Maximilian M Mueller, Andrea Estfeller, Valentin Hingsamer, Tatiana C Monteleone, Robert J O'Brien, Sebastian Conner-Rilk, Craig E Klinger, Gregory S DiFelice
The proposed classification system reliably differentiated PCL tear locations. Multiligament injury, medial meniscus tear, hyperextension-type bone bruise pattern, and younger age were significant predictors of proximal tear location, whereas these factors were inversely associated with midsubstance tears.
PURPOSE: To characterize the epidemiology of posterior cruciate ligament (PCL) tear locations and identify clinicodemographic and injury-related predictors.
METHODS: This retrospective cohort study at a single institution included patients with acute, complete PCL injuries between 2008 and 2023. Exclusion criteria were PCL sprains without ligament disruption, partial tears, or chronic injuries (>60 days). Tears were classified by the relative length (%) of the intact distal remnant: type I (>90%), type Ib (femoral bony avulsion), type II (90%-75%), type III (75%-25%), type IV (10%-25%), type V (<10%), and type Vb (tibial bony avulsion). Clinicodemographic data, concomitant injury types, bone bruise patterns, and injury patterns were analyzed using univariate and multivariate logistic regression analyses.
RESULTS: A total of 148 magnetic resonance imaging studies met eligibility criteria (33% women; mean age, 36 ± 16 years). PCL tear-type distribution was type I 18.9%, type Ib 4.1%, type II 3.4%, type III 43.2%, type IV 15.5%, type V 3.4%, and type Vb 11.5%, with excellent interobserver reliability (κ = 0.96; 95% confidence interval [CI], 0.93-0.99; P < .001). Female patients were significantly older than men (41.6 ± 16.3 vs 32.7 ± 14.6 years; P = .001), more frequently sustained direct contusion injuries (44.4% vs 27.0%; P = .038), and less frequently cutting-sports-related injuries (2.3% vs 23.6%; P = .001). Independent predictors of proximal PCL tears (types I, Ib, and II) were multiligament injury (odds ratio [OR] = 8.2, 95% CI 2.9-26.5, P < .001), hyperextension-type bone bruise pattern (OR = 8.1, 95% CI 2.5-28.9, P < .001), medial meniscus tear (OR = 6.9, 95% CI 2.4-21.6, P < .001), and younger age (OR = 0.96 per year, 95% CI 0.9-1.0, P = .001). Midsubstance tears (type III) showed inverse associations, while no predictors were identified for distal tears (types IV, V, and Vb).
CONCLUSIONS: The proposed classification system reliably differentiated PCL tear locations. Multiligament injury, medial meniscus tear, hyperextension-type bone bruise pattern, and younger age were significant predictors of proximal tear location, whereas these factors were inversely associated with midsubstance tears.
LEVEL OF EVIDENCE: Level III, retrospective cohort study.