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KMID : 0828619980020010025
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Journal of Korean Arthroscopy Society
1998 Volume.2 No. 1 p.25 ~ p.32
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Management of the PCL Injuries
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Abstract
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The distinction between isolated and combined injuries is crucial bosh for treatment
and prognosis. For most combined injuries, surgical treatment continues to be favored
over nonoperative treatment It is generally agreed that isolatel PCL injuries do well
without surgery.
There has been an interest by many authors to fix the graft directly to the posterior
aspect of the tibia (tibial inlay). With this procedure, tibial graft fixation will be more
direct and the oretically reduce the bending effects of the graft with a fixation site far
away from the tibial insertion.
Modified tibial inlay technique which is the posterior approach does not require the
patient to be in the prone or lateral decubitus position during the operation.
Use of a double-bundle reconstructive technique is attractive and has been performed
by some surgeons. At this time this procedure is still being investigated and should not
be routinely used in the clinical setting until studies have indicated an advantage over
current single-bundle techniques.
However theologically, double-bundle reconstructive technique is more useful in severe
posterior unstable knees.
Recent advances have increased our knowledge of the anatomy and mechanical
characteristics of the PCL. Basic science research has further increased our awareness
of the interaction of the posterolateral structures with the PCL.
To achieve restoration of normal posterior laxity, it is critical to address the posterior
as well as the postero-lateral structures.
Surgical treatment is often complex and requires a wide range of surgical techniques
and skills to treat associated injuries. When the PCL is reconstructed, most surgeons
choose to reconstruct the anterolateral component using a graft of sufficient size and
strength. The initial postoperative rehabilitation should be addressed cautiously in an
effort to avoid excessive forces on delicate repairs and reconstructions in these complex
injuries. Further research is necessary to evaluate new surgical approaches such as
double-bundle reconstructions and tibial inlay techniques as well as improved techniques
for capsular and collateral ligament Injuries.
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