The posterior cruciate ligament (PCL) is a primary stabilizer of the knee joint and the major restraint to posterior translation of the tibia. PCL injuries commonly occur as a result of motor vehicle accidents and athletic activities. Numerous specific tests for PCL injury exist, and these tests offer a reliable way to diagnose pathology. Conservative nonsurgical treatment is recommended for acute isolated grade I or grade II PCL tears and consists of splinting and protective weight bearing followed by range-of-motion and quadriceps-strengthening exercises. Indications for surgical intervention include avulsion fractures of the PCL, combined ligamentous injuries involving the PCL, chronic injuries with persistent instability or pain despite nonsurgical treatment, and chronic injuries that demonstrate progressive degenerative changes on bone scans or radiographs. Surgical treatment options include arthroscopic transtibial single-bundle reconstruction, tibial inlay techniques, and double-bundle reconstruction.
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