Sports Medicine Experts Team Up with International Colleagues to Study Posterior Cruciate Ligament Injuries

Researchers from the University of Pittsburgh Departments of Orthopaedic Surgery and Physical Therapy, along with colleagues from Technical University of Munich and Sahlgrenska University Hospital, questioned how much we really know about posterior cruciate ligament injuries. They answered that question in a 2021 study published in Knee Surgery, Sports Traumatology, Arthroscopy.

According to the study, severe anterior knee pain, an increasing feeling of instability, and a striking hyperextension-varus thrust [16] (i.e., triple varus) clearly demonstrated the devastating effects of recurrent posterior cruciate ligament (PCL) and posterolateral corner (PLC) insufficiency in a recently treated patient in the outpatient clinic of the Department of Orthopedic Surgery in Pittsburgh. In an effort to provide the best and most evidence-based scientific knowledge, the team felt compelled to review the literature and present the current standard of care for isolated, combined, and recurrent PCL injuries [21, 22].

The comprehensive literature review opened their eyes. What do we actually know about PCL graft failures and recurrent instability? Was the cause of surgical PCL graft failure in the presented patient an inappropriate graft choice, non-anatomic tunnel placement, underlying bony deformities, wrong timing, non-compliance of the patient, bad luck, or even the decision for operative treatment? The team delves into treatment options and differences between ACL and PCL cases – including all they’ve learned from the late Freddie H. Fu, MD, the most published author in knee ligament research.

The editorial highlights numerous controversies in the management of PCL injuries and appeals to all basic scientists and clinical researchers to continue their vigorous efforts to find more evidence. Given the low incidence of PCL injuries, large-scale studies with a high level of evidence (i.e., randomized controlled trials) are currently missing/on the way. Large-scale prospective clinical studies are required to shed light on controversial topics. The team urges their colleagues to never forget Dr. Fu’s motto, “Respect the past and embrace the future”. Therefore, they look with great curiosity into the future of PCL research.

View the full study.

The Research Team

Volker Musahl, MD
Department of Orthopaedic Surgery, University of Pittsburgh

Jonathan Hughes, MD
Department of Orthopaedic Surgery, University of Pittsburgh

James Irrgang, PhD
Department of Physical Therapy, University of Pittsburgh

Jón Karlsson, MD, PhD 
Department for Orthopaedics, Sahlgrenska University Hospital, Sweden

Philipp W. Winkler, MD
Department for Orthopaedic Sports Medicine, Technical University of Munich, Germany