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The Effect of Posterior Cruciate Ligament Deficiency on Knee Kinematics

Martin Logan, BSc, MBChB, MRCS(Eng, Glasg)^*,, Andrew Williams, MBBS, FRCS(Orth), Jonathon Lavelle, MBBS, FRCS(Orth), Wady Gedroyc, MBBS, FRCP, FRCR and Michael Freeman, MD, FRCS

From the Interventional MR Unit, St. Mary’s Hospital, London, England, and the Department of Orthopaedics and Trauma Surgery, Chelsea and Westminster Hospital, London, England

^* Address correspondence to Martin Logan, BSc, MBChB, MRCS(Eng, Glasg), Clinical Research Fellow, Interventional MR Unit, St. Mary’s Hospital, London, UK W2 1NY (e-mail: mlogan100{at}hotmail.com).

Background: Alteration of the kinematics of the PCL-deficient knee might be a factor in producing the articular damage. Very little is known about the in vivo weightbearing kinematics of the PCL-deficient knee.

Hypothesis: Isolated rupture of the posterior cruciate ligament alters knee kinematics, predisposing the patient to development of early osteoarthritis.

Study Design: Case series.

Methods: Tibiofemoral motion was assessed using open-access magnetic resonance imaging, weightbearing in a squat, through the arc of flexion from 0° to 90° in 6 patients with isolated rupture of the posterior cruciate ligament in one knee and a normal contralateral knee. Passive sagittal laxity was assessed by performing the posterior and anterior drawer tests while the knees were scanned, again using the same magnetic resonance imaging scanner. The tibiofemoral positions during this stress magnetic resonance imaging examination were measured from midmedial and midlateral sagittal images of the knees.

Results: Rupture of the posterior cruciate ligament leads to an increase in passive sagittal laxity in the medial compartment of the knee (P < .006). In the weightbearing scans, posterior cruciate ligament rupture alters the kinematics of the knee with persistent posterior subluxation of the medial tibia so that the femoral condyle rides up the anterior upslope of the medial tibial plateau. This fixed subluxation was observed throughout the extension-flexion arc and was statistically significant at all flexion angles (P < .018 at 0°, P < .013 at 20°, P < .014 at 45°, P < .004 at 90°). The kinematics of the lateral compartment were not altered by posterior cruciate ligament rupture. The posterior drawer test showed increased laxity in the medial compartment.

Conclusion: Posterior cruciate ligament rupture alters the kinematics of the medial compartment of the knee, resulting in "fixed" anterior subluxation of the medial femoral condyle (posterior subluxation of the medial tibial plateau). This study helps to explain the observation of increased incidence of osteoarthritis in the medial compartment, and specifically the femoral condyle, in posterior cruciate ligament–deficient knees.

Key Words: posterior cruciate ligament (PCL) • kinematics • magnetic resonance imaging (MRI) • knee

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