Management of the Posterior Cruciate Ligament-Deficient Knee

Although the injured posterior cruciate ligament (PCL) has gained more attention during the past few years, we as surgeons are still confronted with a high amount of overlooked or underestimated PCL and multiple-ligament injuries. In order not to overlook a PCL injury or to misdiagnose an isolated anterior cruciate ligament injury in PCL deficiency, the authors present their diagnostic scheme, including the standard use of stress radiography, and discuss possible pitfalls during clinical and arthroscopic examination. Because the outcome after PCL reconstruction is still far from achieving reproducible, good results with conventional surgical techniques and after-treatment protocols, the authors consider differentiated perioperative management of the PCL-deficient knee to be essential to improve results. Therefore, the authors present and discuss factors such as the exclusion of fixed posterior subluxation, anatomic tunnel placement, and rigid post-treatment protocol to improve the outcome. They further focus on technical details during replacement surgery of the PCL and the multiple-ligament-deficient knee.