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Posterior cruciate ligament tear

Dr Henry Knipe ◉ ◈ et al.

Posterior cruciate ligament (PCL) tears are less common than anterior cruciate ligament tears.

On this page:

Article:

Epidemiology
Clinical presentation
Pathology
Radiographic features
Treatment and prognosis
Differential diagnosis
Related articles
References

Images:

Cases and figures

Epidemiology

Posterior cruciate ligament tears account for ~10% (range 2-23%) of all knee injuries ².

Clinical presentation

Sports injuries and car accidents (dashboard injury) are equally responsible for these injuries ¹. Many patients will be asymptomatic and their clinical examination is unremarkable. However, some patients may have knee instability or posterior sag sign.

Pathology

Three mechanisms of injury have been proposed ²:

posterior tibial displacement in a flexed knee
hyperextension
rotation with an abduction or adduction force

Associations

PCL injuries are isolated in only 30% of cases and are thus commonly associated with other injuries ^1,2.4:

ligamentous injury (~40%)
meniscal tears
posterolateral corner injury ⁵
bone contusion (80%) or avulsion fracture (<10%)
knee joint effusion

Radiographic features

MRI

Features of posterior ligament tears include ^1,2:

PCL usually remains contiguous (~70%) although there may be complete or partial ligamentous disruption
- absent PCL replaced by high T1 and T2 signal
enlarged and swollen PCL: >7 mm AP diameter of the vertical portion on sagittal imaging is indicative of a tear

Treatment and prognosis

PCL tears may result in chronic instability and early degenerative change ².

Differential diagnosis

mucoid degeneration ³
meniscofemoral ligaments can mimic a PCL tear

References

Knee pathology

The knee is a complex synovial joint that can be affected by a range of pathologies:

bone and cartilage
ligaments
tendons
- patellar tendon rupture
- quadriceps tendon rupture
meniscal lesions
- meniscal tear
  - longitudinal tear
    - horizontal tear
    - longitudinal tear
      - Wrisberg rip
  - radial tear
  - root tear
  - displaced tear
  - signs
  - MRI grading system for meniscal signal intensity
- meniscal contusion
- meniscal/parameniscal cyst
- meniscal flounce
- meniscal fraying
- meniscal maceration
- meniscocapsular separation
- floating meniscus
bursosynovial lesions
fat pad
- fat pad impingement syndromes
  - Hoffa disease
- Hoffa fat pad herniation
popliteal fossa
fascia
- iliotibial band syndrome
alignment
- knee
- patella
  - patellar instability
  - patella alta
  - patella baja
  - indices
gamut

Article information

rID: 37582

System: Musculoskeletal

Tag: knee

Synonyms or Alternate Spellings:

Ruptured PCL
PCL tear
PCL rupture

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Cases and figures

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