2015 ISAKOS Biennial Congress ePoster #2014
PCL-Combined Knee Injuries in a Population of Over 100 Patients: Epidemiology, Diagnosis and Treatment Algorithm
Romain Rousseau, MD, Paris FRANCE
Konstantinos G. Makridis, MD, MSc, PCAOSD, PhD.c, Larisa, THESSALY GREECE
Gilles Pasquier, Roubaix FRANCE
Bruno Miletic, MD, Lille FRANCE
Patrick Djian, MD, Paris FRANCE
Centre Nollet, Paris, FRANCE
FDA Status Not Applicable
Summary: The incidence of PCL injuries is variable and this is probably due to differences in the populations studied as well as to the fact that posterior laxity can be well tolerated and underdiagnosed for a long term.
Objectives: The purpose of this study was to determine the incidence, clinical and radiological diagnostic methods in a large population of over 100 patients with PCL-combined knee injuries.
Between January 2002 and December 2011, one-hundred and twelve patients with posterior knee laxity were treated. Diagnosis was made on the basis of clinical examination (drawer, pivot-shift, dial, varus and valgus stress tests), Magnetic Resonance Imaging (MRI), and Telos™ stress dynamic x-rays with and without contraction of the hamstring muscles. Data were recorded and statistically analysed with the use of Student t-test, Chi-square test, Fischer's exact test and analysis of variance (ANOVA). Significance levels were set at P < 0.05 with confidence intervals at 95% and 99%.
Mean age of patients at the time of injury was 28.6 ± 9.6 years (range 15-61). There were 95 men (84.8%) and 17 women (15.2%). Mean time from the initial injury to diagnosis was 16.3 ± 17.7 months (range 2-120). Road traffic accidents (54%) and sports injuries (42.5%) were the main causes of trauma. Mean time delay to final treatment was 18.6 ± 15.2 months (range 2-64) for road traffic accidents and 14.2 ± 20.8 months (range 2-120) for sports injuries (p=0.2179). Combined ACL and PCL ruptures were due to road traffic accidents in 22 cases (53.6%) and sports injuries in 17 cases (41.5%). Thirty-two patients (28.3%) had isolated posterior laxity, 53 patients (46.9%) had posterior posterolateral laxity, and 21 patients (18.6%) had posterior posteromedial laxity. Meniscal and/or cartilage injuries were found in 70 patients (62%). No significant difference was found between the type of laxity and the presence of cartilage and/or meniscal lesions (p=0.3942). %). Sixteen patients had an ipsilateral diaphyseal fracture of the tibia or femur (14%). One patient had a floating knee injury. In five cases, there was a concomitant ipsilateral hip injury (4.4%) (i.e., dislocation, femoral neck fracture, acetabulum fracture).
Due to the complexity of PCL injuries, a high index of suspicion and systematic examination are needed to avoid a misdiagnosis. Moreover, their coincidence with ipsilateral fractures, soft tissue, meniscal and cartilage lesions have a substantial impact on treatment outcome, especially in young patients who are mainly involved at the time of initial trauma. Despite the improvements that have been made regarding the diagnostic and surgical techniques, further studies are necessary and questions still exist concerning the time to surgery, choice of the graft, rehabilitation and management of concomitant injuries.