Management of the Posterior Cruciate Ligament-Based Multiligament-Injured Knee

Injuries of the posterior cruciate ligament in the setting of the multiligament-injured knee can pose a challenge to the orthopedic surgeon. The decision to proceed with operative or nonoperative management and which surgical technique to use remain controversial. Moreover, sparse clinical data are available to support any one treatment approach for these complicated injuries. In this chapter, we describe our current management strategies for posterior cruciate ligament-based multiligament knee injuries in the context of the existing published data and our own current clinical investigations. We discuss methods of diagnosis, the importance of stress radiography, imaging, indications and timing of surgery, graft selection, and surgical techniques. In addition, we detail our approach to postoperative rehabilitation with regard to thromboprophylaxis, weight-bearing status, and return to work or sport.