PCL tear

PCL is the largest of the knee ligament and is attached from the back of the tibia to the front of the femur. It stabilises the tibia to backward translation.

Isolated PCL tear are uncommon and it is usually associated with other ligament (posterolateral corner (PLC) and meniscal injuries.

The commonest mechanism of injury nowadays is from a direct blow from the dashboard as a result of a car crash but PCL injuries can also occur in sports when a fall or tackle forcibly pushes the tibia backwards. Symptoms are usually of knee pain, swelling and giving way sensation.

Isolated PCL tear can be managed by non surgical options. A PCL rehabilitation program by the specialist physiotherapy will help restore knee function.

If the patient has multi-ligament injury to the knee including PCL this will require a PCL reconstruction along with repair or reconstruction of the other ligaments.

Osteochondral Injury.

Damage to the articular cartilage is a significant injury, especially in a young patient. This can lead to early arthritis.

If the cartilage detaches along with a bony fragment then the prognosis is better. This can be fixed back to the bone arthroscopically (key-hole surgery) with either pins or very small screws (metal or bioabsorbable).

If the lesion is purely cartilaginous then fixation is not an option. Symptomatic full thickness chondral lesions of the knee pose a difficult management issue for both orthopaedists and patients. If injury leads to articular cartilage cell death the best treatment is restoration of the joint surface cells (articular cartilage-the shiny white surface that forms all joints in the body). There are four distinct options for treatment: Microfracture, ACI (Autologous Chondrocyte Implantation), OATS (osteoarticular transfer system) and Osteochondral Allograft.

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