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Natural history of PCL injuries: Long-term results favorable with nonoperative treatment
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CHICAGO — Patients showed no arthritis or joint wear about 17 years after their PCL injuries were treated nonoperatively, based on results of a study presented at the American Academy of Orthopaedic Surgeons Annual Meeting, here.
“Patients remain active, report good subjective results,” K. Donald Shelbourne, MD, said in a presentation. “There is no difference in subjective or objective results based on PCL laxity grades,” he said.
Shelbourne and colleagues treated 68 patients nonoperatively after acute isolated PCL injury and prospectively followed them 17.6 years, average. Yearly, during the follow-up, the patients completed subjective surveys and underwent examinations to evaluate knee range of motion, effusion, quadriceps strength, PCL laxity.
K. Donald Shelbourne
Their knees were also palpated for osteophytes and their joint space was measured radiographically.
Investigators subjectively measured the patients’ results with the International Knee Documentation Committee (IKDC) and modified Noyes knee surveys.
At the initial and follow-up time periods, the researchers found no significant differences in PCL laxity, but quadriceps strength was 97% of the opposite uninvolved leg, based on the results.
All patients had normal knee range of motion.
In eight patients some mild effusion was detected in their involved knee and one patient had mild effusion in both knees. Two patients had osteophytes and there was medial joint space narrowing that exceeded 2 mm in five patients. The IKDC score was about 73 points and the modified Noyes knee score was about 81 points at 17.6 years follow-up.
“This natural history study could serve as a baseline for treatments of other PCL injuries,” Shelbourne said.
Reference:
Shelbourne K. Paper #371. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; March 19-23, 2013; Chicago.
Disclosure: Shelbourne receives royalties from DJ Orthopaedics, is an unpaid consultant for Kneebourne Therapeutics Inc. and owns stock or stock options in Abbott and Pfizer.
Perspective
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Eunkyu Song, MD, PhD
Patients with an isolated PCL injury can have only a few functional limitations, although 26% of them report a feeling of residual instability. Several studies have reported acceptable results with nonoperative treatment of isolated PCL injuries with mild to moderate laxity, however it is well documented that more severe straight posterior laxity or combined injury patterns lead to a worse prognosis. In addition, PCL-deficient knees result in altered loads and kinematics during functional activities as studies by M. Logan and colleagues and J.E. Voos and colleagues have noted. In this study, authors did not describe the degree of PCL laxity and this may mislead readers to perform conservative treatment for all patients with PCL injury regardless of degree of laxity. Treatment options should be individualized based on the pain or instability and I think that reconstruction of the PCL is needed in patients with high degrees of instability, even in cases of isolated PCL injury.
References:
Logan M. Am J Sports Med. 2004;32(8):1915-1922.
Voos JE. Am J Sports Med. 2012; doi:10.1177/0363546511416316.
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