Shelbourne K D, Rubinstein R A
Methodist Sports Medicine Center, Indianapolis, Indiana.
Clin Sports Med. 1994 Jul;13(3):531-43.
The treatment of isolated PCL tears remains controversial. Potential exists for long-term subjective and radiographic deterioration with non-operative treatment. The general consensus for treating combined instabilities that involve the PCL is a surgical reconstruction. The authors would also consider a reconstruction in the isolated grade 2 or greater PCL tear for the high demand patient. Because the results of reconstruction are not as certain or predictable for posterior laxity as they are for anterior laxity, caution is in order, however. Patient selection remains critical and may warrant an attempt at nonoperative treatment initially with continued close follow-up to locate those patients, whether subjectively or radiographically, who do poorly. It is these latter patients who would most likely benefit from an autogenous patellar tendon PCL reconstruction for their isolated laxity. Continued follow-up of both non-operative and operative treatments are needed so we can further refine our current recommendations. Future research should include both prospective natural history studies of acute isolated PCL tears treated non-operatively as well as the long-term results of different operative treatments. Sufficient patient numbers and an objective methodology for patient evaluation must be included in studies of these treatments.
孤立性后交叉韧带（PCL）损伤的治疗仍存在争议。非手术治疗存在长期主观症状及影像学退变的可能性。对于合并PCL损伤的膝关节不稳，目前普遍的共识是采用手术重建治疗。对于高需求患者，作者也会考虑对孤立性2级或更高级别的PCL损伤进行重建。然而，由于重建对于后向松弛的效果不像前向松弛那样确定或可预测，因此需要谨慎。患者的选择仍然至关重要，可能需要首先尝试非手术治疗，并持续密切随访，以找出那些主观症状或影像学表现不佳的患者。正是这些患者最有可能从自体髌腱PCL重建中获益，以解决其孤立性松弛问题。需要对非手术和手术治疗进行持续随访，以便我们能够进一步完善当前的建议。未来的研究应包括对非手术治疗的急性孤立性PCL损伤进行前瞻性自然史研究，以及不同手术治疗的长期结果。这些治疗研究必须纳入足够数量的患者以及客观的患者评估方法。
