Arthroscopy - 2026-09-20 - Journal Article
Multiligament Injury, Medial Meniscus Tear, Hyperextension-Type Bone Bruise Pattern, and Younger Age Predict Magnetic Resonance Imaging-Defined Tear Location in Acute, Complete Posterior Cruciate Ligament Injuries.
Mueller MM, Estfeller A, Hingsamer V, Monteleone TC, O'Brien RJ, Conner-Rilk S, Klinger CE, DiFelice GS
Topics
Key Takeaway
Multiligament injury (OR=8.2), hyperextension bone bruise pattern (OR=8.1), and medial meniscus tear (OR=6.9) are the strongest independent predictors of proximal PCL tear location on MRI in acute complete PCL injuries.
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Summary
This study characterized PCL tear location distribution and identified predictors of proximal versus midsubstance tears using a 7-type MRI classification based on intact distal remnant length percentage. Among 148 acute complete PCL injuries, midsubstance (type III) tears were most common at 43.2%, followed by proximal (type I) at 18.9% and tibial avulsions (type Vb) at 11.5%. Multivariate logistic regression identified multiligament injury, hyperextension bone bruise pattern, medial meniscus tear, and younger age as independent predictors of proximal tear location, with no predictors identified for distal tears.
Key Limitation
The absence of surgical confirmation of MRI-classified tear locations means classification accuracy against an intraoperative gold standard is unvalidated.
Original Abstract
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.