2015 ISAKOS Biennial Congress ePoster #2002

Posterior Cruciate Ligament Injuries Treated by Less Rigid Immobilization and Protective Exercises

Kou Suzuki, MD, Hakodate-Shi, Hokkaido JAPAN
Tatsunori Maeda, MD, Hakodate, Hokkaido JAPAN
Yasumitsu Ohkoshi, MD, Hakodate, Hokkaido JAPAN
Hakodate Orthopaedics Clinic, Hakodate-shi, JAPAN

FDA Status Not Applicable

Summary: In this study, Usefulness of our conservative treatment that the improvement of the posterior instability and clinical symptoms was got from less rigid immobilization and protective exercises for posterior cruciate ligament injuries was shown.

Abstract:

In isolated posterior cruciate ligament (PCL) injuries, there are many reports of conservative treatment producing good results. However, an effective method to improve both instability and clinical symptom has not been established yet. The objective of our study was to investigate the clinical outcome of our non-operative treatment of the PCL injuries. This study included 20 PCL injuries with or without partial injuries of posteromedial/posterolateral structures. Initial immobilization of the knee was begun within one month after the injury (acute phase) in 17 patients and within 1 to 3 months (sub-acute phase) in 3 patients. Our methods of knee immobilization were simple and less rigid. Soft knee brace was applied to all patients at about 10° of knee flexion for initial 2-3 weeks, and full weight bearing was permitted immediately. And then, PCL functional brace was applied for another 3-5 months. Protective exercises to prevent tibial posterior displacement were started to aid the recovery of muscle strength and full mobility. All of the patients were directly examined with minimum follow-up period of 16.7 months (mean, 39.3 months). The initial and follow-up stability was tested by posterior drawer test and graded PCL laxity as 1 to 3. Grade 2 indicates that the anterior tibial plateau is flush with the medial femoral condyle. Clinical symptoms were evaluated using the Lysholm score and Knee Outcome Survey (KOS) at the final follow-up.
The initial PCL laxity was grade 1 in 3 patients, grade 1.5 in 3 patients, grade 2 in 6 patients, grade 2.5 in 2 patients and grade 3 in 6 patients. Follow-up PCL laxity was less than grade 1 in 10 patients, grade 1 in 4 patients, grade 1.5 in 1 patient, grade 2 in 2 patients, grade 2.5 in 1 patient, grade 3 in 2 patients. Increased laxity from the initial examination to follow-up was found in one patient (5%), and decreased laxity was found in 17 patients (85%). The number of patients with instability grade 1 or less was 15 patients (75%) at the time of follow-up. Three patients that they were treated at the sub-acute phase had improvement of the instability. The PCL reconstruction was carried out in 5 patients (2 cases; re-injury after returning sports activities, 3 cases; severe instability in the daily living. ). Mean Lysholm and KOS scores at a follow up were 95.2±5.3 and 96.4±4.5, respectively. It was considered that initial immobilization is important for the conservative treatment of PCL injuries as several studies reported. This study showed that improvement of both posterior instability and clinical symptom were obtained with our simple and less rigid immobilization, and then protective exercises. Moreover, 3 sub-acute patients showed improvement of posterior instability, this fact indicated high potential of PCL to heal conservatively. It was thought that non-operative treatment for PCL injury should be tried even if it was at the sub-acute phase.