Effect of posterior cruciate ligament deficiency on in vivo translation and rotation of the knee during weightbearing flexion.
BACKGROUND
The effect of posterior cruciate ligament (PCL) deficiency on 6 degrees of freedom in vivo knee-joint kinematics is unclear.


OBJECTIVE
In addition to constraining anterior-posterior translation, the PCL also functions to constrain the medial-lateral translation and rotation of the knee during weightbearing flexion of the knee.


METHODS
Controlled laboratory study.


METHODS
Eight patients with a PCL injury in 1 knee and the other intact were scanned with magnetic resonance imaging, and 3-dimensional models of the femur and tibia were created for both knees. Each knee was imaged during quasistatic weight-bearing flexion (from 0 degrees to 105 degrees ) using a dual-orthogonal fluoroscopic system. The translation and rotation of the PCL-deficient knee were compared with the intact contralateral control.


RESULTS
Posterior cruciate ligament deficiency caused an increase in posterior tibial translation beyond 30 degrees of flexion compared with the intact contralateral knees. At 90 degrees of flexion, PCL deficiency increased posterior tibial translation by 3.5 mm (P < .05). In the medial-lateral direction, PCL deficiency resulted in a 1.1 mm increase in lateral tibial translation at 90 degrees of flexion (P < .05). With regard to rotation, PCL deficiency caused a significantly lower varus rotation (on average, 0.6 degrees lower) at 90 degrees of flexion. Posterior cruciate ligament deficiency caused a decreased internal tibial rotation throughout the range of flexion, but no significant difference was detected.


CONCLUSIONS
This study quantitatively describes the effect of PCL injury on 6 degrees of freedom kinematics of the knee during quasistatic weightbearing flexion. Using the intact contralateral side as a control, we found that PCL injuries not only affect anterior-posterior tibial translation but also medial-lateral translation and rotation of the knee.


CONCLUSIONS
These data provide baseline knowledge of the in vivo kinematics of the knee after PCL injury. Surgical reconstruction of the injured PCL, either using single-bundle or double-bundle technique, should not only focus on restoration of posterior stability of the knee but also the medial-lateral stability as well as the rotational stability. These findings may help to explain the long-term degenerative changes seen in PCL-deficient knees.
Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA. gli1@partners.org
Guoan
G
Li
Ramprasad
R
Papannagari
Meng
M
Li
Jeffrey
J
Bingham
Kyung W
KW
Nha
Dain
D
Allred
Thomas
T
Gill
D000328:Adult; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D007718:Knee Injuries / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D016119:Posterior Cruciate Ligament / Q000293:injuries* / Q000503:physiopathology; D012399:Rotation; D016474:Weight-Bearing / Q000502:physiology*