Posterior Cruciate Ligament Tear

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Posterior Cruciate Ligament Tear

Authors, Editors, Case Information Author: Drew Duerson, MD Affiliation: Nationwide Children's Hospital Senior Editor: Raul Rosario-Concepcion, MD Clinical Vignette: 16-year-old female softball athlete presents after an acute knee injury during a game. While sliding into a base her cleat got stuck in the dirt and knee twisted. She appreciated immediate swelling. She describes knee instability. On exam an effusion is appreciated with a positive posterior drawer. Type of Probe Used: 6-15 MHz linear array transducer. #1 - Video View Video Long axis view of the posterior cruciate ligament insertion on the tibia sliding medial to lateral revealing diffuse hypoechoic thickening of the ligament PCL Doppler Long axis view of the posterior cruciate ligament insertion on the tibia with power doppler and mild hyperemia of the nearby joint capsule. PCL contralateral comparison Long axis view of the posterior cruciate ligament insertion on the tibia of the contralateral knee measuring 4.8 mm thick. PCL Labeled Long axis view of the posterior cruciate ligament insertion on the tibia demonstrating hypoechoic thickening measuring 9.6 mm. PCL Long axis view of the posterior cruciate ligament insertion on the tibia Interpretation Image Interpretation: Sonographic evaluation of the left posterior knee reveals hypoechoic thickening of the posterior cruciate ligament at its distal attachment on the tibia. There is mild hyperemia of nearby capsule. Teaching Pearl: The posterior cruciate ligament (PCL) has its origin from the lateral aspect of the medial femoral condyle and insertion on the posterior intercondylar area of the tibia. PCL injuries have been reported to range from 1 to 44% of all knee injuries. PCL injuries often go overlooked when compared to anterior cruciate ligament tears. While the origin of the PCL is not seen on sonography the distal insertion can be evaluated. Normal ligament is hypoechoic, fan-shaped, and approximately 5 mm in thickness. Injury to the PCL will typically result in an increase in thickness compared to the contralateral knee (1). In a recent systematic review, it was found that in the diagnosis of PCL injury US was reported to have a sensitivity ranging from 83 to 100% and specificity from 87 to 100% supporting the use of this modality as a cost savings option to evaluate and manage PCL injuries (2). References: 1) CC, Tsai WC, Chen CP, Yeh WL, Tang SF, Kuo JK. Ultrasonographic examination of the normal and injured posterior cruciate ligament. J Clin Ultrasound. 2005 Jul-Aug;33(6):277-82. doi: 10.1002/jcu.20136. PMID: 16134155. 2) Stoianov AG, Patrascu JM, Hogea BG, Andor B, Florescu S, Misca LC, Laza R, Fericean RM, Mavrea A, Terzi A, Patrascu JM Jr. Point-of-Care Ultrasound for the Evaluation and Management of Posterior Cruciate Ligament Injuries: A Systematic Review. Diagnostics (Basel). 2023 Jul 12;13(14):2352. doi: 10.3390/diagnostics13142352. PMID: 37510096; PMCID: PMC10378212.
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Authors, Editors, Case Information

#1 - Video

PCL Doppler

PCL contralateral comparison

PCL Labeled

PCL

Interpretation

UPCOMING EVENTS

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