Posterior Cruciate Ligament Tear

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Posterior Cruciate Ligament Tear

Authors, Editors, Case Information Author: Drew Duerson, MD Affiliation: Nationwide Children's Hospital Senior Editor: Raul Rosario-Concepcion, MD Clinical Vignette: A 16-year-old female softball athlete presented after an acute right knee injury during a game. While sliding into a base her cleat got stuck in the dirt and knee twisted. She appreciated immediate swelling. She described knee instability. On exam an effusion was appreciated with a positive posterior drawer. Type of Probe Used: 6-15 MHz linear array transducer. Unlabeled Long Axis View of the Right (Injured) PCL Insertion Unlabeled Long Axis View of the right (injured) PCL Insertion on the tibia Labeled Long Axis View of the Right (Injured) PCL Insertion Labeled Long Axis View of the Right (Injured) PCL Insertion on the tibia demonstrating hypoechoic thickening measuring approximately 9.6 mm. Labeled Long Axis View of the Left (Uninjured) PCL Insertion Labeled Long Axis View of the Left (Uninjured) PCL Insertion on the tibia demonstrating for contralateral comparison, with normal PCL thickness measuring approximately 4.22 mm. Labeled Long Axis View of the Right (Injured) PCL Insertion with Doppler Labeled Long Axis View of the Right (Injured) PCL Insertion on the tibia with power doppler and mild hyperemia of the nearby joint capsule. #5 - Video View Video Long axis cine of the posterior cruciate ligament insertion on the tibia medial to lateral revealing diffuse hypoechoic thickening of the ligament Interpretation Image Interpretation: Hypoechoic thickening of the posterior cruciate ligament at its distal attachment on the tibia. There is mild hyperemia of nearby capsule. Teaching Pearl: PCL injuries can sometimes be overlooked because they are less common than ACL injuries and may present with subtle instability-related symptoms. Ultrasound may show distal PCL thickening, hypoechogenicity, capsular hyperemia, or tibial attachment abnormality, but the ligament is deep and only partly accessible with ultrasound. Ultrasound findings involving the PCL should be treated as supportive, with MRI used when instability, high-energy trauma, multiligament injury, or surgical planning is a concern. References: 1. Stoianov AG, Patrascu JM, Hogea BG, et al. Point-of-care ultrasound for the evaluation and management of posterior cruciate ligament injuries: a systematic review. Diagnostics (Basel). 2023;13(14):2352. doi:10.3390/diagnostics13142352 2. Hsu CC, Tsai WC, Chen CP, Yeh WL, Tang SF, Kuo JK. Ultrasonographic examination of the normal and injured posterior cruciate ligament. J Clin Ultrasound. 2005;33(6):277-282. doi:10.1002/jcu.20136 3. Miller TT. Sonography of injury of the posterior cruciate ligament of the knee. Skeletal Radiol. 2002;31(3):149-154. doi:10.1007/s00256-001-0454-z
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Authors, Editors, Case Information

Unlabeled Long Axis View of the Right (Injured) PCL Insertion

Labeled Long Axis View of the Right (Injured) PCL Insertion

Labeled Long Axis View of the Left (Uninjured) PCL Insertion

Labeled Long Axis View of the Right (Injured) PCL Insertion with Doppler

#5 - Video

Interpretation

UPCOMING EVENTS

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