RUPTURE OF THE POSTERIOR CRUCIATE LIGAMEN T - THE BEST TREATMENT TODAY

The posterior cruciate ligament acts as a complex system and is formed by the anterolateral an posteromedial bundle an the meniscofemoral li gaments. The main function of the ligament is stabilization of the tib ia against posterior subluxation in flex ion of the knee. Isolated PCL deficiency is compensated by increased quadriceps action in many pati ents for years, although natural history studies demonstrate retropate llar and medial osteoarthritis after 5-15 years in a not yet defined p ercentage. Osseous avulsion of the PCL from the tibia have a good prog nosis when treated by open reduction and stable fixation. Ruptures of the ligament should not be treated by suture repair, since this techni que has failed to restore posterior knee stability in most studies. Au gmented repair and reconstruction of the ligament tend to improve the objective results, although the clinical data are not yet conclusive. Complex posterior instability should be treated by acute ligament reco nstruction, since the results of conservative treatment are inferior a nd operative treatment in chronic complex posterior instability is ext remely difficult. Potential osseous abnormalities (varus morphotype) a nd posterolateral rotatory instability must be addressed in these case s. PCL reconstruction with a patellar tendon graft can be performed wi th a two tunnel technique or with a Femur tunnel and a direct tibial g raft fixation via a posterior approach. The results reported in the li terature do not support the use of augmentation devices in PCL surgery .