Posterior cruciate ligament tear
Updates to Article Attributes
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was changed:
Posterior cruciate ligament (PCL) tears are less common than anterior cruciate ligament tears.
Epidemiology
PCLPosterior cruciate ligament tears account for ~10% (range 2-23%) of all knee injuries 2.
Clinical presentation
Many patients will be asymptomatic and their clinical examination is unremarkable. Sports injuries and car accidents are equally responsible for these injuries 1.
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 with other injuries 1,2.4:
- ligamentous injury (~40%)
- meniscal tears
- posterolateral corner injury5
- 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
completecomplete or partial ligamentous disruption- absent PCL replaced by high T1 and T2 signal
- enlarged and swollen PCL: >7 mm AP diameter 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
-<p><strong>Posterior cruciate ligament</strong> (<strong>PCL</strong>) <strong>tears </strong>are less common than <a title="Anterior cruciate ligament tears" href="/articles/anterior-cruciate-ligament-tear">anterior cruciate ligament tears</a>. </p><h4>Epidemiology</h4><p>PCL tears account for ~10% (range 2-23%) of all knee injuries <sup>2</sup>. </p><h4>Clinical presentation</h4><p>Many patients will be asymptomatic and their clinical examination is unremarkable. Sports injuries and car accidents are equally responsible for these injuries <sup>1</sup>. </p><h4>Pathology</h4><p>Three mechanisms of injury have been proposed <sup>2</sup>:</p><ul>- +<p><strong>Posterior cruciate ligament</strong> (<strong>PCL</strong>) <strong>tears </strong>are less common than <a href="/articles/anterior-cruciate-ligament-tear">anterior cruciate ligament tears</a>. </p><h4>Epidemiology</h4><p><a href="/articles/posterior-cruciate-ligament">Posterior cruciate ligament</a> tears account for ~10% (range 2-23%) of all knee injuries <sup>2</sup>. </p><h4>Clinical presentation</h4><p>Many patients will be asymptomatic and their clinical examination is unremarkable. Sports injuries and car accidents are equally responsible for these injuries <sup>1</sup>. </p><h4>Pathology</h4><p>Three mechanisms of injury have been proposed <sup>2</sup>:</p><ul>
-</ul><h5>Associations</h5><p>PCL injuries are isolated in only 30% of cases and are thus commonly associated with other injuries <sup>1,2.4</sup>:</p><ul>- +</ul><h5>Associations</h5><p>PCL injuries are isolated in only 30% of cases and are thus commonly associated with other injuries <sup>1,2.4</sup>:</p><ul>
-<li>anterior cruciate ligament</li>-<li>medial collateral ligament</li>-<li>lateral collateral ligament</li>- +<li><a href="/articles/anterior-cruciate-ligament-tear">anterior cruciate ligament</a></li>
- +<li><a href="/articles/medial-collateral-ligament-of-the-knee">medial collateral ligament</a></li>
- +<li><a href="/articles/lateral-collateral-ligament-of-the-knee">lateral collateral ligament</a></li>
-<li><a title="Meniscal tears" href="/articles/meniscal-tear">meniscal tears</a></li>-<li>bone contusion (80%) or <a title="Avulsion fractures of the knee" href="/articles/avulsion-fractures-of-the-knee">avulsion fracture</a> (<10%)</li>-<li>knee <a title="Joint effusion" href="/articles/joint-effusion">joint effusion</a>- +<li><a href="/articles/meniscal-tear">meniscal tears</a></li>
- +<li>
- +<a href="/articles/posterior-corner-injury-of-the-knee">posterolateral corner injury</a> <sup>5</sup>
- +</li>
- +<li>
- +<a href="/articles/bone-contusion">bone contusion</a> (80%) or <a href="/articles/avulsion-fractures-of-the-knee">avulsion fracture</a> (<10%)</li>
- +<li>knee <a href="/articles/joint-effusion">joint effusion</a>
-<li>PCL usually remains contiguous (~70%) although there may be complete or partial ligamentous disruption<ul><li>absent PCL replaced by high T1 and T2 signal</li></ul>- +<li>PCL usually remains contiguous (~70%) although there may be complete or partial ligamentous disruption<ul><li>absent PCL replaced by high T1 and T2 signal</li></ul>
-</ul><h4>Treatment and prognosis</h4><p>PCL tears may result in chronic instability and early degenerative change <sup>2</sup>. </p><h4>Differential diagnosis</h4><ul><li>mucoid degeneration <sup>3</sup>-</li></ul>- +</ul><h4>Treatment and prognosis</h4><p>PCL tears may result in chronic instability and early degenerative change <sup>2</sup>. </p><h4>Differential diagnosis</h4><ul>
- +<li>mucoid degeneration <sup>3</sup>
- +</li>
- +<li>
- +<a href="/articles/meniscofemoral-ligament">meniscofemoral ligaments</a> can mimic a PCL tear</li>
- +</ul>
References changed:
- 2. Sonin A, Fitzgerald S, Hoff F, Friedman H, Bresler M. MR Imaging of the Posterior Cruciate Ligament: Normal, Abnormal, and Associated Injury Patterns. Radiographics. 1995;15(3):551-61. <a href="https://doi.org/10.1148/radiographics.15.3.7624562">doi:10.1148/radiographics.15.3.7624562</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/7624562">Pubmed</a>
- 3. Mohankumar R, White L, Naraghi A. Pitfalls and Pearls in MRI of the Knee. AJR Am J Roentgenol. 2014;203(3):516-30. <a href="https://doi.org/10.2214/AJR.14.12969">doi:10.2214/AJR.14.12969</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/25148154">Pubmed</a>
- 4. Wolfgang Dähnert. Radiology Review Manual. (2011) ISBN: 9781609139438 - <a href="http://books.google.com/books?vid=ISBN9781609139438">Google Books</a>
- 1. Rodriguez W, Vinson E, Helms C, Toth A. MRI Appearance of Posterior Cruciate Ligament Tears. AJR Am J Roentgenol. 2008;191(4):1031. <a href="https://doi.org/10.2214/AJR.07.2921">doi:10.2214/AJR.07.2921</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/18806138">Pubmed</a>
- 5. Vinson E, Major N, Helms C. The Posterolateral Corner of the Knee. AJR Am J Roentgenol. 2008;190(2):449-58. <a href="https://doi.org/10.2214/AJR.07.2051">doi:10.2214/AJR.07.2051</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/18212232">Pubmed</a>
Tags changed:
- knee
Systems changed:
- Musculoskeletal
Images Changes:
Image 1 MRI (T2) ( create )
Image 2 MRI (T2 fat sat) ( create )
Image 3 MRI (T2 fat sat) ( create )
Image 4 MRI (PD fat sat) ( create )
Image 5 MRI (T1) ( create )
Caption
was added:
Case 5
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