1995;15:551–61. When PCL is damaged, only one of the two bundles may be torn (see later description). As orthopedic surgeons gain more experience with posterior cruciate ligament (PCL) reconstruction and acquire better understanding of the long-term effects of PCL deficiency, it becomes increasingly important for radiologists to identify PCL tears [1, 2]. Treatment of PCL tears is controversial, and, unlike the treatment of an ACL tear, there is little agreement about the optimal treatment for all patients. Direct force is applied to the anterior aspect of the tibia when the knee is flexed, and the tibia is forcefully displaced posteriorly. Radiographics. PCL is also an intra-articular, extra-synovial structure. Case Discussion. Department of Radiology, Saitama Medical University, Moroyama, Saitama, Japan. Knowledge of the diagnosis and management of PCL tears lags behind that of anterior cruciate ligament (ACL) tears. However, as opposed to the ACL, where intact fibres on MRI indicate an intact ACL, intact fibres in the PCL do not mean that the knee is PCL intact. hbspt.forms.create({ Humphrey’s ligament is found in approximately 24% of patients, Wrisberg’s ligament in 23%, and both ligaments in 12% of patients (Fig. Meniscofemoral ligament is also called “the third cruciate ligament” and crosses in front of and behind PCL. PCL can be injured at various levels along itâs course. The most characteristic clinical feature is the âposterior sag sign.â However, a clinical diagnosis of PCL tear can be difficult, and MRI plays a crucial role in diagnosis. 1990;174:527â30. MR imaging of the posterior cruciate ligament: normal, abnormal and associated injury patterns. The ACL is not visible; Its fibres â normally black â are replaced by strands of high signal representing oedema within the torn ligament Sports injuries and car accidents (dashboard injury) are equally responsible for these injuries 1. bone contusion in lateral femoral condyle and posterolateral tibial plateau. Double PCL sign. The double PCL sign is associated with bucket-handle tears of the medial meniscus that occur in the presence of an intact anterior cruciate ligament (ACL). 4.2 PCL Tear PCL is thick and strong, and it is said to be less common than ACL tear (3â20% of all knee injuries, <1% of knee trauma requiring surgical intervention). The spectrum of PCL injuries includes partial tear or intrasubstance injury, complete ligamentous rupture, and avulsion of the PCL insertion site on the posterior tibia. This ligament connects the posterior horn of the lateral meniscus and the posterior surface of the medial femoral condyle. PCL receives tension at all angles during flexion and extension of the knee. Thursday, August 16, 2007 Musculoskeletal MRI. Because the specificity is high, the presence of indirect signs corroborates the diagnosis of ACL tear. Posterior cruciate ligament injury: MR imaging diagnosis and patterns of injury. PCL injuries occur most frequently at the middle portion of the PCL. Thus, the use of PCL stress x-rays is recommended in all patients with a suspected PCL tear to determine if a patient has a partial PCL tear, a complete isolated PCL tear, or a complete PCL tear with other concurrent ligament injuries. The posterior cruciate ligament (PCL) of the knee has received little attention in the radiology literature, but its importance in knee stability has come under close scrutiny in recent years. The PCL may look normal and seem to have healed completely, but the knee may still be PCL-deficient (Figure However, this may be due to the fact that it is difficult to diagnose PCL tear clinically. This is the most common cause of PCL tear. This article is based on a presentation given by David Rubin and adapted for the Radiology Assistant by Robin Smithuis. An isolated PCL injury is usually managed non-operatively. PCL is thick and strong, and it is said to be less common than ACL tear (3–20% of all knee injuries, <1% of knee trauma requiring surgical intervention). Grover JS, Bassett LW, Gross ML, et al. Home ⺠Musculoskeletal MRI ⺠... (NOT to be mistaken for tear ) (T2 bright signals less than fluid bright signals) (c)1-2 years post surgery resembles native PCL. Sonin AH, Fitzgerald SW, Hoff FL, et al. Sagittal T2-weighted FSE fat-suppressed image shows diffuse high-intensity changes ( arrow ) which involve the entire posterolateral bundle and partially the anteromedial bundle at the tibial insertion of the ligament Many patients will be asymptomatic and their clinical examination is unremarkable. Treatment of a PCL Tear . It becomes thinner as it approaches the tibia, and it is partially embedded within the joint capsule. an accurate clinical test to diagnose posterior cruciate ligament 1990;174:527–30. Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window), Lateral Supporting Structures Including Lateral Collateral Ligament (LCL). However, this may be due to the fact that it is difficult to diagnose PCL tear clinically. Likely partial tear of the anterior root. MR imaging of the posterior cruciate ligament: normal, abnormal, and associated injury patterns. Nondisplaced fracture of the posteromedial tibial plateau and grade 1 sprain of the fibular collateral and biceps femoris tendons. Acute PCL tears, with posterior tibial translation between 8 mm ⦠Magnetic resonance imaging of the knee demonstrated a complete tear of the posterior cruciate ligament (PCL). Posterior cruciate ligament: MR imaging. Radiology Imaging. This review focusses on all the non-meniscal pathology of the knee. In general, the literature reports that a complete isolated PCL tear has Note that it has the same name as the deep layer of the MCL (see later description). Anterior cruciate ligament tear: indirect signs at MR imaging. Fill out the form below and we’ll get in touch! Recognition of the normal and injured appearances of the PCL is useful to aid the reader in the detection and characterisation of PCL injuries. Popliteus myotendinous junction sprain with microtears with large hematoma likely arcuate ligament injury. Rodriguez W Jr, Vinson EN, Helms CA, Toth AP. PCL injury alone is very rare, and often damages to ACL, collateral ligaments and menisci coexist. The In normal condition, it is impossible to differentiate these two on MRI, and PCL appears as a one band with homogeneous texture.   Initial treatment of the pain and swelling consists of the use of crutches, ice, and elevation. A bucket-handle tear is a longitudinal tear of a meniscus that results in a displaced but attached meniscal fragment. However, some patients may have Radiology 219:375â380. Uncommonly, it avulses from its tibial attachment. Sonin AH, Fitzgerald SW, Hoff FL et al. Damages to menisci and cartilage secondary to PCL tear is less commonly seen than in ACL tear. Isolated acute PCL tears ⦠When PCL injury and posterolateral instability coexist, surgical repair of the PCL is indicated. It is a highly specific indicator of a bucket-handle meniscal tear (3). It contains two fiber bundles named according to their relative attachments 1: anterolateral; posteromedial; Function Routine knee MRI in eleven patients (7 males, 4 females) with arthroscopically confirmed ⦠Tap on/off image to show/hide findings. In this mechanism, PCL is torn in the middle portion, and the posterior joint capsule may also be disrupted. Fanelli GC, Edson CJ. This study aimed to determine whether posterior tibial translation relative to the femur on routine MRI could serve as an additional sign of PCL tear. Inexperience with this injury is ⦠The posterior drawer test is an accurate clinical test to diagnose posterior cruciate ligament (PCL), indicating laxity of the PCL that allows posterior tibial translation. Associated injuries include injury of other ligaments, meniscal tear, bone injury, and joint effusion. The latter is slightly larger than the former. }); Join for free to access over 300 on-demand lectures from renowned faculty. reduced PCL angle due to buckling of PCL. Posterior cruciate ligament injuries in trauma patients: part II. PCL Mucoid Degeneration-MRI. MRI appearance of posterior cruciate ligament tears. It receives abundant vascular supply. MRI Knee - Sagittal T1 - ACL complete tear. Click image to align with top of page. Learn More About Resident and Group Memberships, Don’t Mess with the Esophagus on Chest Exams, Dr. Susan K. Hobbs (5/21/21), Interesting and Challenging Cases from the ER, Dr. Rony Kampalath (5/19/21), Non-Rheumatological Synovial Diseases, Dr. Tatiane Cantarelli (5/17/21), PCL tears are most commonly due to sports-related trauma and impaction of a flexed knee on a dashboard in motor vehicle accidents, The PCL acts as the primary restraint to posterior tibial translation, Up to 70% of PCL tears are associated with other ligamentous injuries with posterolateral corner injuries being the most common, The PCL consists of anterolateral and posteromedial bundles, The PCL is normally seen on MR as a well defined continuous band of low signal intensity, Partial thickness tears appear as ligament thickening and intrasubstance increased signal, Complete tears are seen as ligamentous disruption and have an abnormal contour, An anteroposterior PCL measurement of 7mm (vertical portion) on T2 weighted imaging is strongly suggestive of a PCL tear, May be associated with tibial avulsion fracture at the PCL insertion site, posterolateral corner injuries and microtrabecular injury to the anterior tibial plateau and posterior femoral condyle, Hyperextension injuries are commonly associated with avulsion at the tibial attachment, The presence of associated ligamentous and/or meniscal injuries is usually an indication for surgical rather than conservative management. Because the sensitivity is low, the absence of these signs does not exclude the diagnosis of ACL tear. Direct force to the anterior aspect of the tibia: This is seen in “dashboard injury” in car accidents. Radiology. Anterior cruciate ligament shows evidence of complete tear seen as a discontinuity of the ligament at its mid-segment with retraction of its fibers. Capsular swelling with large hemarthrosis. The PCL is intracapsular but extrasynovial and is approximately 13 mm in length and less than 6 mm in anteroposterior diameter. http://drrobertlaprademd.com/Colorado knee specialist Dr. Robert LaPrade breaks down the specific on how to read an MRI of a PCL tear. The detection of PCL tears by physical exam relies upon the examinerâs ability to identify abnormal posterior translation of the tibia relative to the femur by various maneuvers. The main questions in PCL tear treatment are to elucidate whether it is an acute or chronic lesion and an isolated or combined injury. To have PCL torn, an enormous force is required, which is mostly due to traffic accident and rarely due to sports injury. In the study performed by Patten et al in 59 patients of acute PCL injury, the PCL tear sites were: 42% at tibial, 36% at femoral and 22% at midsubstance levels.7 Most of the tears of PCL were in the distal two thirds in the Patten et al ⦠Bone bruise may be seen in the posterior surface of the lateral femoral condyle and the anterior part of the tibial plateau (Fig. Hover on/off image to show/hide findings. A complete tear is also called when the PCL in the short axis is thicker than 7mm (Figure 18aâd) . Its tibial attachment site is located 1 cm below the articular surface. Its mean length is 38 mm and mean width is 13 mm. The double posterior cruciate ligament (PCL) sign is a low-signal-intensity band that is parallel and anteroinferior to the PCL on sagittal MR images. These lectures are not eligible for CME. The patient is supine and the knee to be tested is flexed to approximately 90 degrees. Partial tear of the anterior cruciate ligament (ACL) involving more than 75 % of the distal ligament thickness in a 19 year old male. We present a case of mucoid degeneration of the posterior cruciate ligament (PCL) in a 50 year old who complained of knee joint pain on flexion. formId: "466b76e2-29f2-435c-86f4-63bb65f59ad5" Unrepaired injury of the PCL can lead to chronic instability and early joint degeneration. Even if PCL is damaged and its function impaired or lost, the knee instability upon weight-bearing is less commonly seen than in ACL tear, and patients may not be aware of any symptoms. The PCL is normally seen on MR as a well defined continuous band of low signal intensity Partial thickness tears appear as ligament thickening and intrasubstance increased signal Complete tears are seen as ligamentous disruption and have an abnormal contour PCL rupture is easily identified with magnetic resonance (MR) imaging by using simple signal intensity and structural ⦠When a PCL tear is suspected, radiologists will commonly examine the patientâs MR images for secondary ... (2001) Normal and acutely torn posterior cruciate ligament of the knee at US evaluation: preliminary experience. The portion of the meniscofemoral ligament that crosses in front of PCL is Humphrey’s ligament, and that crosses behind PCL is Wrisberg’s ligament. Home Treatment of a Posterior Cruciate Ligament Injury. CT SCAN, MRI, ULTRASOUND, X RAY. Other associated signs are: positive PCL line sign. PCL runs within the intercondylar space in the superior-inferior direction, almost in parallel to the long axis of the knee (Fig. Radiology department of the Washington University School of Medicine, St. Louis, USA and the Rijnland hospital in Leiderdorp, the Netherlands . The most sensitive and specific test to detect injury to the PCL is the For initial treatment of a PCL injury, the ⦠Radiology. In such cases, extraarticular repair of the posterolateral corner is necessary to restore knee motion patterns 2 and to improve the chances of success of the PCL reconstruction 3. PCL consists of two main fibrous bundles, that is, thicker anterolateral bundle and thinner posteromedial bundle. PCL is twice as thick as ACL, and it has twice as strong tensile strength as other ligaments in the knee. The examiner then sits on the toes of the tested extremity to help stabilize it. https://www.cosportsmedicine.com/specialties/knee/pcl-tears-denver-co portalId: "4177793", Publicationdate 2005-8-2 0. Magnetic resonance imaging (MRI) showed a diffusely thickened PCL with increased signal intensity on the T1 weighted sequence. MRI Online is a premium online continuing education resource for practicing radiologists to expand their radiology expertise across all modalities, read a wide variety of cases, and become a more accurate, confident, and efficient reader. MRI Knee - Sagittal T1 - ACL complete tear. Three radiologists retrospectively reviewed MR images and medical records on 32 patients with PCL tears (15 complete, 17 partial) and correlated MRI findings to results of clinical testing and surgery. Sonin AH, et al. Injury to the posterior cruciate ligament (PCL) can range from a stretch to a total tear or rupture of the ligament.
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