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Articular Cartilage Restoration in the PCL-Injured Knee

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Posterior Cruciate Ligament Injuries

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Abstract

Posterior cruciate ligament (PCL) injuries represent a heterogeneous patient population, and many of these patients have concomitant ligamentous, meniscal, chondral, or osteochondral lesions. PCL insufficiency, especially in the multiligament setting, has known detrimental effects on joint mechanics of the knee, and the development of progressive degenerative changes is often ubiquitous with time. Many incidental or even acute traumatic chondral lesions will remain asymptomatic for a period of time without any treatment. Others may be quite debilitating and progress with time. The natural history of most acute chondral injuries is poorly understood, and it is often unknown if and to what degree treatment will alter this course, especially in a joint with abnormal kinematics. With limited evidence that procedures addressing the articular damage will necessarily alter the overall natural history of the joint, it is important to evaluate the lesion, joint, and patient characteristics to determine optimal treatment. Inherent to the discussion of articular cartilage surgery is the reality that optimal treatment is often unknown and controversial; thus, individual surgeon preferences and personal algorithms often play a significant role in treatment. The goal of the articular cartilage surgeon is to address symptomatic lesions in order to improve pain and function, with the hope of delaying the need for future arthroplasty procedures. Acute and secondary treatment algorithms for articular cartilage restoration in the PCL-deficient knee are presented in this chapter in an effort to assist those who treat this challenging patient group. Unfortunately, most who sustain major PCL and multiligamentous-knee injury with concomitant meniscus and articular cartilage injury will eventually go on to develop advanced posttraumatic degenerative arthritis.

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Authors and Affiliations

  1. Eastern Virginia Medical School, Norfolk, VA, USA

    Clay G. Nelson BSc

  2. Jordan-Young Institute, 5716 Cleveland St, Suite 200, 23462, Virginia Beach, VA, USA

    Kevin F. Bonner MD

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  1. Clay G. Nelson BSc
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  2. Kevin F. Bonner MD
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Correspondence to Kevin F. Bonner MD .

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  1. GHS Orthopaedics, Danville, Pennsylvania, USA

    Gregory C. Fanelli, MD

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Nelson, C., Bonner, K. (2015). Articular Cartilage Restoration in the PCL-Injured Knee. In: Fanelli, MD, G. (eds) Posterior Cruciate Ligament Injuries. Springer, Cham. https://doi.org/10.1007/978-3-319-12072-0_23

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