Neuromuscular and biomechanical adaptations of patients with isolated deficiency of the posterior cruciate ligament

Background: Functional adaptations of patients with posterior cruciate ligament deficiency (grade II) are largely unknown despite increased recognition of this injury. Hypothesis: Posterior cruciate ligament-deficient subjects (grade II, 6- to 10-mm bilateral difference in posterior translation) will present with neuromuscular and biomechanical adaptations to overcome significant mechanical instability during gait and drop-landing tasks. Study Design: Controlled laboratory study. Methods: Bilateral comparisons were made among 10 posterior cruciate ligament-deficient subjects using radiographic, instrumented laxity, and range of motion examinations. Biomechanical and neuromuscular characteristics of the involved limb of the posterior cruciate ligament-deficient subjects were compared to their uninvolved limb and to 10 matched control subjects performing gait and drop-landing tasks. Results: Radiographic (15.3 +/- 2.9 to 5.6 +/- 3.7 mm; P = .008) and instrumented laxity (6.3 +/- 2.0 to 1.4 +/- 0.5 mm; P < .001) examinations demonstrated significantly greater posterior displacement of the involved knee within the posterior cruciate ligament-deficient group. The posterior cruciate ligament-deficient group had a significantly decreased maximum knee valgus moment and greater vertical ground reaction force at midstance during gait compared to the control group. During vertical landings, the posterior cruciate ligament-deficient group demonstrated a significantly decreased vertical ground reaction force loading rate. All other analyses reported no significant differences within or between groups. Conclusion: Posterior cruciate ligament-deficient subjects demonstrate minimal biomechanical and neuromuscular differences despite significant clinical laxity. Clinical Relevance: The findings of this study indicate that individuals with grade II posterior cruciate ligament injuries are able to perform gait and drop-landing activities similar to a control group without surgical intervention.