Original Articles
Arthroscopic evaluation of articular cartilage lesions in posterior cruciate ligament—Deficient knees*

https://doi.org/10.1053/jars.2003.50037Get rights and content

Abstract

Purpose: The goal of this study was to gain more information on the likelihood of developing cartilage lesions in posterior cruciate ligament (PCL)-deficient knees. Type of Study: Retrospective clinical study. Methods: Standardized arthroscopy records of 181 patients with a nonsurgically treated acute or chronic PCL injury were analyzed with respect to cartilage degeneration. Subgroups with different duration of PCL insufficiency, the influence of isolated PCL or combined PCL/posterolateral instability, and the grade of posterior laxity was analyzed. Results: PCL insufficiency significantly increased the risk of developing medial femoral condyle and patellar cartilage degeneration over time. Of patients whose PCL deficiency was present for more than 5 years, 77.8% showed degenerative cartilage lesions of the medial femoral condyle and 46.7% showed cartilage degeneration of the patella. After 1 year of PCL insufficiency, the number of medial femoral cartilage lesions increased threefold (13.6% v 39.1%). With the presence of combined PCL/posterolateral insufficiency the amount of medial femoral degeneration was significantly increased (36.6% v 60.6%). Conclusions: We found that PCL insufficiency is not a benign injury with respect to the development of degenerative articular cartilage lesions. The early and continuous increase in cartilage degeneration at the medial femoral condyle and the patella should be considered when discussing operative versus conservative treatment for a PCL-deficient knee. The rapid development of medial arthritis should also be considered during decision making, particularly in patients with combined PCL/posterolateral instability or those who underwent previous partial medial menisectomy.

Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 19, No 3 (March), 2003: pp 262–268

Section snippets

Methods

To diagnose and grade PCL insufficiency, bilateral posterior-stress radiographs were taken of all patients in 90° of knee flexion with a posterior-directed force on the tibia of 200 N using the Telos device (Telos GmbH, Marburg, Germany).18, 19 Stress radiographs were evaluated according to the technique described by Jacobsen20, 21 and others.22 The PCL was determined to be insufficient if a side-to-side difference (SSD) equal to 5 mm or more was present when the knee was stressed.

Standardized

Results

Demographic data for the patient population and subgroups are given in Table 1.

. Patient Demographic Data With Respect to Duration of PCL Deficiency

Empty CellAll patients (N = 181)Group I ≤30 days (n = 22)Group II 31 d-1 yr (n = 64)Group III 1-5 years (n = 50)Group IV >5 years (n = 45)
Time from injury to arthroscopy (mo)48 ± 74.90.4 ± 0.26.6 ± 2.928 ± 12.8152.1 ± 87
Age at injury (yr)26.9 ± 9.428.4 ± 7.828 ± 10.228.7 ± 10.722.8 ± 5.4*
Side-to-side difference of posterior tibial displacement on stress

Discussion

The natural course of the PCL-deficient knee, in particular the progression of degenerative articular cartilage changes, is still a focus of current debate.2, 4 In a larger prospective study of 133 sports active and young PCL deficient patients, Shelbourne et al.5 found no correlation between objective and subjective knee function and the grade of posterior laxity. Also, the degenerative changes seen with standard radiographs were not significantly increased after a mean follow-up of 5 years.

Acknowledgements

Acknowledgment: We gratefully acknowledge the help of Mrs. Petra Broschinski for data acquisition.

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    *

    Address correspondence and reprint requests to Michael J. Strobel, M.D., Orthopädische Gemeinschaftspraxis, Hebbelstrasse 14a, 94315 Straubing, Germany. E-mail: [email protected]

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