The posterior cruciate ligament (PCL) is vital for regulating posterior tibial translation in relation to the femur, which is critical for knee stability. PCL tears are infrequently isolated in knee injuries; however, the absence of the PCL results in abnormal knee kinematics, which may cause injuries to other ligaments. The ideal tendon source for PCL reconstruction is still a subject of debate.

To evaluate the results of employing the peroneus longus tendon (PLT) in PCL reconstruction.

A comprehensive search was conducted to identify relevant randomized controlled trials and retrospective observational studies discussing the outcomes of using the PLT for PCL reconstruction. Studies published up to August 2024 were searched across multiple databases, including PubMed, EMBASE, Scopus, Web of Science, Cochrane Library, and Google Scholar. Full texts of the selected articles were retrieved, reviewed, and independently assessed by the investigators. Discrepancies were resolved by consensus, with any remaining disagreements being arbitrated by a third author.

This meta-analysis included five studies on PLT use for PCL reconstruction: (1) Four prospective studies with 104 patients; and (2) One retrospective study with 18 patients. Most studies followed up participants for 24 months, while one had a shorter follow-up of 18 months. Lysholm and modified cincinnati scores improved by pooled means of 32.2 (95%CI: 29.3-35.1, I² = 0%) and 31.1 (95%CI: 27.98-34.22, I² = 0%), respectively. Postoperative American Orthopaedic Foot and Ankle Society and Foot and Ankle Disability Index scores were 94.5 (I² = 61.5%) and 94.5 (I² = 80.09%), respectively. Single-hop and triple-hop test scores averaged 95.5 (95%CI: 94.5-96.5) and 92.4 (95%CI: 91.9-92.9) respectively. No significant differences were observed in thigh circumference at 10 cm and 20 cm between the injured and healthy sides.

Evidence supports PLT autografts for PCL reconstruction, improving knee function and patient outcomes. Larger randomized trials are needed to confirm efficacy and compare graft options.

• Functional outcomes
• Peroneus longus tendon
• Autograft
• Posterior cruciate ligament
• Reconstruction
• Knee function
• Graft
• Meta-analysis

• Humans
• Biomechanical Phenomena
• Posterior Cruciate Ligament Reconstruction/methods
• Suture Techniques
• Posterior Cruciate Ligament/surgery
• Postoperative Complications
• Sutures
• Surgical Tape
• Treatment Outcome

• PCL
• Posterior cruciate ligament
• athletics
• injury
• knee
• sports
• trauma

• Humans
• Posterior Cruciate Ligament/injuries
• Posterior Cruciate Ligament/surgery
• Internet
• Knee Injuries/diagnosis
• Consumer Health Information/standards
• Patient Education as Topic

• dynamometer
• knee
• muscle strength
• posterior cruciate ligament
• torque

• combined posterior instability
• posterior cruciate ligament
• posterior tibial displacement
• posterolateral corner
• posteromedial corner

• None

• anterior cruciate ligament
• anterior cruciate ligament reconstruction
• hamstring tendon
• joint instability
• knee dislocation
• posterior cruciate ligament
• posterior cruciate ligament reconstruction

• child
• erthrofibrosis
• knee
• surgery

• Humans
• Child
• Fibrosis
• Orthopedic Procedures/methods
• Postoperative Complications/etiology
• Knee Injuries/surgery
• Tissue Adhesions/etiology
• Joint Diseases/etiology
• Joint Diseases/surgery
• Joint Diseases/therapy
• Knee Joint/surgery
• Knee Joint/pathology

• PCL
• knee injury
• pediatric
• tibial slope

• Humans
• Female
• Male
• Posterior Cruciate Ligament/injuries
• Posterior Cruciate Ligament/diagnostic imaging
• Adolescent
• Child
• Tibia/diagnostic imaging
• Knee Injuries/diagnostic imaging
• Risk Factors
• Retrospective Studies
• Case-Control Studies
• Magnetic Resonance Imaging
• Radiography
• Cohort Studies

• double-bundle
• killer turn
• knee
• kneeling stress view
• posterior cruciate ligament
• side-to-side difference
• tibial tunnel

• Humans
• Male
• Female
• Retrospective Studies
• Adult
• Tibia/surgery
• Tibia/diagnostic imaging
• Follow-Up Studies
• Posterior Cruciate Ligament Reconstruction/methods
• Range of Motion, Articular
• Middle Aged
• Treatment Outcome
• Posterior Cruciate Ligament/surgery
• Posterior Cruciate Ligament/injuries
• Tomography, X-Ray Computed/methods
• Cohort Studies
• Radiography/methods

• CMRPG3M2031 Linkou Chang Gung Memorial Hospital
• CMRPG5K0091 Linkou Chang Gung Memorial Hospital
• NSTC112-2628-B-182A-002 Taiwan Minister of Science and Technology

• augmentation
• multiligament
• posterior cruciate ligament
• posterior cruciate ligament reconstruction
• posterior cruciate ligament repair

• Chronic
• Diagnosis
• Posterior cruciate ligament
• Ultrasonography

• Male
• Humans
• Female
• Adolescent
• Young Adult
• Adult
• Posterior Cruciate Ligament/diagnostic imaging
• Posterior Cruciate Ligament/injuries
• Knee Injuries/diagnosis
• Knee Joint
• Knee
• Ultrasonography/methods

• PCL
• double-bundle reconstruction
• posterior cruciate ligament
• posteromedial bundle
• single-bundle reconstruction

• Humans
• Posterior Cruciate Ligament Reconstruction/methods
• Posterior Cruciate Ligament/surgery
• Prospective Studies
• Biomechanical Phenomena
• Joint Instability/surgery
• Joint Instability/etiology
• Knee Joint/surgery
• Treatment Outcome

• injury
• knee
• ligament
• posterior cruciate ligament
• reconstruction

• Isometric knee strength
• Non-operative treatment
• Physiotherapy
• Progressive exercises
• Self-reported outcome

• Long-term outcome
• Non-surgical treatment
• Posterior cruciate ligament

• Functional outcome
• Posterior cruciate ligament (PCL) rupture
• Radiographic outcome
• Secretome (conditioned medium)
• Umbilical cord mesenchymal stem cell (UC-MSC)

• Posterior cruciate ligament injury
• Posterior cruciate ligament reconstruction
• Rehabilitation
• Return to play

(1) Background: Isolated posterior cruciate ligament (PCL) tears represent a severe type of injury. In hospitals, PCL reconstruction (PCL-R) is less frequently performed than other types of knee surgery. It is unclear whether there is consensus among surgeons on how to perform rehabilitation after PCL-R or if there are different, more individual approaches in daily routines. (2) Methods: Rehabilitation protocols and their main criteria (the progression of weight bearing and range of motion, the use of knee braces, rehabilitation training, and sports-specific training) were retrospectively analyzed after PCL-R. (3) Results: Only 33 of 120 (27.5%) analyzed institutes use rehabilitation protocols after PCL-R. The applied protocols showed vast differences between the individual rehabilitation criteria, especially with regard to the progression of weight bearing and the range of motion. The only standardized recommendations were the obligatory use of knee braces and the general restriction of weight bearing and range of motion immediately post-surgery. Therefore, because of the lack of a consensus about a standardized rehabilitation protocol after PCL-R, no recommendation can be made on one particular protocol. (4) Conclusion: There is no acknowledged standardized rehabilitation protocol after PCL-R. In clinical practice, recommendations are influenced by, i.a., surgeons’ opinions and experience. The lack of scientific evidence on a particular standardized rehabilitation protocol after PCL-R suggests that rehabilitation protocols need to be tailored to the individual patient.

To perform a systematic review of posterior tibial stress radiography techniques and radiographic measurement methods to compare their accuracy and efficacy to aid clinicians in quantifying posterior cruciate ligament laxity.

Electronic databases, including PubMed, MEDLINE, Embase.com 1947- , Ovid Medline 1946- , Scopus 1823- , Cochrane Central Register of Controlled Trials (CENTRAL), and Clinicaltrials.gov 1997- were queried in December 2020. The abstracts of articles were reviewed by 2 authors for published studies comparing posterior tibial stress radiography techniques, describing, and comparing radiographic measurement methods, and comparing stress radiographs with instrumented knee testing.

The systematic review included 13 studies that satisfied the inclusion and exclusion criteria. There were 3 studies comparing stress radiography with instrumented knee devices, 6 studies comparing stress radiography techniques, and 5 studies evaluating the reliability of radiographic measurements. Stress radiography was more sensitive for detecting posterior tibial translation than KT-1000 and KT-2000 and was similar to the Rolimeter knee arthrometer. The majority of studies found TELOS stress radiography to be more sensitive than gravity or hamstring contraction stress views. Kneeling stress radiographs were found to be equivalent to TELOS in one study and superior in another. All reported methods of radiographic measurement for posterior tibial translation showed good-to-excellent intraobserver and interobserver reliability, and no single technique demonstrated clear superiority.

The results of this systematic review indicate that posterior stress radiography with TELOS and kneeling stress radiography are the most reliable methods to evaluate posterior cruciate ligament laxity. Gravity stress and hamstring contraction can be used but may underestimate posterior tibial translation. Radiographic measurement methods are reliable and no single method is clearly superior.

This information will allow clinicians to use various radiographic methods to objectively measure posterior tibial translation to formulate a treatment plan.

• autograft
• bone-patellar tendon-bone
• hamstring
• peroneus longus
• posterior cruciate ligament
• quadriceps

• Anterior Cruciate Ligament Injuries/surgery
• Anterior Cruciate Ligament Reconstruction
• Autografts/surgery
• Humans
• Patellar Ligament/transplantation
• Posterior Cruciate Ligament Reconstruction
• Tendons/surgery

To assess clinical and functional outcomes of patients aged 40 years or older receiving PCL reconstruction surgery.

All patients older than 40 years with isolated PCL rupture who underwent PCL reconstruction surgery were enrolled into the retrospective study. Associated meniscal injuries, osteochondral lesions, postoperative complications, and the rate of return to the preinjury level of activity were extracted. Outcomes included International Knee Documentation Committee (IKDC) subjective score, Lysholm score, and Tegner activity score. The minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) were used to evaluate the clinically relevant value of PCL reconstruction in this population.

In total, 41 patients with a mean age of 51.7 years were included. The mean follow-up time was 32.8 months. Associated lesions included meniscal injuries (48.8%) and osteochondral lesions (97.6%). Improvement in the IKDC score (from 46.5 preoperatively to 79.0 postoperatively, p < 0.0001), Lysholm score (from 65.5 to 88.3, p < 0.0001), and Tegner activity score (from 2.3 to 4.0, p < 0.0001) was recorded. The clinically relevant value based on the MCID showed that 34 of 41 patients (82.9%) had a ΔIKDC score exceeding 16.8; all patients (100%) showed a ΔLysholm score exceeding 8.9; and 35 of 41 patients (85.4%) showed a ΔTegner activity score exceeding 0.5. Regarding the PASS, none of the patients had an IKDC score exceeding 75.9 preoperatively, whereas 27 of 41 patients (65.9%) had a score of more than 75.9 postoperatively. All patient had ≥ grade II knee instability preoperatively. Postoperatively, 36 patients (87.8%) had no significant joint translation, and 5 patients (12.2%) had grade I instability. Twenty-one patients (51.2%) returned to their preinjury level of activity. Five patients (12.2%) developed Ahlbäck grade I radiographic osteoarthritis. No rerupture or other major perioperative complications were reported.

PCL reconstruction is a reliable surgery for middle-aged patients suffering from persistent instability even after failed conservative treatment, with significant improvement in patient-reported outcomes that exceeded MCID in the majority of patients, restoration of subjective instability, and approximately half of the patients returned to preinjury activity levels.

Level IV, therapeutic case series.

Cheerleading is a highly popular youth sport in the United States and has been increasingly recognized in recent years for its athleticism and competitive nature. The sport has changed dramatically since its inception. When the sport of cheerleading was first developed, its primary purpose was to entertain crowds and support other athletes. Today, cheerleaders are competitive athletes themselves. Cheerleaders, most of whom are in the pediatric age group, and their parents commonly approach orthopaedic surgeons and sports medicine physicians with questions regarding the risks associated with participation in the sport. Appropriate clinical guidance is especially important for athletes returning to the sport after an injury. However, unlike other popular sports (eg, football, basketball, and volleyball), the intricacies of cheerleading are not well-known to those outside the sport, including many health care providers. Previous studies have reported on the epidemiological patterns of injuries associated with cheerleading and how such aesthetic sports affect the body, finding that fractures and concussions are prevalent and that catastrophic injuries are more common than in most other sports. Here, we provide an evidence-based discussion of 10 pertinent topics regarding cheerleading and its risks to the musculoskeletal system. The purpose of this review is to provide a comprehensive resource for orthopaedic surgeons and sports medicine physicians who care for these athletes.

• Epidemiology
• Injury mechanism
• Knee ligament
• Ligament registry
• Multiligament knee injury
• Posterior cruciate ligament

• Anterior Cruciate Ligament Injuries/epidemiology
• Anterior Cruciate Ligament Injuries/surgery
• Cohort Studies
• Humans
• Posterior Cruciate Ligament/injuries
• Posterior Cruciate Ligament/surgery
• Registries
• Sweden/epidemiology

• Sahlgrenska Universitetssjukhuset
• University of Gothenburg

• Magnetic resonance imaging
• Morphological characteristics
• Posterior cruciate ligament rupture

• concomitant
• medial meniscus avulsion fracture
• pcl avulsion fracture
• posterior approach

• Adult
• Arthroscopy
• Fractures, Avulsion/diagnostic imaging
• Fractures, Avulsion/surgery
• Humans
• Knee Injuries/diagnostic imaging
• Knee Injuries/surgery
• Male
• Menisci, Tibial/diagnostic imaging
• Open Fracture Reduction/methods
• Posterior Cruciate Ligament/diagnostic imaging
• Posterior Cruciate Ligament/injuries
• Posterior Cruciate Ligament/surgery
• Tibial Meniscus Injuries/diagnostic imaging
• Tibial Meniscus Injuries/etiology
• Tibial Meniscus Injuries/surgery
• Treatment Outcome

Ligament reconstruction is indicated in patients with an isolated posterior cruciate ligament (PCL) injury who fail conservative treatment. To eliminate the need for PCL reconstruction, an ideal rehabilitation program is important for patients with an isolated PCL injury. The purpose of this study was to investigate the improvement in functional outcome, proprioception, and muscle strength after a Both Sides Up (BOSU) ball was used in a balance combined with strength training program in patients with an isolated PCL injury. Ten patients with isolated PCL injuries were recruited to receive a 12 week training program as a study group. In the control group (post-PCL reconstruction group), ten subjects who had undergone isolated PCL reconstruction for more than 2 years were enrolled without current rehabilitation. The Lysholm score, IKDC score, proprioception (active and passive), and isokinetic muscle strength tests at 60°/s, 120°/s, and 240°/s, were used before and after training on the injured and normal knees in the study group, and in the post-PCL reconstruction group. The results were analyzed with a paired t-test to compare the change between pre-training, post-training, and the normal leg in the study group, and with an independent t-test for comparisons between the study and post-PCL reconstruction groups. Both the Lysholm and IKDC scores were significantly improved (p < 0.01) after training, and no difference was observed compared to the post-PCL reconstruction group. The active and passive proprioception was improved post-training compared to pre-training, with no difference to that in the post-PCL reconstruction group. Isokinetic knee quadriceps muscle strength was significantly greater post-training than pre-training in PCL injured knees at 60°/s, 120°/s, and 240°/s, and in hamstring muscle strength at 60°/s and 120°/s. Muscle strength in the post-training injured knee group showed no significant difference compared to that in the post-training normal leg and the post-PCL reconstruction group. The post-training improvement of muscle strength was higher in the PCL injured leg compared to the normal leg and there was no difference between the dominant and non-dominant injured leg in the study group. After 12 weeks of BOSU balance with strength training in patients with an isolated PCL injury, the functional outcome, proprioception, and isokinetic muscle strength were significantly improved, and comparable to the contralateral normal leg and the post-PCL reconstruction group. We suggest that programs combining BOSU balance and strength training should be introduced in patients with a PCL injury to promote positive clinical results.

• IKDC
• Lysholm score
• balance training
• posterior cruciate ligament
• proprioception

• Anterior Cruciate Ligament Injuries
• Humans
• Knee Joint
• Muscle Strength
• Posterior Cruciate Ligament/surgery
• Proprioception
• Resistance Training
• Treatment Outcome

The posterior cruciate ligament is crucial for posterior stability of the knee joint, and, as well as anterior cruciate ligament reconstruction, posterior cruciate ligament reconstruction (PCLR) has attracted interest in orthopedic literature. A few studies have investigated epidemiologic data of PCLR in Western countries. However, there has been no report on the epidemiological pattern of PCLR in the Asian population, including South Korea. Therefore, this study investigated the incidence and trends of PCLR in South Korea using the Korean National Health Insurance (NHI) System Database.

The data was collected by the Korean Health Insurance Review and Assessment Service (HIRA) from 2008 to 2016 in South Korea. Patients with a record of cruciate ligament reconstruction and PCLR were allocated from the database. An analysis of the total number and incidence per 100,000 people/year of PCLR procedures and other epidemiologic parameters was conducted according to sex and age.

The incidence of PCLR procedures rose from 2.3 to 2.6 per 100,000 people (from 1101 to 1299 total cases; 13% increase) between 2008 and 2016: from 3.8 to 4.0 (from 901 to 1000) in males, and from 0.8 to 1.2 (from 200 to 299) in females. PCLR was performed more frequently in males than in females, however, the rate of increase was higher in females than males. The incidence of PCLR over 9  years was highest in patients in their 20s, followed by patients in their 40s and 30s.

The incidence of PCLR procedures increased by 13% over 9 years in South Korea. PCLR was performed approximately three times more in men than in women. The incidence of PCLR was highest in patients in their 20s, followed by those in their 40s. The current study will enhance our understanding of the epidemiology of PCLR.

Descriptive Epidemiology Study.

• Epidemiology
• Incidence
• Knee
• Posterior cruciate ligament
• Reconstruction

• Biomechanical Phenomena
• Cadaver
• Humans
• Knee/surgery
• Knee Joint/surgery
• Posterior Cruciate Ligament/surgery
• Posterior Cruciate Ligament Reconstruction
• Tibia/surgery

• PCL
• adolescent
• avulsion
• pediatric
• peel-off
• posterior cruciate ligament
• skeletally immature

• Cartilage
• Magnetic resonance imaging
• Meniscal injury
• Posterior cruciate ligament reconstruction

• NGF-TrkA axis
• NMDA receptor
• NO
• acute compression axonopathy
• glutamate
• non-contact ACL injury
• proprioception
• prostaglandin E2
• proximal tibia

• Anatomy
• Humphrey's ligament
• Meniscofemoral ligaments
• Posterior cruciate ligament

Posterior cruciate ligament (PCL) injuries are not as common as other knee ligament injuries, but may present a challenging scenario for even skilled knee surgeons. Complete PCL tears are typically encountered in the setting of multiligament knee injuries and require surgical treatment. Isolated complete PCL injuries are uncommon and the best treatment is debated, and likely depends on the degree of symptoms and objective instability. However, many PCL injuries will be partial tears (grade I or II). The purpose of this chapter is to describe our treatment of choice for partial PCL injuries through a conservative approach.

Level of evidence  Level IV.

• PCL
• PRP
• growth factors
• knee brace
• treatment

Background: The posterior cruciate ligament (PCL) is an essential element in knee stability. PCL reconstructions represent an under-investigated topic in the literature due to the rarity of this type of knee injury. This study aims to investigate the incidence of PCL reconstructive surgeries in Italy, following their trend during a 15-year period. Methods: The National Hospital Discharge records (SDO) collected by the Italian Ministry of Health between January 2001 and October 2015 were analyzed. The database reports anonymous data comprising patients’ ages, genders, International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes for diagnosis and intervention, census regions, regions of hospitalization, lengths of hospitalization and types of reimbursement. Results: The overall incidence of PCL reconstructions in the Italian population during the study period was 0.46 surgeries per 100,000 inhabitants/year, ranging from 0.32 to 0.54. The median patient’s age was 30 years old, and the male:female ratio was 5.3. PCL lesions were isolated in 39.7% of patients, while anterior cruciate ligament injuries were the most frequently associated lesions (31.1%). Conclusions: The incidence of PCL reconstruction in Italy was low and stable during the study period. Young men are the category at the highest risk for these procedures. Given the paucity of epidemiological data on PCL reconstructions, this data may represent a reference for the current and foreseeable needs in PCL surgeries for countries sharing similar cultural context.

• PCL
• epidemiology
• incidence
• ligament reconstruction
• sports trauma

• Double-bundle
• Failure
• Knee
• PCL
• Posterior cruciate ligament
• Revision
• Risk factors
• Single-bundle
• Tibial inlay
• Transtibial

• Biomechanical Phenomena
• Female
• Humans
• Joint Instability/prevention & control
• Knee Injuries/rehabilitation
• Knee Injuries/surgery
• Knee Joint/surgery
• Male
• Posterior Cruciate Ligament/injuries
• Posterior Cruciate Ligament/surgery
• Posterior Cruciate Ligament Reconstruction/methods
• Postoperative Complications/prevention & control
• Range of Motion, Articular
• Recurrence
• Reoperation/statistics & numerical data
• Risk Factors
• Tibia/surgery
• Treatment Outcome

• Klinikum rechts der Isar der Technischen Universität München (8934)

The nature of posterior cruciate ligament (PCL) injuries and the scarcity of data on this issue have made reports on clinical and epidemiological features of PCL injuries valuable. We aimed to report our experiences with PCL injuries in our region.

Any patient who referred with a diagnosis of PCL rupture from 2004 to 2018 to our center, was included in this report. We evaluated pre- and postoperative outcomes and compared patients with isolated and combined (multi-ligament) PCL injuries.

Overall, 55 patients were included in our study. Majority of patients were men (87.2%). Mean age of patients was 28.12 ± 8.53 years old.

Average follow-up period was 28.83 ± 20.62 months and mean duration between trauma and surgery was 27.8 ± 38.0 months. Most common cause of PCL injury was traffic accidents (70.9%) followed by sports injuries (5.5%). Majority of patients (69.1%) had combined PCL injuries.

Majority of patients underwent single tibial-double femoral tunnel reconstruction (56.4%), followed by single tibial-single femoral tunnel (34.5%) reconstruction. Allografts were used in 60% of patient. Average Cincinnati knee rating scale (CKRC) was 35.87 ± 11.4, which improved significantly after PCL reconstruction (79.45 ± 11.90, p <  0.001). Full range of motion only existed in 29.1% of patient prior to surgery, which improved after surgery (92.7%, p <  0.001).

Three patients had postoperative arthrofibrosis and motion stiffness, 1 had deep vein thrombosis and 3 patients had infections.

Those with isolated PCL injuries had higher pre-operative CKRS (42.05 ± 8.96 vs. 33.10 ± 11.45, p = 0.006) and lower pre-operative posterior drawer test (2.76 ± 0.43 vs. 3.1 ± 0.6, p = 0.042) compared to those with combined injuries.

Today with advances in surgical techniques, considering treatment of collateral ligament injuries, use of stronger allografts and more secure fixation methods, better rehabilitation programs and early range of motion, results of reconstruction of the PCL has become very promising. Accordingly we recommend surgical treatment even for isolated PCL tears, with the goal to prevent functional deficit and to prevent degenerative arthritis.

• Iran
• Outcome
• Posterior cruciate ligament
• Reconstruction
• Trauma

• Acute PCL lesion
• Internal bracing
• Knee dislocation
• Multi-ligament injuries
• PCL bracing
• Posterior cruciate ligament

• Adult
• Female
• Follow-Up Studies
• Humans
• Internal Fixators
• Joint Instability/diagnostic imaging
• Joint Instability/surgery
• Knee Injuries/diagnostic imaging
• Knee Injuries/surgery
• Magnetic Resonance Imaging
• Male
• Middle Aged
• Posterior Cruciate Ligament/diagnostic imaging
• Posterior Cruciate Ligament/injuries
• Posterior Cruciate Ligament/surgery
• Radiography
• Retrospective Studies
• Suture Anchors
• Treatment Outcome
• Young Adult

• Arthroscopic suture fixation
• Isolated PCL avulsion fracture
• Knee
• Knee arthroscopy
• Lysholm score

• Ingrowth
• LARS Artificial graft
• MRI
• PCL reconstruction
• Scaffold

• chondroprotectors
• conservative treatment
• functional dynamic braces
• knee joint
• ligament damage
• operative treatment
• posterior cruciate ligament
• posterior cruciate ligament rupture
• secondary osteoarthritis

• Biomechanical Phenomena
• Humans
• Joint Instability
• Knee Joint
• Osteoarthritis/prevention & control
• Posterior Cruciate Ligament
• Secondary Prevention

Although often performed using a variety of reconstructive techniques and strategies, no clinically significant differences presently exist between the approaches available for isolated PCL reconstructions. Given the operatively challenging nature of these procedures, there lies a potentially increased risk of postoperative complications and healthcare expenditures. Our investigation sought to identify patient and surgical risk factors associated with prolonged hospital stays following isolated PCL reconstruction and determine the incidence of 30-day complications after PCL reconstruction using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database.

Patients undergoing isolated PCL reconstructions between 2005 and 2016 were identified in the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database using Current Procedural Terminology codes. Baseline patient and operative characteristics were evaluated as possible risk factors for overnight hospital admissions following PCL reconstruction and analyzed using multivariate analyses.

A total of 249 patients were identified. Multivariate analyses demonstrated that increased operative duration >120 mins (OR 5.04, CI 2.44–10.40; p <0.001) was associated with an increased risk of overnight hospital stay. Major complications occurred in 0.4% (N=1), and minor complications occurred in 0.8% (N=2) with overall complications occurring in 1.2% (N=3) of all patients. Wound dehiscence was the only major complication while superficial surgical site infection and deep vein thrombosis were the only minor complications. 34.1% (N=85) of patients required an overnight hospital stay postoperatively.

Surgical duration >120 mins carried an increased risk of overnight hospital stay after isolated PCL reconstructions. As there are presently minimal significant clinical differences between current PCL reconstruction techniques, improved surgeon familiarity and comfort with a single technique is recommended to decrease operative time and avoid prolonged hospital stays and healthcare expenditures.

III, retrospective comparative study.

• American College of Surgeons National Surgical Quality Improvement Program
• NSQIP
• healthcare expenditures
• operative time
• overnight hospital stays

The rates of return to full activity, persistent disability, complications, and surgical revisions after operative management of posterior cruciate ligament (PCL) tears in a physically active population have not been reported.

To evaluate the clinical outcomes of active military patients with symptomatic PCL tears who underwent surgical reconstruction and compare outcomes between isolated PCL and multiligament injuries.

Cohort study; Level of evidence, 3.

Individuals undergoing surgical reconstruction of the PCL (Current Procedural Terminology code 29889) were isolated from the Military Health System Management Analysis and Reporting Tool between fiscal years 2005 and 2010. Demographic variables and rates of postoperative complications, activity limitations, rates of revision surgery, physical disability ratings, and ultimate medical discharge were recorded from the electronic medical record and US Army Physical Disability Agency database.

A total of 182 patients underwent 193 surgeries, including 118 isolated PCL reconstructions and 75 multiligament knee reconstructions, with an average follow-up of 19.5 months. There were 174 primary procedures and 19 revision reconstructions. The mean ± SD patient age was 28.4 ± 7.2 years, with males comprising 96.2% of patients. The overall surgical complication rate was 12.4%, with a significantly higher rate in multiligament knee reconstructions compared with isolated PCL reconstructions (18.7% vs 8.5%; P = .045). Overall, 35.1% of patients were discharged from military service due to disability. Rates of discharge were significantly higher in those undergoing surgery at lower volume institutions (those that performed <2 PCL reconstructions per year during the study period) than those at higher volume institutions (41.1% vs 26%; P = .040). The overall revision rate was 10.9%, with no significant difference between the isolated PCL and multiligament knee reconstructions. Of the 103 patients with primary isolated PCL reconstructions, 35% underwent medical discharge for persistent knee complaints, and 12.6% required revision PCL reconstruction. The overall failure rate for primary isolated PCL reconstructions, which includes both revision surgery and knee-related medical discharge from military service, was 42.7%.

In a physically active, military population, nearly one-third of patients were unable to return to previous level of military function, and 12.6% required revision at short-term follow-up due to persistent instability. Perioperative complication rates were significantly higher among patients with multiligament knee reconstructions.

• disability
• knee reconstruction
• military
• posterior cruciate ligament