AANA Lab Course 1002 -3rd Annual Fellows/Chief Residents-Posterior Cruciate Ligament

Posterior Cruciate Ligament – Who, When, How & Rehab-Aman Dhawan, M.D.

Pdf Summary

Dr. Aman Dhawan from Penn State College of Medicine presented a comprehensive overview of posterior cruciate ligament (PCL) injuries, focusing on patient evaluation, surgical indications, reconstruction techniques, and postoperative rehabilitation.<br /><br />The case discussed involved a 28-year-old male construction worker who sustained a right knee injury from a 15-foot fall. Clinical exam showed knee effusion, positive posterior drawer and dial tests, and increased varus opening, indicating a PCL and posterolateral corner (PLC) injury confirmed by imaging and stress radiographs. Stress radiographs help differentiate partial from complete PCL tears, with side-to-side differences guiding the diagnosis. Often, PCL injuries coexist with other ligament damage, particularly PLC injuries.<br /><br />Surgical treatment is indicated acutely for PCL avulsions or combined structural injuries, and chronically if symptoms persist or combined injuries are present. Dr. Dhawan prefers double bundle (DB) transtibial PCL reconstruction due to better posterior stability and patient outcomes compared to single bundle (SB). There is no significant outcome difference between transtibial and tibial inlay techniques.<br /><br />The described surgical technique uses a split Achilles tendon graft with single bone block, employing arthroscopic portals and fluoroscopic guidance to create tibial and femoral tunnels, with attention to minimizing graft stress ("killer turn"). Grafts are fixed with interference screws at specific knee flexion angles. The reconstruction prioritizes PCL fixation, followed by addressing PLC or posteromedial corner injuries.<br /><br />Postoperative management includes six weeks non-weight bearing with early quadriceps activation, followed by gradual weight-bearing and strengthening. A PCL brace is worn continuously for six months and during activities for two years. Return to play is considered at 12+ months based on functional testing and healing, including repeat kneeling stress radiographs.<br /><br />Overall, effective management of PCL injuries requires careful diagnosis of combined ligamentous damage, meticulous surgical technique emphasizing double bundle reconstruction, and structured rehabilitation to optimize knee stability and function.

Keywords

posterior cruciate ligament

PCL injuries

patient evaluation

surgical indications

double bundle reconstruction

transtibial technique

posterolateral corner injury

Achilles tendon graft

postoperative rehabilitation

knee stability