Can We Predict Posterior Cruciate Ligament Degeneration with Functional Tests?

The PCL (posterior cruciate ligament) is the primary stabilizer to prevent posterior translation of the knee. It provides femoral roll-back, stability and proprioception. Pathology of the PCL are limited in the literature. The aim of this study was to histopathologically examine the PCL of patients undergoing total knee arthroplasty for gonarthrosis and to investigate the correlation of PCL histopathology with preoperative functional scores.

Seventy-three patients (19 males, 54 females) aged 50-75 years, with primary osteoarthritis, where bilateral knee arthroplasty was performed in three patients, resulting in 76 tibial plateaus, were included in the present study. Patients with a history of previous intra-articular knee surgery and rheumatic disease were excluded. Posterior cruciate ligament materials were graded between stages 0 and 4 according to the extent of histopathological changes recorded under light microscopy. Correlation of PCL histopathology with preoperative functional scores. SF-36 limitations of activities and physical health problems, Pain Quality Assessment Scale (PQAS), Lysholm and WOMAC scoring systems were assessed preoperatively.

There were significant correlations between light microscopic histopathologic staging of PCL and preoperative SF-36 limitations of activities (p<0.01), physical health problems (p<0.05); PQAS intense (p<0.05), radiating (p<0.01), throbbing (p<0.05), aching (p<0.05), heavy (p<0.05); Lysholm total (p<0.001); and WOMAC total scores (p<0.01). The correlation between histopathologic staging of PCL and using a cane or crutches of Lysholm and radiating of PQAS was found to be moderately significant (p<0.001, p<0.01).

Despite significant correlations, the commonly used functional scores may not be sufficiently precise for granular preoperative assessment of PCL microscopic degeneration, highlighting the need for PCL-specific scoring systems.