Clancy et al. describe a PCL reconstruction technique using a free bone-patellar tendon-bone autograft (medial one-third of the patellar tendon) in 48 patients. The paper reports clinical outcomes in 23 patients with minimum 2-year follow-up and documents the natural history of articular cartilage destruction in all 33 chronic cases. The central question: does early reconstruction prevent the progressive medial compartment chondral damage that untreated PCL insufficiency causes?
The 2-year mark after PCL injury is a critical threshold. Before this paper, the chondral consequences of untreated PCL insufficiency were not well characterized for isolated injuries. Clancy's intraoperative data showed that articular cartilage destruction is already present in the majority of patients who present for late reconstruction.
When you evaluate a suspected PCL tear, test the posterior drawer in neutral rotation first. A drawer that diminishes or disappears in internal rotation does not mean the PCL is intact — it means the ligament of Humphry or Wrisberg is doing the work. Confirm the diagnosis with neutral-rotation testing and imaging before reassuring the patient.
For chronic PCL insufficiency, do not be falsely reassured by normal radiographs. This paper shows X-rays detected moderate or severe chondral damage in only 31% of cases where it was present at surgery. If you're considering delayed reconstruction, the cartilage is likely worse than the films suggest.
When both PCL and ACL are deficient, reconstruct the PCL first (or both simultaneously). Isolated ACL reconstruction in this setting fails at higher rates because the tibia continues to subluxate posteriorly, unloading and stretching the new ACL graft before it can incorporate.
Clancy et al. describe a PCL reconstruction technique using a free bone-patellar tendon-bone autograft (medial one-third of the patellar tendon) in 48 patients. The paper reports clinical outcomes in 23 patients with minimum 2-year follow-up and documents the natural history of articular cartilage destruction in all 33 chronic cases. The central question: does early reconstruction prevent the progressive medial compartment chondral damage that untreated PCL insufficiency causes?
The 2-year mark after PCL injury is a critical threshold. Before this paper, the chondral consequences of untreated PCL insufficiency were not well characterized for isolated injuries. Clancy's intraoperative data showed that articular cartilage destruction is already present in the majority of patients who present for late reconstruction.
When you evaluate a suspected PCL tear, test the posterior drawer in neutral rotation first. A drawer that diminishes or disappears in internal rotation does not mean the PCL is intact — it means the ligament of Humphry or Wrisberg is doing the work. Confirm the diagnosis with neutral-rotation testing and imaging before reassuring the patient.
For chronic PCL insufficiency, do not be falsely reassured by normal radiographs. This paper shows X-rays detected moderate or severe chondral damage in only 31% of cases where it was present at surgery. If you're considering delayed reconstruction, the cartilage is likely worse than the films suggest.
When both PCL and ACL are deficient, reconstruct the PCL first (or both simultaneously). Isolated ACL reconstruction in this setting fails at higher rates because the tibia continues to subluxate posteriorly, unloading and stretching the new ACL graft before it can incorporate.