Knee Posterior ..

A 24-year-old male is referred to a physical therapy clinic after sustaining a right knee injury playing soccer 6 days ago. The patient reports that the injury occurred when another player tackled him. He describes the impact as a posterior and laterally directed force to the medial tibia. Since the incident, he reports pain with prolonged walking and difficulty descending stairs. The patient reports minimal to no knee instability. Anti-inflammatory medication decreases the pain and allows him to descend stairs without difficulty. The patient reports a history of right patellar tendinitis. The patient's medical history is unremarkable.

What examination signs may be associated with this suspected diagnosis?

What are the most appropriate examination tests?

What are the most appropriate physical therapy interventions?

POSTERIOR CRUCIATE LIGAMENT (PCL): Intracapsular ligament of the knee that extends from the posterior intercondylar region of the tibia to the medial femoral condyle; the PCL limits posterior translation of the tibia

POSTEROLATERAL CORNER (PLC): Region of the knee composed of the popliteofibular ligament, fibular collateral ligament, and the popliteus muscle

VARUS FORCE: Force applied to a limb that results in the distal aspect of the limb moving toward the midline of the body

1. Describe pathomechanics for a posterior cruciate ligament injury.

2. Identify appropriate clinical special tests to evaluate a patient with potential injury to the posterior cruciate ligament.

3. Implement evidence-based rehabilitation treatments for posterior cruciate ligament injuries.

PT considerations during management of the individual with a diagnosis of PCL injury:

• General physical therapy plan of care/goals: Decrease pain and swelling, prevent muscular inhibition, normalize gait abnormalities, restore range of motion (ROM), maintain cardiovascular fitness
• Physical therapy interventions: Patient education; home exercise program (HEP); modalities; manual therapy to decrease pain, swelling, and increase ROM; patellar mobilization; gait training
• Precautions during physical therapy: Assess vital signs, monitor neurovascular status (e.g., distal pulses, sensory and motor function); decrease posterior tibial shear forces
• Complications interfering with physical therapy: Fibular nerve dysfunction with possible progression into foot drop, which may require the need for ankle-foot orthosis

The PCL is approximately twice as thick and strong as the anterior cruciate ligament (ACL).1,2 The PCL is 13 millimeters (mm) wide and 38 mm long.1,2 It originates from the anterolateral aspect of the medial femoral condyle near the intercondylar notch.1–3 The PCL inserts on the posterior tibial plateau, approximately one centimeter distal to the joint line. The PCL is intracapsular; however, it is isolated with the ACL from the synovial cavity. The PCL can be further divided into an anterolateral bundle and posteromedial bundle. The anterolateral bundle is larger and represents 65% of the substance.1–3 In knee flexion, the anterolateral bundle is taut and the posteromedial bundle is lax. The posteromedial bundle, ...

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