Natural history of nonoperatively treated posterior cruciate ligament injuries

The treatment of isolated posterior cruciate ligament (PCL) injuries remains controversial. This review discusses the physical examination and diagnosis of PCL injuries, the healing potential of the PCL, and the findings of the natural history of isolated PCL injuries. The diagnosis of isolated PCL laxity can be difficult owing to the low-energy mechanism for injury. A thorough history of the injury and associated symptoms is essential. The posterior drawer test with the knee in 90 degrees of flexion is the most sensitive for detecting PCL laxity. There was no correlation between grade of isolated PCL laxity and radiographic joint space narrowing at 5 years after injury. The mean total subjective score was 84 points, which indicates some level of difficulty. The subjective scores did not correlate with PCL laxity grade, patient's age, or time from injury. Of patients who scored above 90 points at 1 year after the injury, 90% continued to score above 90 points in the long term. Independent of grade of PCL laxity, one half of patients returned to their preinjury activities at the same level, one third returned to the same activities at a lower level, and one sixth did not return to their preinjury activities.