scoring system (Lysholm knee score, Cincinnati Score and International Knee Documentation Committee (IKDC) score). RESULTS: 20 patients were enrolled in this study with a mean age of 27.65 ± 9.78. Lysholm knee means the score was improved from 59.80 ± 18.73 pre-operative and 80.55 ± 11.72 post-operative (p < 0.05). Cincinnati mean score was improved from 52.01 ± 20.29 pre-operative to 72.95 ± 15.26 post-operative (p < 0.05). IKDC mean score was improved from 48.36 ± 13.18 at pre-operative to 72.5 ± 13.13 post-operative (p < 0.05). CONCLUSION: PCL reconstruction using adjustable loop femoral cortical suspension device using peroneus longus tendon autograft showed good clinical outcome and knee functional outcome (Lysholm, Cincinnati, and IKDC score) at 6 months follow-up.

Posterior cruciate ligament (PCL) injuries are relatively common injuries associated with athletic activities and high-energy trauma. Posterolateral corner (PLC) injuries frequently accompany injury to the PCL. Diagnosis can be challenging and requires a comprehensive history and physical examination. Patients frequently report vague, nonspecific symptoms and the mechanism of injury is often useful in localizing injured structures. Two of the more common mechanisms for PCL injury include a direct blow to the proximal anterior tibia with the knee flexed, as well as a significant knee hyperextension injury. With a PCL tear, patients rarely describe an audible "pop" that is commonly reported in ACL injuries. On physical exam, a frequent finding in PCL tears is a loss of 10 to 20° of knee flexion. Although the most common clinical tests for PCL tears include the posterior drawer test, the posterior sag sign, and the quadriceps active test, there is a lack of high-quality diagnostic accuracy studies.Two cases of U.S. Military Academy Cadets who sustained PCL injuries while removing combat boots during military survival swim training are presented. The results of the clinical examination are accompanied by magnetic resonance imaging results and intraoperative arthroscopic images to highlight key findings.Both patients were evaluated and diagnosed with PCL injures within 10 days of their injuries. Each reported feeling/hearing a "pop," which is atypical in PCL tears. Both patients demonstrated a lack of active and passive knee flexion, which is a commonly reported impairment. One patient was managed nonsurgically with physical therapy and eventually returned to full duty without limitations 9 months after his injury. The other patient, who sustained a combined PCL-PLC injury, underwent a PCL reconstruction and PLC repair and reconstruction 8 weeks after his injury. He returned all training, with the exception of contact/collision sports, 9 months after surgery. Both patient's rehabilitation programs consisted of a progression of exercises to improve range of motion, muscle strength/endurance, motor control, and muscular power.Military and sports medicine professionals should be aware of the potential for PCL injury with this unusual, and previously unreported, mechanism of injury during survival swim training. Prompt diagnosis and appropriate treatment is essential to prevent long-term disability.

Anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) are two major ligaments that stabilize the knee. Injuries can occur to these ligaments by both contact and noncontact mechanisms. An injury to the ACL may present with a “popping” noise, pain and swelling, and an unsteady knee. An injury to the PCL most often presents as pain with swelling that leads to a stiff knee. Clinical diagnosis of an ACL tear can be made by the anterior drawer test or Lachman’s test and for a PCL tear by the posterior drawer test. Both diagnoses can be confirmed by an MRI scan. Conservative management consists of rest, bracing, and therapy. In addition, surgical repair may be pursued for those interested.

Background there is need to ascertain clinical and imaging outcomes after posterior cruciate ligament (PCL) augmentation. Methods we performed a retrospective analysis of clinical, imaging and functional data on 21 physically active males who underwent arthroscopic trans-tibial augmentation of the PCL for symptomatic grade III PCL insufficiency. The average follow-up time was 50 months (24-60 months). The Lysholm knee score was administered to all the patients, ligament laxity was evaluated with the posterior drawer test, the KT-1000 arthrometer, and the anteromedial tibial step-off. Standing antero-posterior, lateral and Merchant's view radiographs were taken preoperatively and at annual follow-up. Results post-operatively, ligament laxity and Lysholm knee scores were significantly improved than at baseline. Sixteen patients (73%) returned to pre-injury sport activity level, 3 patients (14%) returned to a lower level, 2 had to stop. We found radiographic degenerative changes in 5 of 22 affected knees (23%), with evidence of a statistically significant association between the occurrence of degenerative changes and the interval time from injury to surgery and duration of the follow up. Conclusions arthroscopic transtibial single bundle autograft hamstring augmentation significantly improves the function of the knee, with an overall satisfactory outcome of 82% at 2-5 years from surgery.

Background: Avulsion fractures of tibial insertion of the posterior cruciate ligament are rare among the knee injuries. Purpose of this study is to determine the functional outcome of arthroscopic reattachment of tibial avulsion of the Posterior cruciate ligament by ABS button (Arthrex) and tight rope.Methods: 15 Patients with PCL avulsion fracture were included. The Inclusion criteria were: 1) Displaced avulsion fractures (type-2 and type-3). They were followed at regular intervals using IKDC score, Lysholm score and subjective questionnaire.Results: All cases showed complete osseous union during follow up. All knees are stable on examination by posterior sag sign and posterior drawer test. Two patients had loss of about 100 flexion. According to the IKDC form assessment 13 patients classified as normal and 2 were classified as near normal.Conclusions: Arthroscopic reattachment of tibial avulsion fractures of the posterior cruciate ligament using ABS button and tightrope gives fairly good clinical outcomes.

Purpose In this study, we compared femoral tunnel pairs that differ by group in a double-bundle Achilles tendon allograft posterior cruciate ligament (PCL) reconstruction. Methods Group 1 patients had femoral tunnels drilled nearly within the footprint area most proximal and most distal to the axis of the femur. Group 2 patients had femoral tunnels drilled eccentrically within the footprint along an axis nearly perpendicular to the axis of the femur. Patient assessments were made subjectively with preoperative and postoperative assessments of Lysholm rating scale, posterior drawer test, and dial test. Objective assessments used range of motion and quadriceps circumference. Group 1 contained 7 patients with a mean age of 32 years (range, 20 to 46 years). Group 2 contained 10 patients with a mean age of 32 years (range, 20 to 46 years). Results Group 2 patients had significantly less posterior laxity than group 1 patients. Postoperatively, 6 patients in group 1 (86%) had a positive posterior drawer test compared with 3 in group 2 (30%). Rotational laxity was identified by dial test results postoperatively in 3 patients in group 1 (43%) compared with 0% in group 2. Extension deficit occurred in 2 patients in group 1 (29%) and 1 patient in group 2 (10%). Flexion deficit occurred more than twice as frequently in group 1 (71% [5 patients]) than in group 2 (30% [3 patients]). There were no statistically significant differences for other comparisons. Conclusions The clinical outcomes support the group 2 method with femoral tunnel placement at the anterior-most and posterior-most portions of the femoral PCL insertion. The group 2 procedure described in this study incorporates advanced principles for successful outcomes with Achilles double-bundle PCL reconstruction. Level of Evidence Level III, case-control study.

Partial posterior cruciate ligament (PCL) injuries often occur in athletes; however, limited information is available about the laxity of knees with different degrees of PCL injury. In this study, a three-dimensional finite element model of the human tibiofemoral joint with articular cartilage layers, menisci and four main ligaments was constructed to investigate the changes in the knee laxity for different PCL injuries. The simulation of PCL injury (slight, medium, severe, and rupture) was simplified by reducing the elastic modulus (25%, 50%, 75%, and 100%) of the intact PCL. A posterior tibial force (100 N, 200 N) was applied to the knee joint at 0 °, 30°, 60°, and 90° of flexion. The boundary conditions included constraining all degrees of freedom at the top surface of the femur and assuming non-constraint on the bottom of the tibia except for flexion-extension motion. Under 100 N and 200 N forces applied to the tibia at full extension in the intact PCL model, the maximum posterior tibial translations in the lateral compartment were 3.60 mm and 4.53 mm, coupled with tibial external rotation of 2.60° and 2.64°, respectively. The posterior tibial translation and tibial external rotation increase gradually with increasing knee flexion. The laxity responses of slight and medium PCL injury models were not noticeably different from those of the intact PCL model. In the severe PCL injury model, the external tibial rotation was noticeably decreased at 100 N, and was changed to internal rotation at 200 N. The PCL rupture caused obviously greater posterior tibial translation (6.77 mm and 9.68 mm under 100 N and 200 N drawer force, respectively) in the medial tibia, which, coupled with internal tibial rotation (‐3.00° and ‐4.56° under 100 N and 200 N drawer force, respectively) at full extension. The posterior translation of the medial tibia and tibial internal rotation increased with increasing knee flexion. According to our study, the posterior drawer test does not necessarily indicate the existence of an isolated PCL injury, especially in partial cases. Furthermore, the magnitude of the loading affects the performance of mechanics in knees with PCL injuries, and internal tibial rotation is an important indication a knee with a PCL injury.

The posterior drawer test is an accurate clinical test to diagnose posterior cruciate ligament (PCL), indicating laxity of the PCL that allows posterior tibial translation. This study aimed to determine whether posterior tibial translation relative to the femur on routine MRI could serve as an additional sign of PCL tear. Routine knee MRI in eleven patients (7 males, 4 females) with arthroscopically confirmed isolated PCL tears were reviewed independently by two musculoskeletal radiologists. Measurements of tibial translation were made in the medial and lateral compartments of patients and controls (10 males, 12 females) without clinical or MRI evidence of ligament injury. Significant medial compartment posterior tibial translation was present in patients with PCL tear compared to controls (+2.93 mm versus +0.03 mm,P=0.002) with excellent interobserver agreement (intraclass correlation coefficient (ICC) = 0.94). No significant difference in lateral compartment tibial translation was observed (+0.17 mm versus −0.57 mm,P=0.366) despite excellent interobserver agreement (ICC = 0.96). Posterior tibial translation in the midmedial compartment may be a secondary sign of isolated PCL tear on routine knee MRI with passive extension without manipulation or weight bearing. Additional work in a larger cohort may better address the accuracy of this finding.

Controversy regarding whether to reconstruct posterior cruciate ligament (PCL)-deficient knees and if so, how best to accomplish this task, continues. The PCL originates on the medial femoral condyle as 2 separate bundles and inserts on the posterior tibia below the joint line. Its key function is to prevent posterior translation of the leg in flexion. Diagnosis is best confirmed with history (blow to anterior tibia), physical examination (posterior drawer test), and imaging (stress radiographs and magnetic resonance imaging). Associated posterolateral injuries must be recognized (external rotation asymmetry). Nonoperative management has been associated with late patellofemoral and medial femoral condylar arthrosis. When operative intervention is elected, we prefer the tibial inlay technique to avoid problems associated with the killer turn seen with standard arthroscopic techniques. The tibial inlay procedure is described and illustrated in this article. Postoperative management (early prone motion), complications, and preliminary results are also discussed. We are encouraged with our early results with this technique and hope to report these in the peer-reviewed literature in the near future.

We reviewed the clinical examinations and knee arthrometry evaluations of 40 patients: 10 with posterior cruciate ligament injuries, 10 with combination anterior and posterior cruciate ligament injuries, 10 with anterior cruciate ligament injuries alone, and 10 with no history of knee injury. Using a 3-mm side-to-side difference as the minimal limit for detection of posterior cruciate ligament injury, the sensitivity of the arthrometer at 40 pounds of posterior force was 90%, the specificity was 100%, the predictive value of a positive test was 100%, and the predictive value of a negative test was 91%. When total anterior-posterior translation was assessed, the sensitivity was 100%, the specificity was 85%, the predictive value of a positive test was 87%, and the predictive value of a negative test was 100%. The overall accuracy of arthrometry for detection of posterior cruciate ligament injury was 96% for 40 pounds of posterior force and 94% for total anterior-posterior translation at 40 pounds. Grade 1 posterior cruciate ligament injuries had significantly greater arthrometric posterior translation compared with grade 0 (normal) knees. Regression analysis showed arthrometric laxity measurements correlated well with the clinical grade of the posterior drawer test. Finally, the accuracy of the arthrometer was not affected by concomitant anterior cruciate ligament injury.

Posterior cruciate ligament (PCL) injuries are difficult to detect because patients rarely present with findings that suggest a severe ligament injury. The keys to diagnosis include learning the mechanism of injury and performing a posterior drawer test. A complete knee exam rules out associated injuries. Nonoperative treatment is indicated for low-grade, isolated PCL injuries, but patients should be monitored for any degenerative changes. Combined injuries, high-grade injuries, and avulsion fractures require surgery. Rehabilitation goals for all PCL injuries include regaining full range of motion and quadriceps strength.

In order to justify the diagnostic criteria for the cruciate ligament injury of the knee joint, a series of 44 Chinese patients were enrolled for retrospective analysis. There were 15 anterior cruciate ligament (ACL) and 29 posterior cruciate ligament (PCL) injuries. In addition, 80 normal volunteer subjects were recruited for the control group. Preoperatively, all the patients underwent the KT-1000 and Genucom analyses (except for 6 PCL patients without the Genucom test) of the injured and uninjured knees. Similarly, all the control subjects underwent the same assessments. In the ACL deficient group, the between-knee displacement difference in the anterior drawer test at knee flexion of 30° was 5.2 ± 3.9 mm with KT 1000, and 3.5 ± 2.1 mm with Genucom. The between knee difference of quadriceps active displacement and manual maximum displacement in KT-1000 were 4.4 ± 3.3 mm and 4.8 ± 2.3 mm, respectively. In the PCL deficient group, the between-knee displacement difference via posterior drawer test at knee flexion of 70° was 8.2 ± 3.9 mm with KT-1000, while with Genucom at knee flexion of 90°, the displacement difference was 4.6 ± 4.8 mm. Meanwhile, the quadriceps active displacement in KT-1000 was 4.9 ± 2.2 mm at knee flexion of 90°. All of the ACL deficient patients exhibited a more than 2 mm between knee difference in the manual maximum test. Among the PCL deficient knees, 97% of them in the corrected posterior drawer test and 89% in the quadriceps active displacement, exhibited a greater than 3 mm between knee difference. A significant side-to-side difference existed between the injured patient and control normal subjects (p < 0.001). The findings indicated that the between-knee difference of more than 3 mm in the corrected posterior drawer test is highly suggestive of a PCL injury; while a 2 mm in manual maximum displacement implied the existence of ACL insufficiency. These results could be useful in substantiating the clinical screening judgement of cruciate ligamentous injury of knee joints, in addition to the history and physical examinations.

In many medical fields, the result of operation or diagnosis depends on a doctor's empirical value. As you know, doctor's medical experiences vary appreciably from person to person and it causes health disparities. To eliminate health disparities from our society, the author has been developing some medical devices using mechatronics to improvement the accuracy and quantitative reliability of medical treatments like operation or diagnosis. In this paper, the author introduced two medical devices. The first device is arm-holding manipulator “EXPERT” which aims to reduce the surgeon fatigue and realize intuitive operation support in microscopic neurosurgery. The developed system was successfully used in 9 clinical cases at Shinshu University School of Medicine, STA-MCA anastomosis, meningioma removals, and aneurysmal clipping treatments. The second device is orthopaedic physical examination assisting system that aims to improve accuracy and reproducibility of knee laxity diagnosis. The examination result of posterior drawer test with the developed system showed that the examination accuracy was significantly improved in all evaluation parameters.

Posterior cruciate ligament (PCL) injuries associated with multiple ligament injuries can be easily diagnosed, but isolated PCL tears are less symptomatic, very difficult to diagnose, and frequently misdiagnosed. If a detailed investigation of the history of illness suggests a PCL injury, careful physical examinations including the posterior drawer test, dial test, varus and valgus test should be done especially if the patient complains of severe posterior knee pain in >90° of flexion. Vascular assessment and treatment should be done to avoid critical complications. An individualized treatment plan should be established after consideration of the type of tear, time after injury, associated collateral ligament injuries, bony alignment, and status of remnant. The rehabilitation should be carried out slower than that after anterior cruciate ligament reconstruction.

In brief Posterior cruciate ligament (PCL) injuries typically occur during hyperflexion or with a blow to the knee during hyperextension. Physical findings such as a positive posterior drawer test or a posterior sag and standard x-rays are keys to expedient diagnosis. Acute isolated PCL injuries often are treated conservatively with strengthening and proprioceptive exercises. Chronic isolated PCL injuries and combined ligament injuries usually require surgical reconstruction.

Submitted by Guilherme Lemeszenski (guilherme@nead.unesp.br) on 2013-08-22T19:03:50Z No. of bitstreams: 1 S1413-78522007000500008.pdf: 556955 bytes, checksum: 237ab7b4729398c8e93d43076bc6b9fe (MD5) Made available in DSpace on 2013-08-22T19:03:50Z (GMT). No. of bitstreams: 1 S1413-78522007000500008.pdf: 556955 bytes, checksum: 237ab7b4729398c8e93d43076bc6b9fe (MD5) Previous issue date: 2007-01-01 Made available in DSpace on 2013-09-30T20:06:10Z (GMT). No. of bitstreams: 2 S1413-78522007000500008.pdf: 556955 bytes, checksum: 237ab7b4729398c8e93d43076bc6b9fe (MD5) S1413-78522007000500008.pdf.txt: 18036 bytes, checksum: f9ab6790101113b68758ad8d1414a327 (MD5) Previous issue date: 2007-01-01 Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-20T15:16:55Z No. of bitstreams: 2 S1413-78522007000500008.pdf: 556955 bytes, checksum: 237ab7b4729398c8e93d43076bc6b9fe (MD5) S1413-78522007000500008.pdf.txt: 18036 bytes, checksum: f9ab6790101113b68758ad8d1414a327 (MD5) Made available in DSpace on 2014-05-20T15:16:55Z (GMT). No. of bitstreams: 2 S1413-78522007000500008.pdf: 556955 bytes, checksum: 237ab7b4729398c8e93d43076bc6b9fe (MD5) S1413-78522007000500008.pdf.txt: 18036 bytes, checksum: f9ab6790101113b68758ad8d1414a327 (MD5) Previous issue date: 2007-01-01 Avaliamos 21 pacientes, sendo 16 pacientes do sexo masculino e 5 do feminino, com idade média de 30 anos, foram submetidos à tratamento cirúrgico da fratura-avulsão do LCP. em 57% dos casos a lesão foi secundária a acidente motociclístico e 19% a acidente automobilístico. em 72% dos casos foi identificada uma lesão na face anterior do joelho. O tratamento cirúrgico consistiu na abordagem posterior do joelho e fixação do fragmento ósseo com parafuso e arruela em 18 casos; e amarrilhas trans-ósseas em 3 casos, onde o fragmento ósseo era muito pequeno. em 91% dos casos, a cirurgia foi realizada dentro dos primeiros 15 dias apos a lesão. Os pacientes foram avaliados objetivamente (teste de gaveta posterior) e subjetivamente (Escala de Lysholm), apos um seguimento pós-operatório mínimo de 12 meses. A análise estatística não mostrou diferença significativa, ao nível de 5%, entre as avaliações objetiva e subjetiva. A ausência de lesão ligamentar periférica pode ter contribuído para que os resultados clínicos pós-operatórios tenham avaliação subjetiva satisfatória; entretanto, a presença de uma posteriorização tibial residual sugere que a fratura-avulsão do ligamento cruzado posterior deve ser abordada não como uma lesão óssea pura, mas sim, como uma lesão ósteo-ligamentar. We assessed 21 patients (16 males and 5 females), with mean age of 30 years who underwent surgical treatment for PCL avulsion fracture. In 57% of the cases, injuries were secondary to motorcycle accidents and 19% resulted from car accidents. Injuries on knee's anterior surface were detected in 72% of the cases. The surgical procedure involved posterior approach and bone fragment fixation using nut and screw in 18 cases, the trans-bone suture loop fixation in 3 cases with small bone fragments. In 91% of the cases, surgery was performed within the first two weeks following injury. The patients were objectively (posterior drawer test) and subjectively (Lysholm scale) re-evaluated after a minimum follow-up period of 12 postoperative months. The statistical analysis of objective and subjective assessments did not demonstrate any significant difference (p = 0.05). The satisfactory results of the subjective clinical postoperative evaluation may have been due to the absence of peripheral ligament injury. However, the presence of residual tibial posteriorization suggests that the avulsion fracture of the PCL should be treated as bone-ligament injury, and not just as a bone lesion. Faculdade de Ciências Médicas Unesp-Botucatu Departamento de Bioestatística Unesp-Botucatu Departamento de Bioestatística

Submitted by Guilherme Lemeszenski (guilherme@nead.unesp.br) on 2013-08-22T19:03:48Z No. of bitstreams: 1 S1413-78522006000200007.pdf: 338288 bytes, checksum: 0222df1b77f749bb7615d607e9e8067b (MD5) Made available in DSpace on 2013-08-22T19:03:48Z (GMT). No. of bitstreams: 1 S1413-78522006000200007.pdf: 338288 bytes, checksum: 0222df1b77f749bb7615d607e9e8067b (MD5) Previous issue date: 2006-01-01 Made available in DSpace on 2013-09-30T20:06:08Z (GMT). No. of bitstreams: 2 S1413-78522006000200007.pdf: 338288 bytes, checksum: 0222df1b77f749bb7615d607e9e8067b (MD5) S1413-78522006000200007.pdf.txt: 20380 bytes, checksum: fbd15ad5ebd114784338b8e06fae4cdf (MD5) Previous issue date: 2006-01-01 Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-20T15:16:54Z No. of bitstreams: 2 S1413-78522006000200007.pdf: 338288 bytes, checksum: 0222df1b77f749bb7615d607e9e8067b (MD5) S1413-78522006000200007.pdf.txt: 20380 bytes, checksum: fbd15ad5ebd114784338b8e06fae4cdf (MD5) Made available in DSpace on 2014-05-20T15:16:54Z (GMT). No. of bitstreams: 2 S1413-78522006000200007.pdf: 338288 bytes, checksum: 0222df1b77f749bb7615d607e9e8067b (MD5) S1413-78522006000200007.pdf.txt: 20380 bytes, checksum: fbd15ad5ebd114784338b8e06fae4cdf (MD5) Previous issue date: 2006-01-01 A reconstrução cirúrgica do ligamento cruzado posterior (L.C.P.) do joelho ainda permanece como um grande desafio terapêutico. Neste trabalho avaliamos 30 pacientes submetidos à reconstrução cirúrgica do L.C.P. com a técnica de fixação do enxerto tendíneo no leito tibial por abordagem direta (INLAY). 28 pacientes eram do sexo masculino e 2 do feminino, com idade média de 31,10 anos. O tempo médio de lesão foi de 34,24 meses em 67% dos casos a lesão foi secundária a acidente motociclístico. As lesões condrais e do ligamento cruzado anterior (L.C.A.) do joelho estavam presentes em 67% e 33% dos casos, respectivamente. Os pacientes foram avaliados objetivamente (teste de gaveta posterior) e subjetivamente (Escala de Lysholm). O seguimento pós-operatório médio foi de 21,7 meses. Cerca de 66% dos casos foram classificados como bom e excelente na avaliação subjetiva e objetiva. A análise estatística apresentou comportamento semelhante para as duas avaliações.Os resultados clínicos pós-operatórios obtidos neste trabalho têm nos encorajado a seguir com esta técnica cirúrgica. Surgical reconstruction of the knee posterior cruciate ligament (P.C.L.) still remains as a major therapeutic challenge. In this paper, we assessed 30 patients submitted to surgical reconstruction of the P.C.L. with a technique of tendinous graft fixation on tibial bed by direct approach (INLAY). Twentyeight male patients and 2 female patients, with mean age of 31.10 years, participated on the study. The average injury time was 34.24 months. In 67% of the cases, injury was secondary to motorcycle accidents. Chondral injuries and knee anterior cruciate ligament (ACL) injuries were present in 67% and 33% of the cases, respectively. Patients were assessed objectively (posterior drawer test) and subjectively (Lysholm's Scale). Mean post-operative follow-up time was 21.7 months. About 66% of the cases were rated as good and excellent at the subjective and objective evaluation. The statistical analysis showed a similar behavior for both evaluations. Post-operative clinical outcomes achieved in this study have encouraged us to keep using this surgical technique. Unicamp Faculdade de Ciências Médicas UNICAMP HC DOT Unesp-Botucatu Departamento de Bioestatística Unesp-Botucatu Departamento de Bioestatística

Purpose: The objective of this study was to evaluate the efficacy of different stress radiography techniques in quantifying a posterior cruciate ligament (PCL) lesion. Type of Study: Prospective serial study. Methods: Sixty patients with subacute or chronic PCL injuries, confirmed using magnetic resonance imaging (MRI) or arthroscopic evaluation, were enrolled in this study. The patients underwent a KT-2000 (Medmetric, San Diego, CA) examination and a series of stress radiographs that included a radiographic posterior drawer test with Telos (Telos, Weterstadt, Germany) at 90° and 25° of knee flexion, an active radiograph at 90° of knee flexion, and an axial view radiograph. Results: Stress radiography performed with Telos showed an average posterior tibial displacement of 11.54 ± 4.93 mm and 7.97 ± 3.16 mm at 90° and 25°, respectively. The active radiographs showed an average posterior tibial displacement of 11.48 ± 5.14 mm. Conclusions: Stress radiographs were shown to be superior to arthrometric evaluation in quantifying posterior tibial translation. The techniques performed with the knee at 90° of knee flexion allowed for greater posterior tibial displacement and, consequently, an easier quantification of the degree of ligament insufficiency. Stress radiographs performed through hamstring contraction gave the same results as those performed with Telos at 90° of knee flexion.

Conservative treatment is currently recommended for most isolated posterior cruciate ligament (PCL) injuries in athletes. However, it is not known whether conservative treatment is applicable even in high performance athletes with isolated PCL injury. The results in two extremely high performance athletes, professional baseball players with isolated acute PCL injury treated conservatively are reported. A catcher and an out fielder, who were regular players, hurt their knees in baseball games. Magnetic resonance images of the knee detected complete PCL rupture. Following a carefully guided physical therapy program, a 3-week period of immobilization of the knee in full extension was achieved with a knee brace, while performing hard quadriceps muscle strengthening exercise, and then running exercise was started. Six to eight weeks after injury, they were able to return fully to their original sporting activity despite tibial posterior translation on posterior drawer test, and to sustain this activity over 2 years. Switching of weight-bearing to non-weight-bearing in a deep knee flexion is considered to contribute to subjective instability in athletes with PCL-deficiency. Probably because our cases, even though extremely high performance athletes were infrequently subjected to such a situation while playing baseball, they were able to return to their pre-injury level of athletic performance without severe subjective instability through conservative treatment.

One hundred and fifty asymptomatic shoulders in 75 schoolchildren were studied. The shoulders were tested for instability and a hyperextensometer was used to assess joint laxity. Signs of instability were found in 57% of the shoulders in boys and 48% in girls; the commonest sign was a positive posterior drawer test which was found in 63 shoulders. A positive sulcus sign was found in 17 shoulders and 17 subjects had signs of multidirectional instability. General joint laxity was not a feature of subjects whose shoulders had positive instability signs.

Purpose : This report introduces a new method for tensioning the remnant PCL with a reconstruction of the anterolateral (AL) bundle of the PCL using a modified tibial inlay technique with an assessment of the outcome of this method in chronic PCL injury. Materials and Methods : From January 1998 to August 2003, eighty six patients was underwent tensioning of a laxed remnant PCL with a reconstruction of the anterolateral bundle of the PCL. Of these, fifty two patients who were followed up for more than 2 years were evaluated. Tensioning was performed using a distal transfer of the tibial attachment with the posteromedial approach in the supine position. The AL bundle of the PCL was reconstructed with 4 bundles of a hamstring autograft or tibialis anterior tendon allograft. The stability was assessed objectively using stress radiographs with the Telos® device and the maximal manual test with the KT-1000 arthrometer. The clinical results were assessed by the IKDC (International Knee Documentation Committee) and OAK (Orthopadische Arbeitsgruppe Knie) scores. The posterior drawer test, varus stress test, posterolateral drawer test and dial test in 30˚ and 90˚ flexion were performed for a physical examination. Results : The average side to side difference of the posterior tibial translation in stress radiographs with the Telos® device decreased from 10.4±2.0 mm to 2.2±1.0 mm. The average side to side difference in the maximal manual test with the KT-1000 arthrometer also decreased from 8.2±1.5 mm to 1.9±1.0 mm. The final IKDC score was A in eleven (21.2%), B in thirty-five (67.3%) and C in six (11.5%) patients. The average OAK score improved from 64.3±8.9 to 90.8±7.2. Conclusion : Tensioning of the laxed remnant PCL with a reconstruction of the AL bundle in chronic PCL injuries showed good clinical results and excellent posterior stability.

The posterior cruciate ligament, situated near the center of the knee, functions as the basic stabilizer and is located close to the axis of motion. We diagnosed and repaired thirty-two consecutive acute tears of the posterior cruciate ligament associated with tears of medial or lateral-compartment ligaments, or of both. Of the twenty-nine knees that we could evaluate, twenty-three demonstrated a 2+ to 3+ positive abduction or adduction stress test done in maximum extension and a positive anterior drawer test done in maximum internal rotation, while only nine had a definitely positive posterior drawer test. In all knees we repaired the tears, using the medial meniscus as a graft in nine knees in which the repair of the posterior cruciate ligament did not produce immediate adequate stability at operation. Five to sixteen years after operation, twenty of these twenty-nine knees were available for evaluation. The objective results were good in thirteen, fair in four, and poor in three.

Over a 10 year period, 24 of 54 acute PCL tears in cases of straight medial instability demonstrated an absent or an equivocal posterior drawer test. Most of these (22, 91.6%) were contact injuries, and in the 11 cases where the mechanism of injury was known (45.8%), were incurred by a blow to the outer aspect of the leg while the foot was planted. The ACL was normal in 6 of the 24 knees. The abduction stress test at 0° extension was severely positive (2+ or more) in 21 of the 24 knees (87.5%). The phenomenon of an absent or equivocal posterior drawer test in the situation of acute straight medial instability is felt to occur when the mechanism of injury does not stress, strain, or tear the arcuate complex. If the PCL tear is not discovered and repaired, repeated stressful activity stretches the arcuate complex, and the chronically unstable knee subsequently presents with a positive posterior drawer test.

T2 mapping assesses tissue ultrastructure and composition, yet the association of imaging features and tissue functionality is oftentimes unclear. This study aimed to elucidate this association for the posterior cruciate ligament (PCL) across the micro- and macroscale and as a function of loading. Ten human cadaveric knee joints were imaged using a clinical 3.0T scanner and high-resolution morphologic and T2 mapping sequences. Emulating the posterior drawer test, the joints were imaged in the unloaded (δ0) and loaded (δ1) configurations. For the entire PCL, its subregions, and its osseous insertion sites, loading-induced changes were parameterized as summary statistics and texture variables, i.e., entropy, homogeneity, contrast, and variance. Histology confirmed structural integrity. Statistical analysis was based on parametric and non-parametric tests. Mean PCL length (37.8 ± 1.8 mm [δ0]; 44.0 ± 1.6 mm [δ1] [p < 0.01]), mean T2 (35.5 ± 2.0 ms [δ0]; 37.9 ± 1.3 ms [δ1] [p = 0.01]), and mean contrast values (4.0 ± 0.6 [δ0]; 4.9 ± 0.9 [δ1] [p = 0.01]) increased significantly under loading. Other texture features or ligamentous, osseous, and meniscal structures remained unaltered. Beyond providing normative T2 values across various scales and configurations, this study suggests that ligaments can be imaged morphologically and functionally based on joint loading and advanced MRI acquisition and post-processing techniques to assess ligament integrity and functionality in variable diagnostic contexts.