[Rupture of the posterior cruciate ligament: status of current treatment]

The posterior cruciate ligament acts as a complex system and is formed by the anterolateral an posteromedial bundle an the meniscofemoral ligaments. The main function of the ligament is stabilization of the tibia against posterior subluxation in flexion of the knee. Isolated PCL deficiency is compensated by increased quadriceps action in many patients for years, although natural history studies demonstrate retropatellar and medial osteoarthritis after 5-15 years in a not yet defined percentage. Osseous avulsion of the PCL from the tibia have a good prognosis when treated by open reduction and stable fixation. Ruptures of the ligament should not be treated by suture repair, since this technique has failed to restore posterior knee stability in most studies. Augmented 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 reconstruction, since the results of conservative treatment are inferior and operative treatment in chronic complex posterior instability is extremely difficult. Potential osseous abnormalities (varus morphotype) and posterolateral rotatory instability must be addressed in these cases. PCL reconstruction with a patellar tendon graft can be performed with a two tunnel technique or with a Femur tunnel and a direct tibial graft fixation via a posterior approach. The results reported in the literature do not support the use of augmentation devices in PCL surgery.