Rehabilitation of isolated and combined posterior cruciate ligament injuries.

In conclusion, PCL injuries occur more commonly than previously noted. The PCL-deficient knee is a serious pathology; it is one of functional disability, not functional instability as seen with an ACL disruption. This functional disability is secondary to pain and inflammation from articular cartilage degeneration. The degeneration process occurs over a period of time normally greater than 5 years; eventually knee function is seriously limited. The rehabilitation of the PCL reconstructive or nonoperative patient is greatly dependent on dynamic quadriceps stability. The biomechanics of the PCL and PLC during various exercises are not well understood; however, research is being performed to advance the clinical management following these injuries. The clinician must realize that tremendous tibiofemoral shear forces are created during various knee exercises, in both the closed and open chain. In particular, various knee exercises, in both the closed and open chain. In particular, there are tremendous stresses applied to the PCL during OKC-resisted knee flexion. The clinician must also realize the role of the hamstrings during most closed chain exercises; therefore the author recommends an early program emphasizing isolated open chain quadriceps strengthening progressing to closed chain drills once adequate quadriceps strength has been established. The numerous clinical challenges for the rehabilitation team to hurdle when treating a PCL-injured knee patient have been discussed in this article. The PCL rehabilitation program can no longer be thought of an an ACL rehabilitation program "turned around." The anatomy, biomechanics, and natural history of the PCL-deficient knee differs dramatically from the ACL-deficient knee, and the treatment approach should reflect these considerations.