Principles of posterior knee joint instability treatment (literature review)

Maksim Golovakha, Inna Didenko, Sergiy Krasnoperov, Rostyslav Titarchuk, Кarl Benedetto, Weniamin Orljanski


Damage of posterior crucial ligament postern-lateral stabiliz­ing structures is a significant injury to the knee. Incomplete diagnosis of lesions in the acute period of trauma and subse­quent inadequate treatment leads to functional instability and rapid progression of degenerative processes.

Objective: based on the analysis of scientific literature to identify further direc­tion for improving surgical techniques and improving outcomes of patients with posterior instability of the knee joint.

Meth­ods: keyword search on problems of diagnosis, classification and selection method for treating posterior knee instability in the english-speaking academic libraries, databases Pubmed, Medline, Cochrane library and the Russian media over the past 15 years.

Results: mechanisms of posterior crucial ligament inju­ry are very diverse. Damage can be isolated or combined, have a chronic course. In recent years, increased interest in the re­construction of all the internal structures of the knee. Reports of the functional results of posterior crucial ligament surgi­cal treatment is less than anterior crucial ligament. The sig­nificance of the problem is associated with low frequency and less surgical treatment of posterior crucial ligament injuries, as well as the heterogeneity of acute, chronic and combined it with the potential damage involving posterolateral joint. Damage of posterior crucial ligament often remains unrecognized and therefore untreated. The authors analyzed the methods used to­day to treat patients with posterior instability of the knee joint, whereby defined prospects for improving surgical techniques and improving outcomes.


knee; posterior crucial ligament; posterior instability; surgical treatment


Abdrakhmanov AZh. Clinical diagnosis of posterior knee joint stability in athletes: abstracts book of scientific meeting «Modern problems of sport traumatology and orthopedics» Moskow, 1997:7. (in Russian)

Dubrov VE. Surgical correction of cruciform аnd collateral ligaments of the knee in acute period of injury. Clinical and experimental research: abstract dis. the doctor of medical science. Moskow, 2003. 48 p. (in Russian)

Kotelnikov G.P. Kuropatkin G.V., Pivovarov M.V. Post-traumatic knee joint instability. Biomechanical studies in traumatology and orthopedics. Moskow, 1988;(1):13–6. (in Russian)

Levenets VM, Linko YaV, Moskotin PM. Modern approaches to diagnosis and treatment instability of the knee joint. Orthopаedics, traumatology and prosthetics. 2000;(1):10–4. (in Ukrainian)

Linko YV. Diagnosis and treatment of posterior instability knee joint. Bulletin of orthopedics, traumatology and prosthetics. 2001;(1):106–9. (in Russian)

Linko YV. Anatomical and functional bases of the of the posterior instability of the knee joint. 2000;9:47–51.

Linko YV. Posttraumatic posterior instability of the knee joint: clinical and experimental research. Abstract of Thesis Candidate medical Sciences. Kyiv, 2004. 16 p. (in Russian)

Lisitsyn MP Arthroscopic diagnosis and treatment acute and chronic lesions of the capsule ligament structures of the knee joint with athletes. Abstract of Thesis Candidate medical Sciences. Moscow, 1996. 196 p. (in Russian)

Malygin MA, Nevzorov AM, Gavryushenko NS. The durability characteristics of the anterior cruciate ligament of the knee joint and its endoprostheses: Sb.mate. III cong. Russian arthroscopic volume. Moskow, 1999. 103 р. (in Russian)

Mironov SP, Mironov ZS, Orlepsky AK. Operative treatment of damage to cruciate ligaments of the knee joint (retrospective analysis). Reporter of Traumatology and Orthopedics named Priorov 2001;(2):51–5. (in Russian)

Nikitin VV, Penkovaya AM. Immuno-physiological aspects of the clinic and surgical tactics for damages of the ligament apparatus. Ufa, 1992. 121 p. (in Russian)

Orlecki A.K. Operative methods of treatment of posttraumatic- Chronic instability of the knee. Abstract of Thesis Candidate medical Sciences. Moskow, 1998. 38 p. (in Russian)

Bergfeld JA, McAllister DR, Parker RD, et al. A biomechanical comparison of posterior cruciate ligament reconstruction techniques. Am J Sports Med. 2001;29(2):129–36.

Osti M, Tschann P, Kunzel KH, Benedetto KP. Anatomie characteristics and radiographic references of the anterolateral and posteromedial bundles of the posterior cruciate ligament. Am J Sports Med. 2012;40(7):1558–63. doi: 10.1177/0363546512445166.

Benedetto KP. Arthroskopischer Ersatz des hinteren Kreuzbandes. Jatros Unfallchirurgie & Sporttraumatologie. 2012;4:6–8.

Benedetto KP, Hoffeiner T, Osti M. The biomechanical characteristics of arthroscopic tibial inlay techniques for posterior cruciate ligament reconstruction: in vitro comparison of tibial graft tunnel placement. Int Orthop. 2014;38(11):2363–68. doi: 10.1007/s00264-014-2458-z.

Benedetto KP. Tibial-inlay-Technik beim hinteren Kreuzbandersatz Arthroskopie. 2006;19(6):258–64. doi: 10.1007/s00142-006-0361-3.

Campbell RB, Jordan SS, Sekiya JK. Arthroscopic tibial inlay for posterior cruciate ligament reconstruction. Arthroscopy. 2007;23(12):1356.e1–e4. doi: 10.1016/j.arthro.2007.01.020.

Christel P. Basic principles for surgical reconstruction of the PCL in chronic posterior knee instability. Knee Surg. Sports Traumatol Arthrose. 2003;11 (5):289–96. doi: 10.1007/s00167-003-0407-2.

Campbell RB, Torrie A, Hecker A, Sekiya JK. Comparison of tibial graft fixation between simulated arthroscopic and open inlay techniques for posterior cruciate ligament reconstruction. Am J Sports Med. 2007;35(10):1731–1738. doi: 10.1177/0363546507302216.

Cury Rde P, Mestriner MB, Kaleka CC, Severino NR, de Oliveira VM, Camargo OP. Double-bundle PCL reconstruction using autogenous quadriceps tendon and semitendinous graft: surgical technique with 2-year follow-up clinical results. Knee. 2014;21(3):763–8. doi: 10.1016/j.knee.2014.02.021.

Harner CD, Hoher J. Evaluation and treatment of posterior cruciate ligament injuries. Am. J Sports Med. 1998;26(3):471–82.

Jordan SS, Campbell RB, Sekiya JK. Posterior cruciate ligament reconstruction using a new arthroscopic tibial inlay double-bundle technique. Sports Med Arthrose. 2007;15(4):176–83. doi: 10.1097/JSA.0b013e3181595b95.

Jung TM, Schmeling A, Weiler A. Periphere Instabilitäten bei Läsion des hin¬teren Kreuzbandes. Arthroskopie. 2006;19(3):265–76. doi: 10.1007/s00142-006-0359-x.

Mariani PP, Margheritini F. Full arthroscopic inlay reconstruction of posterior cruciate ligament. Knee Surg Sports Traumatol. Arthrose. 2006;14(11):1038–44.

Markolf KL, Zemanovic JR, McAllister DR. Cyclic loading of posterior cruciate ligament replacements fixed with tibial tunnel and tibial inlay methods. J Bone Joint Surg Am. 2002;84-A(4):518–24.

McAllister DR, Hussain SM. Tibial inlay posterior cruciate ligament recon¬struction: surgicai techniques and results. Sports Med Arthrose. 2010;8(4):249–53. doi: 10.1097/JSA.0b013e3181faaee1.

Parolie JM, Bergfeld JA. Long-term results of nonoperative treatment of isolated posterior cruciate ligament injuries in the athlete. Am.J Sports Med. 1986;14(1):35–8.

Petersen W, Zantop T, Tillmann B. Anatomie des hinteren Kreuzbandes sowie der posterolateralen und posteromedialen Strukturen. Arthroskopie. 2006;19(3):198–206. doi: 10.1007/s00142-006-0357-z.

Margheritini F, Frascari Diotallevi F, Mariani PP. Posterior cruciate ligament reconstruction using an arthroscopic femoral inlay technique. Knee Surg Sports Traumatol Arthrose. 2011;19(12):2033–35. doi: 10.1007/ s00167-011-1469-1.

Russe K, Schulz MS, Strobel MJ. Epidemiologie der hinteren Kreuzbandverletzung. Arthroskopie. 2006;19(3):215–20. doi: 10.1007/s00142-006-0354-2.

Salata MJ, Sekiya JK. Arthroscopic posterior cruciate ligament tibial inlay reconstruction: a surgical technique that may influence rehabilitation. Sports Health. 2011;3(1):52–8. doi: 10.1177/1941738110385308.

Schewe B, Fritz J. Die Rekonstruktion des hinteren Kreuzbandes Operationstechnik. SFA Arthroskopie Aktuell. 2007. 20 p.

Strobel MJ, Weiler A. Therapie der chronischen HKB-Lasion. Arthroskopie. 2006;19(3):243–57. doi: 10.1007/s00142-006-0360-4.

Montgomery SR, Johnson JS, McAllister DR, Petrigliano FA. Surgical management of PCL injuries: indications, techniques, and outcomes. Curr Rev Musculoskelet. Med. 2013;6(2):115–23. doi: 10.1007/ s12178-013-9162-2.

Logan M, Williams A, Lavelle J, Gedroyc W, Freeman M The effect of posterior cruciate ligament deficiency on knee kinematics. Am J Sports Med. 2004;32(8):1915–22.

Chuang TY, Chen CH, Chou SW, Chen YJ, Chen WJ. Tibial inlay technique with quardriceps tendon-bone autograft for posterior cruciate ligament. Arthroscopy. 2004;20 (3):331–5. doi: 10.1016/j.arthro.2003.11.043.

Torisu T. Isolated avulsion fracture of the tibial attachment of the posterior cruciate ligament. J Bone Joint Surg. Am. 1977;59(1):68–72.

Weiler A, Schmeling A, Jung TM. Management der akuten HKB-Verletzung. Arthroskopie. 2006;19(3):229–42. doi: 10.1007/s00142-006-0356-0.229-242.

Copyright (c) 2017 Maksim Golovakha, Inna Didenko, Sergiy Krasnoperov, Rostyslav Titarchuk, Кarl Benedetto, Weniamin Orljanski

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.