Scope Essentials 2024-Posterior Cruciate Ligament

Video Transcription

Video Summary

Dr. John Grant from the University of Michigan discusses posterior cruciate ligament (PCL) injuries, focusing on diagnosis, assessment, and surgical reconstruction. He presents a 35-year-old male patient with persistent knee instability post-snow sledding injury, despite conservative management. PCL injuries often result from dashboard injuries or sports impacts driving the tibia posteriorly. Physical examination includes posterior drawer and sag tests, with stress radiographs—kneeling or weighted gravity views—being crucial for chronic cases. A difference greater than 8 mm in posterior translation indicates complete rupture. Surgical reconstruction options favor Achilles allograft or quadriceps tendon autografts, emphasizing detailed knowledge of PCL anatomy and careful tunnel placement to avoid vascular injury. Techniques for single- or double-bundle femoral reconstruction are discussed, including graft passage and fixation at specific knee flexion angles. Effective tensioning, especially in multiligament injuries, may utilize fluoroscopy to ensure proper alignment, aiming to restore stability and function while mitigating osteoarthritis progression.

Asset Caption

John Grant, M.D.

Keywords

Posterior cruciate ligament

PCL injury diagnosis

Surgical reconstruction techniques

Achilles allograft

Knee instability assessment