The treatment of posterior cruciate ligament injuries is a controversial issue, and there are many things that are relevant and inconclusive. These include the following points.
First, why is it difficult to reach a consensus on issues related to posterior cruciate ligament injuries?
One answer is that posterior cruciate ligament injuries are relatively uncommon. It is generally estimated that the incidence is only of posterior cruciate ligament injuries. For a relatively rare injury two, posterior cruciate ligament injury why is rare?
There are several important reasons for this.
1, the posterior cruciate ligament is biomechanically stronger than other soft tissue structures of the knee such as the posterior cruciate ligament, resulting in a greater external force required for its injury.
2. the mechanism of injury to the posterior cruciate ligament is more specific, i.e., the superior tibial segment is subjected to posterior violence anteriorly, which is uncommon in everyday life. Therefore, posterior cruciate ligament injuries are usually only seen in car accidents in the so-called “dashboard injury” or sports landing in the flexed knee position.
3, the lack of specificity of clinical symptoms of posterior cruciate ligament injury has led to a certain degree of underdiagnosis and misdiagnosis.
Second, how is the degree of posterior cruciate ligament injury determined?
1, first need to distinguish between an isolated (or simple) posterior cruciate ligament injury or a compound posterior cruciate ligament injury. The latter refers to a combination of injuries to other knee structures. The more common of these are the medial collateral ligament and the posterior lateral structures of the knee. It is generally accepted that compound posterior cruciate ligament injuries are more common than isolated ones.
2. Secondly, it is important to understand that the posterior cruciate ligament posterior cruciate ligament can be functionally divided into two strands: the anterolateral strand and the posterior medial strand. Because its strength, course, and especially the tension during knee extension and flexion are inconsistent, single-strand injuries are not uncommon.
Third, what is the consensus on the surgical treatment of posterior cruciate ligament injuries?
There is very little consensus, but the following two points are agreed upon by most orthopedic surgeons.
1, compound posterior cruciate ligament injuries require more surgery.
2. Microscopic surgery is preferable to open surgery.
Other than that, there is little agreement on the timing of surgery for PCL injuries, the materials used for reconstruction, the way the reconstruction is fixed, and so on.
Fourth, why isolated posterior cruciate ligament injury can be treated conservatively?
1. Knee instability due to posterior cruciate ligament deficiency is limited. This is because the primary function of the posterior cruciate ligament is to prevent the tibia from shifting back relative to the femur, and it plays an important role in this regard. It is because of this presence that patients with unreconstructed posterior cruciate ligament injuries express more clinical symptoms of some degree of joint discomfort or pain rather than significant instability.
2. The effects of posterior cruciate ligament loss on the cartilage or other soft tissue structures of the knee are inconclusive. Consider this question: Why the enthusiasm for suturing, or even transplantation, of the ruptured meniscus? It is not because the meniscus has an indispensable role for the present joint function, but because the progression of joint degeneration is clearly accelerated after meniscectomy.
3. Conservative treatment can achieve satisfactory results, especially in patients with a positive grade I or II posterior drawer test. With prior immobilization and subsequent muscle training, more than half of the patients can reach or even exceed the pre-injury level of motion.
V. Why is posterior cruciate ligament reconstruction surgery less common?
In addition to the small number of cases and indications, another important reason why posterior cruciate ligament reconstruction surgery is rare is the technical difficulty. This technical difficulty is determined by the unique anatomical location of the posterior cruciate ligament and the limitations of current arthroscopy.