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Posterior Cruciate Ligament Injuries

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Posterior Cruciate Ligament Injuries

Comprehensive exam-ready guide to PCL injuries - grading, isolated vs combined, surgical indications

complete
Updated: 2025-12-17
High Yield Overview

POSTERIOR CRUCIATE LIGAMENT INJURIES

Dashboard Injury | Posterior Drawer | Isolated vs Combined

3-40%Of knee ligament injuries
Grade IIUsually conservative
CombinedUsually surgical
PLCMost common associated

PCL GRADING (Posterior Drawer)

Grade I
Pattern0-5mm posterior translation
TreatmentTibia anterior to femoral condyles
Grade II
Pattern5-10mm translation
TreatmentTibia flush with condyles
Grade III
PatternGreater than 10mm translation
TreatmentTibia posterior to condyles

Critical Must-Knows

  • PCL is PRIMARY restraint to posterior tibial translation
  • Dashboard injury = flexed knee against dashboard
  • Isolated Grade I-II injuries often do well non-operatively
  • Combined injuries (especially with PLC) = surgical indication
  • Posterior drawer test is the key examination

Examiner's Pearls

  • "
    PCL has better blood supply than ACL - some healing capacity
  • "
    Posterior sag sign - observe with hip and knee 90 degrees
  • "
    MRI sensitivity 99%+ for PCL injuries
  • "
    Reconstruct early if combined injury to avoid contracture

Clinical Imaging

Imaging Gallery

Bone bruise pattern in posterior cruciate ligament (PCL) injury. Arrow indicates bone bruise in the anterior portion of lateral tibial plateu that occurred in a patient with grade III PCL injury shows
Click to expand
Bone bruise pattern in posterior cruciate ligament (PCL) injury. Arrow indicates bone bruise in the anterior portion of lateral tibial plateu that occCredit: Lee BK et al. via Knee Surg Relat Res via Open-i (NIH) (Open Access (CC BY))
Example asymptomatic posterior cruciate ligament (PCL) showing (A) T2 mapping image slice, (B) histogram of T2 values for the entire PCL volume with a kernel distribution fit line, (C) T2* mapping ima
Click to expand
Example asymptomatic posterior cruciate ligament (PCL) showing (A) T2 mapping image slice, (B) histogram of T2 values for the entire PCL volume with aCredit: Wilson KJ et al. via Orthop J Sports Med via Open-i (NIH) (Open Access (CC BY))
Examples of subjects in which the distal posterior cruciate ligament (PCL) exhibited significantly higher mean, standard deviation, variance, and contrast of T2 mapping values compared with both the m
Click to expand
Examples of subjects in which the distal posterior cruciate ligament (PCL) exhibited significantly higher mean, standard deviation, variance, and contCredit: Wilson KJ et al. via Orthop J Sports Med via Open-i (NIH) (Open Access (CC BY))
T2 sag image demonstrates fluid signal extending partially through the tibial attachment of the PCL consistent with a partial thickness tear of the PCL at tibial attachment.
Click to expand
T2 sag image demonstrates fluid signal extending partially through the tibial attachment of the PCL consistent with a partial thickness tear of the PCredit: USU Teaching File MUTF et al. via MedPix via Open-i (NIH) (Open Access (CC BY))
Clinical examination for PCL injury showing posterior sag and drawer test
Click to expand
Clinical examination for PCL injury: (a) Posterior sag sign with knee flexed - observe the dropped tibial tuberosity, (b) Bilateral comparison view demonstrating posterior tibial subluxation on the affected side, (c) Posterior drawer test - examiner applying posterior force to the proximal tibia with knee at 90 degrees flexion.Credit: PMC - CC BY 4.0

Critical Exam Concepts

Isolated vs Combined

Isolated Grade I-II often conservative. Combined injuries (especially with PLC) usually need surgery. Always check for associated injuries.

Dashboard Injury

Classic mechanism - proximal tibia hits dashboard with knee flexed. Posterior force on tibia. Always check vascular status.

Posterior Drawer

Key test at 90 degrees flexion. Grade by relationship of tibia to femoral condyles. Start position critical (sag may false positive).

PLC Association

PLC injury most commonly associated with PCL tears. Dial test at 30 degrees and 90 degrees differentiates isolated PLC from combined.

PCL Injury Treatment Guide

GradeTranslationFindingTreatment
Grade I0-5mmTibia anterior to condylesConservative
Grade II5-10mmTibia flush with condylesUsually conservative
Grade III IsolatedGreater than 10mmTibia posterior to condylesConsider surgery
Combined InjuryVariablePLC or ACL involvementSurgery indicated
Mnemonic

DASHPCL Injury Mechanism

D
Dashboard
Proximal tibia hits dashboard
A
Anterior force on tibia
From front
S
Sag develops
Posterior tibial subluxation
H
Hyperflexion
Also a mechanism

Memory Hook:DASH to the dashboard causes PCL injury!

Mnemonic

SPDQPCL Examination

S
Sag sign
Observe posterior sag 90/90
P
Posterior drawer
Key test at 90 degrees
D
Dial test
30 and 90 degrees for PLC
Q
Quadriceps active
Tibia translates forward with quad

Memory Hook:Do SPDQ tests for PCL!

Mnemonic

COGSPCL Reconstruction Indications

C
Combined injuries
With PLC, ACL, or MCL
O
Ongoing instability
Failed conservative treatment
G
Grade III isolated
In active patient
S
Symptomatic Grade II
Not improving

Memory Hook:Turn the COGS toward surgery when indicated!

Overview and Epidemiology

PCL Injury Underdiagnosed

PCL injuries are often missed on initial presentation. Look for posterior knee pain, instability going downstairs, and subtle posterior sag. MRI confirms diagnosis.

Epidemiology

  • 3-40% of knee ligament injuries
  • MVCs most common cause
  • Sports: football, soccer, skiing
  • Males greater than females
  • Often associated injuries (60%+)

Mechanism

  • Dashboard: Proximal tibia hits dashboard
  • Fall on flexed knee: Direct blow
  • Hyperflexion: Forced flexion
  • Hyperextension: May also tear
  • Sports contact: Direct blow to tibia

Pathophysiology and Mechanisms

PCL Anatomy

Origin: Lateral aspect of medial femoral condyle (in notch).

Insertion: Posterior intercondylar area of tibia, depression below plateau.

Two bundles:

  • Anterolateral (AL): larger, tight in flexion
  • Posteromedial (PM): smaller, tight in extension

Blood supply: Middle genicular artery. Better than ACL.

Length: 32-38mm. Cross-sectional area greater than ACL.

PCL Function

Primary restraint: Posterior tibial translation (95% near full flexion).

Secondary restraints: External rotation, varus/valgus in extension.

The AL bundle is the primary restraint throughout flexion range.

Loss of PCL = increased posterior translation = abnormal knee kinematics.

Injury Biomechanics

Dashboard mechanism: Posterior force on proximal tibia with knee flexed.

Sequential failure: AL bundle fails first, then PM bundle.

Combined injuries: PLC commonly injured with PCL due to similar mechanism (varus/external rotation).

Meniscofemoral ligaments: Humphrey (anterior) and Wrisberg (posterior) provide some backup.

Check for PLC Injury

PCL and PLC injuries often occur together. Varus/external rotation force injures both. Always perform dial test at 30 and 90 degrees. Missing PLC leads to poor outcomes.

Classification Systems

PCL Injury Grading

GradeTranslationTibial PositionImplication
I (Partial)0-5mmAnterior to femoral condylesPartial tear, good prognosis
II (Complete)5-10mmFlush with condylesComplete tear, often conservative
III (Complete+)Greater than 10mmPosterior to condylesCombined injury likely

Grade III usually indicates associated PLC or capsular injury.

Chronicity Classification

Acute: Within 3 weeks. Hemarthrosis, limited ROM, identifiable mechanism.

Subacute: 3 weeks to 3 months. Swelling settled, better examination.

Chronic: Greater than 3 months. Adaptive changes, possible OA.

Chronic PCL deficiency may be well-tolerated but risks patellofemoral and medial compartment OA.

Injury Pattern

Isolated PCL: Single ligament. Often conservative treatment.

Combined PCL/PLC: Most common combination. Surgical indication.

Combined PCL/ACL: Floating knee equivalent. Surgical.

Multiligament: Knee dislocation pattern. Vascular assessment critical.

Combined injuries have worse outcomes if missed.

Clinical Assessment

History

  • Mechanism: Dashboard, fall on flexed knee
  • Pain: Posterior knee, may be mild
  • Instability: Downstairs, deceleration
  • Swelling: Often less than ACL
  • Other injuries: Common (60%+)

Examination

  • Posterior sag: Observe at 90/90 position
  • Posterior drawer: At 90 degrees flexion
  • Quadriceps active: Tibia translates forward
  • Dial test: 30 and 90 degrees for PLC
  • Varus/valgus: Check collaterals

Posterior Drawer Test

Patient supine, knee 90 degrees. Ensure tibia not already sagged (start from reduced position). Push tibia posteriorly. Grade by tibial plateau position relative to femoral condyles. Compare to contralateral side.

Key Clinical Pearls

Posterior sag sign: With patient supine, hip and knee 90 degrees, observe profile of tibial tuberosity. Sagged tibia = PCL injury.

Quadriceps active test: From 90/90 position, have patient contract quad. Positive = tibia translates forward (reduces posterior sag).

Investigations

MRI Assessment

MRI showing PCL mucoid degeneration
Click to expand
Sagittal MRI series of knee showing PCL pathology: (A) T1-weighted, (B) T2-weighted, (C) STIR, (D) sagittal view demonstrating abnormal signal within the PCL consistent with mucoid degeneration or partial tear. MRI has 99%+ sensitivity for PCL injuries.Credit: PMC - CC BY 4.0
MRI showing PCL avulsion fracture
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Sagittal MRI sequence demonstrating PCL tibial avulsion injury: (a) T1-weighted showing displaced bony fragment at PCL insertion, (b) T2-weighted with bone marrow edema, (c) STIR sequence highlighting the avulsion and soft tissue changes. This pattern may be amenable to direct fixation rather than reconstruction.Credit: PMC - CC BY 4.0

Sensitivity: 99%+ for PCL injuries.

Specificity: Very high.

Findings: Increased signal, discontinuity, thickening.

Associated injuries: PLC, meniscus, cartilage, other ligaments.

Essential for surgical planning and identifying all pathology.

Plain Radiographs

AP and lateral X-rays showing PCL tibial avulsion fracture
Click to expand
AP (a) and lateral (b) knee radiographs demonstrating PCL tibial avulsion fracture. The lateral view shows the characteristic avulsion fragment from the posterior tibial insertion site of the PCL - this bony avulsion is an indication for direct fixation rather than ligament reconstruction.Credit: PMC - CC BY 4.0
3D CT reconstruction showing PCL tibial avulsion fracture
Click to expand
3D CT reconstruction of proximal tibia demonstrating PCL tibial avulsion fracture morphology. The posterior tibial plateau shows the displaced bony fragment at the PCL footprint. CT provides detailed fracture characterization for surgical planning.Credit: PMC - CC BY 4.0

Stress views: Kneeling vs standing posterior translation.

Avulsion: Tibial insertion avulsion fracture.

OA changes: Chronic PCL deficiency leads to patellofemoral and medial OA.

Weight-bearing views assess alignment and arthrosis.

Stress Radiography

Telos device: Applies posterior stress, measures translation.

Kneeling views: Compare posterior translation bilaterally.

Quantifies instability and monitors treatment.

MRI PCL Assessment

MRI gold standard for PCL diagnosis. Look for bucket-handle appearance (horizontal tear pattern) and assess both bundles. Always evaluate PLC, menisci, and cartilage.

Management Algorithm

📊 Management Algorithm
pcl injuries management algorithm
Click to expand
Management algorithm for pcl injuriesCredit: OrthoVellum

Treatment Decision

PCL Injury Management

AssessmentGrade and Pattern

Determine Grade I-III. Identify isolated vs combined. Check PLC with dial test.

Isolated I-IIConservative

Quadriceps strengthening program. Avoid posterior tibial sag. Brace in extension.

Isolated IIIConsider Surgery

In active patient with significant laxity. May trial conservative in low-demand.

CombinedSurgery

Combined with PLC, ACL, or persistent instability. Reconstruct all injured structures.

Non-Operative Approach

Indicated for:

  • Isolated Grade I-II injuries
  • Low-demand patients with Grade III
  • Patient preference after counseling

Protocol:

  • Brace in extension initially
  • Quadriceps strengthening (prevents posterior sag)
  • Avoid hamstring exercises (increase posterior force)
  • Progressive return to activity

Many isolated Grade I-II do well long-term.

Surgical Indications

Absolute:

  • Combined PCL/PLC injury
  • Multiligament injury
  • Tibial avulsion fracture (fix fragment)

Relative:

  • Isolated Grade III in active patient
  • Failed conservative treatment
  • Symptomatic chronic instability

Early surgery in combined injuries prevents PLC contracture.

Surgical Technique

PCL Reconstruction

Graft choice:

  • Achilles allograft: Most common
  • BTB autograft: Stronger fixation
  • Hamstring autograft: Less morbidity

Tunnel placement:

  • Tibial tunnel: Posterior, safe zone for popliteal vessels
  • Femoral tunnel: At native PCL footprint

Single vs double bundle: Double bundle may better restore rotation but technically demanding.

All-inside techniques minimize dissection.

Combined PCL/PLC Reconstruction

Stage or same-day:

  • Acute: Single-stage PCL + PLC reconstruction
  • Chronic: May need staged (PLC first for contracture)

Order of surgery:

  1. Address PCL first
  2. Reconstruct PLC
  3. Tension in appropriate position

Missing or undertreating PLC leads to PCL graft failure.

Tibial Avulsion Repair

Good bone fragment: Open or arthroscopic fixation.

Technique: Posterior approach, fix with screw or suture anchors.

Advantage: Anatomic, healing potential.

Usually excellent outcomes with bony healing.

Tibial Tunnel Safety

Popliteal artery at risk during tibial tunnel drilling. Stay within safe zone. Use posterior approach or trans-septal technique to visualize. Avoid exiting too posterior.

Complications

ComplicationCausePreventionManagement
Residual laxityGraft stretch, tunnel malpositionAnatomic placement, adequate graftRevision or accept
StiffnessImmobilization, adhesionsEarly ROMManipulation, arthrolysis
Vascular injuryTibial tunnel drillingSafe zone, visualizationImmediate repair
Patellofemoral OAAltered kinematicsRestore PCL functionSymptomatic treatment

Long-Term Outcomes

Chronic PCL deficiency leads to patellofemoral and medial compartment OA. Altered kinematics increase joint loading. Early intervention in combined injuries may prevent this.

Postoperative Care

PCL Reconstruction Rehabilitation

Week 0-2Protection

Brace locked extension. Non-weight bearing or toe touch. Quad sets only.

Week 2-6Early Motion

Progressive flexion (avoid beyond 90 degrees early). Avoid hamstring loading.

Month 2-4Progressive Loading

Full ROM. Weight bearing progression. Closed chain exercises.

Month 4-6Strengthening

Sport-specific preparation. Pool running. Light jogging.

Month 9-12Return to Sport

Full activity after passing functional tests. May be longer than ACL.

Protect the Graft

Avoid hamstring activation early (increases posterior tibial translation). Emphasize quads. Limit flexion beyond 90 degrees initially. Progress slower than ACL rehab.

Outcomes and Prognosis

Isolated vs Combined Outcomes

Isolated conservative: Many do well with rehabilitation. Some develop chronic laxity and OA over time.

Isolated reconstruction: Good outcomes in motivated patients. Return to sport possible.

Combined reconstruction: Outcomes depend on addressing all injured structures. Missing PLC leads to failure.

Long-Term Concerns

Patellofemoral OA: Common long-term sequela of PCL deficiency.

Medial compartment OA: Also increased with chronic PCL laxity.

Evidence Base and Key Studies

Natural History of Isolated PCL Injury

4
Shelbourne KD et al. • Am J Sports Med (1999)
Key Findings:
  • 133 isolated PCL injuries followed
  • Most returned to sport
  • Radiographic changes developed over time
  • Symptoms minimal in most
Clinical Implication: Isolated PCL injuries may be managed conservatively with good short-term outcomes.
Limitation: Long-term OA risk remains.

Combined PCL/PLC Reconstruction

4
LaPrade RF et al. • Am J Sports Med (2011)
Key Findings:
  • Combined reconstruction in 25 knees
  • Significant improvement in laxity
  • 80% good/excellent outcomes
  • Address both structures for success
Clinical Implication: Combined injuries need combined reconstruction for best outcomes.
Limitation: Small series, single surgeon.

Single vs Double Bundle PCL

1
Li Y et al. • Knee Surg Sports Traumatol Arthrosc (2018)
Key Findings:
  • Meta-analysis of SB vs DB PCL reconstruction
  • Similar clinical outcomes
  • DB may better restore rotation
  • No significant functional difference
Clinical Implication: Single bundle is acceptable; double bundle has theoretical advantages.
Limitation: Heterogeneous studies.

PCL Reconstruction Graft Choice

3
Chahla J et al. • Am J Sports Med (2019)
Key Findings:
  • Systematic review of graft options
  • Achilles allograft most common
  • Autograft lower failure in some studies
  • No clear superiority
Clinical Implication: Graft choice depends on surgeon preference and patient factors.
Limitation: Limited comparative data.

Outcomes of Tibial Avulsion Fixation

4
Katsman A et al. • Arthroscopy (2018)
Key Findings:
  • Systematic review of avulsion fracture fixation
  • Excellent outcomes with bony healing
  • Low failure rate
  • Anatomic restoration
Clinical Implication: Fix tibial avulsions - better outcomes than reconstruction.
Limitation: Limited high-quality studies.

Exam Viva Scenarios

Practice these scenarios to excel in your viva examination

VIVA SCENARIOStandard

Scenario 1: Dashboard Injury

EXAMINER

"A 35-year-old man presents after an MVC. His knee hit the dashboard. He has posterior knee pain and mild swelling. Posterior drawer shows the tibia flush with the femoral condyles. Dial test is negative. MRI confirms isolated PCL tear. How would you manage this?"

EXCEPTIONAL ANSWER
This is a Grade II isolated PCL injury from a classic dashboard mechanism. With the dial test negative, there is no associated PLC injury. Isolated Grade II PCL injuries generally do well with conservative management. My treatment would include initial bracing in extension to prevent posterior sag, followed by an aggressive quadriceps strengthening program. I would specifically avoid hamstring exercises initially as these increase posterior tibial translation. I would counsel him that most isolated Grade I-II PCL injuries have good functional outcomes with rehabilitation. He can return to normal activities once he has regained good quadriceps strength and is asymptomatic. I would monitor clinically and repeat stress examination if he develops any instability symptoms. However, if he had ongoing symptomatic instability after exhaustive rehabilitation (6+ months), I would consider PCL reconstruction.
KEY POINTS TO SCORE
Grade II = tibia flush with condyles
Dial test negative = isolated PCL
Conservative treatment appropriate
Quad strengthening, avoid hamstrings
Good prognosis for isolated Grade II
COMMON TRAPS
✗Rushing to surgery for isolated Grade II
✗Missing associated PLC injury
✗Excessive hamstring work early
✗Not counseling about long-term OA risk
LIKELY FOLLOW-UPS
"What if dial test was positive at 30 degrees?"
"When would you recommend surgery?"
"What is his long-term prognosis?"
VIVA SCENARIOChallenging

Scenario 2: Combined PCL/PLC Injury

EXAMINER

"A 28-year-old football player has a knee injury during a game. He has posterior and lateral knee pain. Posterior drawer shows Grade III laxity. Dial test shows 15 degrees increased external rotation at both 30 and 90 degrees compared to the opposite side. What is your management?"

EXCEPTIONAL ANSWER
This is a combined PCL and posterolateral corner injury. The Grade III posterior drawer indicates complete PCL disruption. The increased dial test at both 30 and 90 degrees suggests combined PCL and PLC injury (isolated PLC would only show increased rotation at 30 degrees). This combined injury pattern is a surgical indication. I would obtain MRI to confirm and delineate the PLC injury pattern (FCL, popliteus, posterolateral capsule). My surgical plan would be combined PCL and PLC reconstruction, ideally performed acutely within 2-3 weeks before PLC contracture develops. For PCL, I would use Achilles allograft or autograft through tibial and femoral tunnels. For PLC, I would use a reconstruction technique such as the LaPrade anatomic reconstruction addressing FCL and popliteus. Both structures must be addressed - missing PLC leads to PCL graft failure. Postoperatively, protected rehabilitation with emphasis on quad strengthening and avoiding hamstring loading. Return to sport at 9-12 months after passing functional testing.
KEY POINTS TO SCORE
Combined PCL + PLC injury pattern
Dial test positive at 30 AND 90 = combined
Surgical indication for combined injuries
Reconstruct both PCL and PLC
Early surgery prevents PLC contracture
COMMON TRAPS
✗Treating PCL alone (PLC will fail)
✗Delayed surgery with PLC contracture
✗Misinterpreting dial test
✗Missing the severity of injury
LIKELY FOLLOW-UPS
"How do you reconstruct the PLC?"
"What graft would you use for PCL?"
"What if this was chronic?"
VIVA SCENARIOCritical

Scenario 3: Chronic PCL Deficiency

EXAMINER

"A 40-year-old presents with anterior knee pain and medial knee pain for 2 years. He had a PCL injury 10 years ago treated conservatively. He now has difficulty with stairs. X-rays show Grade 2 patellofemoral and medial OA. Posterior drawer is Grade II. What would you recommend?"

EXCEPTIONAL ANSWER
This is chronic PCL deficiency with secondary osteoarthritis affecting the patellofemoral and medial compartments. This is a known long-term consequence of PCL insufficiency - altered knee kinematics increase loading on these compartments. My management approach would depend on his predominant symptoms and functional demands. Given he has established arthritic changes, PCL reconstruction alone may not address his pain and could potentially accelerate arthritis. I would first optimize conservative management: activity modification, physiotherapy for quadriceps strengthening, weight management if applicable, and analgesics. If he has persistent mechanical instability symptoms as the primary complaint, and the OA is not too advanced, I would consider PCL reconstruction. However, if his primary symptoms are arthritic pain rather than instability, reconstruction is less likely to help. In that scenario, I would discuss future options including possible osteotomy for malalignment or arthroplasty if symptoms warrant. This is a difficult clinical scenario where prevention (early surgery in combined injuries) would have been preferable.
KEY POINTS TO SCORE
Chronic PCL leads to PF and medial OA
Secondary to altered kinematics
Distinguish instability vs arthritis symptoms
Reconstruction may not help arthritis
Conservative management, future arthroplasty
COMMON TRAPS
✗Promising reconstruction will fix OA
✗Ignoring the arthritic component
✗Missing that this could have been prevented
✗Not optimizing conservative treatment
LIKELY FOLLOW-UPS
"What causes the OA pattern in PCL deficiency?"
"Would you do arthroplasty with PCL deficiency?"
"Could an osteotomy help?"

MCQ Practice Points

Primary PCL Function

Q: What is the primary function of the PCL? A: Restraint to posterior tibial translation - provides 95% of restraint near full flexion.

Classic Mechanism

Q: What is the classic mechanism for PCL injury? A: Dashboard injury - proximal tibia strikes dashboard with knee flexed, driving tibia posteriorly.

Grade II Definition

Q: What defines a Grade II PCL injury? A: Tibia flush with femoral condyles on posterior drawer. 5-10mm translation. Complete tear but may do well conservative.

Dial Test Interpretation

Q: Dial test positive at 30 degrees only vs 30 and 90 degrees? A: 30 degrees only = isolated PLC. 30 and 90 degrees = combined PCL + PLC. At 90 degrees, intact PCL prevents rotation.

Long-Term Sequela

Q: What are long-term consequences of PCL deficiency? A: Patellofemoral and medial compartment OA. Altered kinematics increase loading on these compartments.

Combined Injury Treatment

Q: Why do combined PCL/PLC injuries need surgery? A: PLC must be addressed to prevent PCL graft failure. Isolated PCL reconstruction with untreated PLC has high failure rate.

Australian Context

Clinical Practice

  • Relatively uncommon compared to ACL
  • Trend toward conservative for isolated
  • Combined injuries surgically treated
  • MRI readily available for diagnosis
  • Sports medicine specialists manage

Funding and Access

  • Allograft availability variable
  • Private covers procedures
  • Rehabilitation accessible
  • Variable wait times public

Orthopaedic Exam Relevance

PCL injuries are important viva topics. Know the grading system, dial test interpretation, and when to operate. Be prepared to discuss combined injuries and the rationale for addressing PLC.

POSTERIOR CRUCIATE LIGAMENT INJURIES

High-Yield Exam Summary

Grading (Posterior Drawer)

  • •Grade I: Tibia anterior to condyles (0-5mm)
  • •Grade II: Tibia flush with condyles (5-10mm)
  • •Grade III: Tibia posterior to condyles (greater than 10mm)
  • •Grade III often indicates combined injury

Clinical Tests (SPDQ)

  • •Sag sign: Observe at 90/90
  • •Posterior drawer: Key test at 90 degrees
  • •Dial test: 30 and 90 degrees for PLC
  • •Quadriceps active: Forward translation

Dial Test

  • •Positive at 30 only = isolated PLC
  • •Positive at 30 AND 90 = combined PCL + PLC
  • •At 90 degrees, intact PCL prevents rotation
  • •Critical for operative planning

Treatment Guidelines

  • •Isolated Grade I-II: Conservative with quad rehab
  • •Isolated Grade III: Consider surgery if active
  • •Combined injuries: Surgery for both
  • •Address PLC or PCL graft will fail

Surgical Pearls

  • •Fix tibial avulsions if present
  • •Tibial tunnel: beware popliteal artery
  • •Reconstruct PLC if combined
  • •Early surgery prevents PLC contracture
Quick Stats
Reading Time72 min
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