1. Cosgarea AJ, Jay PR: Posterior cruciate ligament injuries: Evaluation and management. J Am Acad Orthop Surg 2001;9:297-307.
2. Miller MD, Cooper DE, Fanelli GC, et al: Posterior cruciate ligament: Current concepts. Instr Course Lect 2002;51:347-351.
3. White LM, Miniaci A: Cruciate and posterolateral corner injuries in the athlete: Clinical and magnetic resonance imaging features. Semin Mus-culoskelet Radiol 2004;8:111-131.
4. Dowd GSE: Reconstruction of the posterior cruciate ligament: Indications and results. J Bone Joint Surg Br 2004;86:480-491.
5. Margheritini F, Rihn J, Musahl A, et al: Posterior cruciate ligament injuries in the athlete: An anatomical, biomechanical and clinical review. Sports Med 2002;32:393-408.
6. St. Pierre P, Miller MD: Posterior cruciate ligament injuries. Clin Sports Med 1999;18:199-221.
7. Schulte KR, Chu ET, Fu FH: Arthroscopic posterior cruciate ligament reconstruction. Clin Sports Med 1997;16:145-156.
ing potential surgical failures, it is important to remember that the reference position of the anterior tibial plateau with respect to medial femoral condyle can be significantly altered after PCL reconstruction. This can, therefore, markedly affect subsequent evaluation and interpretation of posterior tibial translation.15 If clinical and radiographic examination leads to the diagnosis of surgical failure, special consideration must be given to prior surgical scarring, potential loss of bone stock from tunnel enlargement, interference from previous tunnel positions, and location of hardware. As a rule, final stability in revision cases is usually worse that that obtained in primary procedures.10
Finally, although covered in detail in another chapter, multiligament injuries have relatively poor outcomes if treated nonoperatively. Most commonly, these occur as grade III PCL injury combined with posterolateral corner insufficiency, resulting in additive laxity in the posterior and external rotation vectors. For acute injuries, attempts to repair all damaged structures are warranted. The posterolateral corner especially will scar and obliterate normal anatomy if not addressed within 2 to 3 weeks of injury. Combined ACL and PCL injuries often represent an unrecognized knee dislocation. Some authors recommend acute repair or reconstruction, while others initiate early range-of-motion exercises and delay surgery for fear of arthrofibrosis.1 Treatment of combined PCL and MCL injuries may depend on the degree of MCL laxity. Low-grade MCL tears may heal with bracing and protection, while high-grade MCL injuries will have marked valgus instability and typically require acute repair.
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