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Document Title: Logan-AJSM-Dec04.shtml
Article Title: The Effect of Posterior Cruciate Ligament Deficiency on Knee Kinematics
Authors: Martin Logan, BSc, MBChB, MRCS(Eng, Glasg), Andrew Williams, MBBS, FRCS(Orth), Jonathon Lavelle, MBBS, FRCS(Orth), Wady Gedroyc, MBBS, FRCP, FRCR and Michael Freeman, MD, FRCS
Publication: American Journal of Sports Medicine, Baltimore, Maryland
Date: December 2004
Volume 32, pages 1915-1922
Keywords: Knee kinematics, kinetics, biomechanics, PCL, posterior cruciate ligament, tearing, damage, surgery, reconstruction, need for double-bundle PCL reconstruction, magnetic resonance imaging, MRI, NMR.
(Reference-denoting numbers appear in the same font and point size as the document text. As with all Knee Library documents, this article is provided in full-text form, complete with all figures and tables.)
Comments: This study looked at six knees with isolated PCL injures and no reconstruction. The authors noted that isolated PCL rupture leads to an increase in the passive sagittal laxity of the medial compartment of the knee. In their discussion, they quote previous research that PCL reconstruction does not produce a better functional outcome than conservative management; however, this quoting is from older research. They make it clear that single-bundle PCL reconstruction (which was still considered current in 2004) does not restore normal knee kinematics and biomechanics. Newer, dual-bundle PCL reconstruction methods, combined with improved understanding of the importance of the PCL and also a better understanding of why past PCL reconstructions often did not bring good results, mean that PCL reconstruction (using the double-bundle method) is now the preferred treatment of choice for fully torn PCLs. The following Noyes-and-Barber-Westin articles provide excellent discussion of these aspects: Noyes-AJSM-May05a.shtml, Noyes-AJSM-May05b.shtml, and Noyes-JBJS-Jun05.shtml. Logan et al. also point out that if the knee is left PCL-deficient for extended periods of time, then fixed deformity (as posterior subluxation) becomes a problem. So, the best solution is to have a fully dysfunctional PCL reconstructed promptly using the double-bundle technique pioneered by Noyes and others, and discussed in Noyes-JBJS-Jun05.shtml, Noyes-AJSM-May05b.shtml, Noyes-AJSM-May05a.shtml, Noyes-AJARS-Oct03.shtml, Stannard-AJSM-Mar03.shtml, Bergfeld-AJSM-Mar01.shtml, and Mannor-AJSM-Nov00.shtml.
ABSTRACT
Background: Alteration of the kinematics of the PCL-deficient knee might be a factor in producing the articular damage. Very little is known about the in vivo weightbearing kinematics of the PCL-deficient knee.
Hypothesis: Isolated rupture of the posterior cruciate ligament alters knee kinematics, predisposing the patient to development of early osteoarthritis.
Study Design: Case series.
Methods: Tibiofemoral motion was assessed using open-access magnetic resonance imaging, weightbearing in a squat, through the arc of flexion from 0° to 90° in 6 patients with isolated rupture of the posterior cruciate ligament in one knee and a normal contralateral knee. Passive sagittal laxity was assessed by performing the posterior and anterior drawer tests while the knees were scanned, again using the same magnetic resonance imaging scanner. The tibiofemoral positions during this stress magnetic resonance imaging examination were measured from midmedial and midlateral sagittal images of the knees.
Results: Rupture of the posterior cruciate ligament leads to an increase in passive sagittal laxity in the medial compartment of the knee (P < .006). In the weightbearing scans, posterior cruciate ligament rupture alters the kinematics of the knee with persistent posterior subluxation of the medial tibia so that the femoral condyle rides up the anterior upslope of the medial tibial plateau. This fixed subluxation was observed throughout the extension-flexion arc and was statistically significant at all flexion angles (P < .018 at 0°, P < .013 at 20°, P < .014 at 45°, P < .004 at 90°). The kinematics of the lateral compartment were not altered by posterior cruciate ligament rupture. The posterior drawer test showed increased laxity in the medial compartment.
Conclusion: Posterior cruciate ligament rupture alters the kinematics of the medial compartment of the knee, resulting in "fixed" anterior subluxation of the medial femoral condyle (posterior subluxation of the medial tibial plateau). This study helps to explain the observation of increased incidence of osteoarthritis in the medial compartment, and specifically the femoral condyle, in posterior cruciate ligament–deficient knees.
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