Posterior Cruciate Ligament Rupture

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This male academy football player presented after a fall onto his flexed knee. When examined he had an increase in his posterior drawer, a limitation of terminal knee flexion and no effusion. He had no other significant signs.

An x-ray series of the knee was normal. This sagittal MRI image shows a complete rupture of the player’s posterior cruciate ligament. There is a loss of the contour of the posterior cruciate ligament with the structure being thickened and of abnormal signal. There is no other major structural abnormality.

The player was managed with a six week period of rehabilitation. He responded well to a short period of relative rest, followed by a progressive running programme and a return to football. This happened six weeks after diagnosis.

Injuries to the posterior cruciate ligament typically occur (in a sporting context) after a fall onto a flexed knee or from a direct blow to the anterior tibia with the foot planted. Clinical findings are of pain in the posterior aspect of the knee which may not be associated with an effusion as the ligament is extra-articular. The diagnosis can often be made on clinical grounds with the finding of an increased posterior draw. X-rays should be requested – but are generally normal. An MRI scan can define this injury very well. 

In contrast to injuries involving the anterior cruciate ligament, it would be rare for this injury to be managed surgically. It is relatively unusual to have significant ongoing disability (in the short to medium term) and in particular instability. The most common complication is persisting anterior knee pain. Most players are able to return to football at around the six weeks post injury.

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