..

MR Imaging of the
. Posterior Cruciate
Ligament: Normal,
Abnormal, and Associ-
ated Injury Patterns1
Andrew H. Sonin, MD
Steven WFitzgerald, MD
Frederick L. Hoff MD
Harold Friedman, MD
Michael E. Bresle, MD

The posterior cruciate ligament (PCL) of the knee has received little at-
tention in the radiology literature, but its importance in knee stability
has come under close scrutiny in recent years. Unrepaired injury of the
PCL can lead to chronic instability and early joint degeneration. Three
major mechanisms of trauma that involves the PCL are posterior dis-
placement of the tibia in a flexed knee, hyperextension, and rotation
combined with an adduction or abduction force. The spectrum of PCL
injuries includes partial tear or intrasubstance injury, complete ligamen-
tous rupture, and avulsion of the PCL insertion site on the posterior
tibia. Associated injuries include injury of other ligaments, meniscal tear,
bone injury, and joint effusion. PCL rupture is easily identified with mag-
netic resonance (MR) imaging by using simple signal intensity and struc-
tural characteristics. Because clinical and arthroscopic assessment of the
PCL can be difficult, MR imaging can be valuable for evaluating the acute-
ly injured knee when operative repair of the PCL is being considered.

U INTRODUCTION
Injury of the posterior cruciate ligament (PCL) occurs less frequently than injury of the
anterior cruciate ligament (ACL) (1,2). Historically, isolated PCL tears were thought to
be relatively insignificant and were usually not treated unless associated with bone
avulsion of the tibial insertion (2-6). As the potential for chronic instability leading to

Abbreviations: ACL = anterior cruciate Iigarncnt, PCL = posterior cruciate ligamcnt. STIR = short inversion time inver-
sion recovery, TE = echo time. TR = repetition time

Index terms: Knee, injuries, 4526.4857 Knee.

#{149} ligaments. menisci. and cartilage, 4526.487 - Ligaments, injuries,
4526.4857

RadloGraphlcs 1995; 15:55 1-561

u From the Department of Radiology. Northwestern University Medical School, Olson Pavilion, 710 N Fairbanks Court,
Chicago. IL 6061 1 (A.H.S.. S.W.F., FLIt); Northeast Illinois MRI. Lincolnshire. Ill (HF.); and I3erwyn Radiology, Chicago,
Ill (M.E.B.). Presented as a scientific exhibit at the 1993 RSNA scientific assembly. Received April 18. 1994: revision re-
questedjune 9 and received November 18; accepted November 21. Address reprint requests to A.H.S.

, RSNA. 1995

551
 early degenerative changes becomes more rec- of the PCL and can accurately demonstrate the
ognized, increasing emphasis is being placed on presence and degree of injury to the PCL as
primary repair of acute PCL tears (7-9). More well as associated ligamentous, meniscal, and
complex injuries involving multiple knee liga- bone abnormalities (2,7-9). This article de-
ments, particularly the posterolateral complex, scribes the normal appearance of the PCL on
which includes the lateral collateral ligament, MR images and the mechanisms of PCL injury,
popliteal tendon, posterior horn of the medial illustrates the spectrum of appearances in PCL
meniscus, lateral head of the gastrocnemius injury, and discusses the types and frequencies
muscle, and posterior joint capsule, are less of associated knee injuries.
likely to result in a functionally satisfactory re-
sult without surgical intervention (3). U NORMAL ANATOMY AND MR
Attention has recently been
focused on the IMAGING PROTOCOL
integrity of the posterior joint
capsule and its The PCL is a spirally oriented fiber bundle that
effect on the success of repair
or augmentation courses from the lateral aspect of the medial
of the PCL (9). Because clinical
evaluation is of- femoral condyle to its insertion in a depression
ten difficult or has misleading
results, the diag- in the posterior aspect of the intraarticular
nosis of PCL tear can be missed ( 1 0); for in- tibia, approximately 1 cm below the articular
stance, the ACL is often torn in conjunction surface. The PCL is thicker (thickness, 1 .3 cm)
with the PCL, and physical examination find- and stronger than the ACL and has twice the
ings of tibial laxity may not be correctly as- tensile strength of any other knee ligament
cribed to rupture of the PCL (1 ,2,7). In addi- (15). Like the ACL, the PCL is extrasynovial but
tion, the PCL can be difficult to evaluate arthro- intracapsular. It is taut in flexion and becomes
scopically when the ACL is intact, and it usually predominantly lax in extension, with tension
cannot be directly visualized from the anterior retained in the posterior aspect. The ligament
approach unless the ACL is torn ( 1 1 ,12). Fur- subtends a vertical angle of 30#{176}-45#{176},
depending
ther, an intact meniscofemoral ligament of on the degree of flexion. Its blood supply is
Humphry can simulate an intact PCL even if the more abundant than that of the ACL (1). The
PCL is ruptured (13). Thus, an isolated partial P(:L serves as the major stabilizing structure in
tear of the PCL is often not confirmed at arthro- the knee, preventing posterior translation of
scopy even when suspected clinically on the the tibia on the femur and working in concert
basis of posterior tibial laxity. with the ACL and collateral ligaments to limit
Orthopedic management of acute PCL inju- rotatory motion.
ries has traditionally depended on the presence Imaging of the PCL is accomplished with
and severity of associated ligamentous injury standard knee protocols. At Northwestern Uni-
(1 -4,9). A marked increase in degenerative ar- versity Medical School, PCL imaging requires a
thritis and chronic instability of the knee has dedicated surface coil. We employ Ti-weighted
been noted in patients with PCL tears who re- sagittal images oriented along the long axis of
ceive conservative therapy and who have inju- the ACL, a 3-mm section thickness, a 0.6-mm
ries of the ACL, collateral ligament, or posterior gap, a 16-cm field of view, a repetition time
capsule (1 ,3,4,8, 14). The orthopedic literature (TR) msec/echo time (TE) msec of 500-600/15,
has advocated an approach to acute PCL injury and one signal. We also use coronal and axial
that specifies conservative treatment for iso- turbo spin-echo dual-echo sequences with a 4-
bated PCL injury and operative therapy for PCL mm section thickness; a 0.8-mm gap; a 14-16-
tears associated with other knee injuries cm field of view; an effective TRTFE of 4,000-
(1 ,4,5). However, controversy has recently 5,000/22, 90; one signal; and an echo train
arisen regarding the treatment of isolated acute length of seven. Additional sequences, such as
PCL rupture, with some authors advocating ag- turbo short inversion time inversion recovery
gressive surgical repair (3,8,14). (STIR), are used at the discretion of the super-
In contrast to the amount of attention de- vising radiologist.
voted to magnetic resonance (MR) imaging of On MR images, the normal PCL appears as a
the ACL in the radiology literature, surprisingly well-defined band of very low signal intensity
little has been written about MR imaging of the that courses between the medial femoral
PCL (7,8). In particular, the various types of condyle and the posterior tibia. In the sagittal
PCL injury and the frequency of associated biga- plane, the normal PCL is essentially always visu-
mentous and cartilaginous injuries in patients alized, appearing near the midline of the joint
with PCL tears have not been well described on two or three consecutive images. In exten-
(8). MR imaging provides reliable visualization sion (the usual imaging position), the PCL is lax
and describes a thick, gentle arc posteroinferi-
orly from the femur to the tibia (Fig la). The

552 U Scientific Exhibit Volume 15 Number 3

C. d.

Figure 1. Normal MR imaging anatomy of the PCL.

(a) Sagittal Tl-weighted image of a normal knee
shows the PCL as a gently curved area of signal void
that extends from the medial femoral intercondylar
notch to the posterior tibia (arrow). The anterior
bundle of the meniscofemoral ligament (ie, the liga-
ment of Humphry) is seen (arrowhead). (b-c) Turbo
spin-echo proton-density-weighted images. (b) Corn-
nal image through the posterior knee demonstrates
the vertical portion of the PCL rising from its tibial at-
tachment site (large arrow); the plane of section in-
cludes the ligament of Humphry (small arrow), which
extends from the medial femoral condyle to the pos-
terior horn of the lateral meniscus. (c) Coronal image
obtained more anteriorly shows the horizontal por-
tion of the PCL as an ovoid area of signal void (solid
arrow) adjacent to the medial femoral condyle. The
ACL (open arrow) extends along the lateral femoral
condyle. (d) Axial image at the level of the knee joint
demonstrates the vertical portion of the PCL (arrow).
C. (e) Axial image obtained more superiorly shows that
the PCL has a flattened appearance (solid arrow). The
ACL is seen laterally (open arrow).

May 1995 Sonin et a! U RadioGraphics U 553

 Figure 2. Posterior tibial translation as a mechanism
of PCL rupture. (a) Diagram of a typical “dashboard in-
jury” shows the tibia driven posteriorly relative to the
femur. The major source of posterior stabilization, the
PCL ruptures under stress (large arrow), usually in its
midportion (medium-sized arrow). The posterior joint
capsule may be disrupted (small arrow). The anterior
tibia strikes the femur, often along the lateral condyle,
resulting in contusions or fractures (shaded areas). (Re-
printed, with permission, from reference 8.) (b) Sagit-
tal TI-weighted image of a patient who fell on a flexed
knee demonstrates high signal intensity within the sub-
stance of the PCL (large arrow), consistent with partial
rupture. The cortical discontinuity of the anterior tibia
represents a displaced fracture (small arrow). (c) Sagit-
tal Ti-weighted image obtained further laterally shows
an area of low signal intensity in the lateral femoral
condyle that represents a matching contusion (arrow).
a.

b. C.

meniscofemoral ligaments of Humphry and cab portion of the PCL from its tibial insertion to
Wrisberg are often seen immediately adjacent the genu, where it is seen as an ovoid signal
to the PCL as they course from the medial void (Fig id, le).
femoral condyle to the posterior horn of the lat-
eral meniscus; they are situated anterior and U MECHANISMS OF INJURY
posterior to the PCL, respectively (Fig la). On According to the orthopedic literature, injuries
coronal images, the posterior vertical portion of of the PCL represent 2%-23% of all knee inju-
the PCL is seen in the intercondylar notch, adja- ries (3, i6). In 30% of cases, PCL injury is iso-
cent to the lateral aspect of the medial femoral bated; in the remaining cases, there is some co-
condyle (Fig 1 b). The ligament curves forward existent ligamentous injury (2). The two most
anteriorly, and the horizontal portion appears common causes of PCL injury are motor vehicle
as a circular or ovoid area of low signal inten- accidents and sports activity. Three common
sity within the intercondylar notch (Fig ic). mechanisms of PCL injury are as follows
Axial images are useful in visualizing the verti- (2,6,7):
1 A direct
. blow to the proximal anterior
tibia in a flexed knee, forcefully displacing the
tibia posteriorly and usually resulting in a
midsubstance tear of the PCL and often in in-

554 U Scientific Exhibit Volume 15 Number 3

a. b.
Figure 3. PCL rupture as a result of a hyperextension injury. (a) Diagram of a hyperexten-
sion injury shows an avulsion fracture of the tibial insertion site of the PCL (arrow); the liga-
ment itself remains intact. This pattern of injury is OflC of several; the PCL may rupture with-
out an avulsion injury. The ACL is also frequently torn (not shown). (Reprinted, with permis-
sion, from reference 8.) (b) Sagittal Ti-weighted image of a 20-year-old man who suffered a
partial PCL tear as a result of a hyperextension injury in a motorcycle accident shows match-
ing anterior femoral and tibial contusions (black arrows). A medial meniscal tear is also seen
(white arrow).

jury to the posterior joint capsule. This mecha- 3. Severe abduction or adduction forces,
nism is often seen in the setting of motor ye- when associated with rotational forces, may
hide accidents, where impact with the dash- rupture the cruciate ligaments after the colbat-
board results in posterior tibial displacement. eral ligaments fail. The ACL tends to rupture be-
Alternatively, a fall a hyperfiexed
Ofl knee can fore the PCL, particularly under valgus stress.
drive the tibia posteriorly, tearing the PCL. Internal rotation increases the tension on the
Tibial translation is limited by contact of the cruciate ligaments and is more likely to result in
calf and posterior thigh muscles, and the poste- injury of these ligaments. Meniscal tears are
rior joint capsule is less likely to be damaged. seen in conjunction with this mechanism ow-
With posterior tibial displacement, the collat- ing to torsional and distraction forces and can
eral ligaments usually remain intact. Bone con- involve either the medial or lateral meniscus.
tusions tend to occur at the site of impact be- Bone contusions occur at sites of impaction; in
tween the anterior tibial plateau and the poste- valgus or internal rotation injuries, for example,
rior femoral condybes (Fig 2). they are usually seen in the posterolateral as-
2. Hyperextension may cause avubsion of the pect of the tibia and in the articubar surface of
tibial attachment of the PCL, with preservation the medial femoral condyle.
of the bigamentous substance. With continued
extension, particularly when associated with U MR IMAGING FINDINGS
anterior tibial translation, the ACL may rupture Signs of a complete PCL tear include (a) failure
as well (Fig 3a). When PCL rupture is associ- to identify the PCL, (b) amorphous high signal
ated with varus or valgus force, collateral liga- intensity in the region of the PCL on Ti- and T2-
ment disruption is not uncommon. Contusions
are commonly identified in the anterior portion
of the tibiab articular surface and in the anterior
aspects of the femoral condyles (Fig 3b).

May 1995 Sonin et al U RadloGraphics U 555

 4a. 4b.

5a.
Figures 4, 5. (4) Complete rupture of the PCL. (a) Sagittal Ti-weighted image through the expected region
of the PCL reveals an ill-defined mass of intermediate signal intensity that roughly conforms to the shape of the
ICL (arrow). Normal PCL fibers were not identified. (b) Corresponding turbo T2-weighted image shows discon-
tifluitv of the PCL, with a focal fluid collection at the point of rupture (arrow). (5) Partial rupture of the PCL.
(a) Sagittal Ti-weighted image demonstrates a well-defined region of abnormal intermediate signal intensity
within the proximal aspect of the PCL (open arrow); however, intact fibers are noted superiorly (solid arrow).
These findings are consistent with a partial tear of the PCL. (b) Coronal turbo spin-echo proton-density-
weighted image shows an enlarged horizontal portion of the PCL that contains abnormal intermediate signal in-
tcflsitv (large arrow), consistent with a partial tear. The ACL is ruptured (small arrow).

weighted images without definable ligamentous high signal intensity within the substance of the
fibers, or (c) visualization of PCL fibers with fo- PCL in the elderly (17); in such cases, findings
cal discrete disruption of all visible fibers (Fig of intrasubstance injury must be correlated
4). A partial PCL tear or intrasubstance injury with an appropriate history of trauma.
does not meet these criteria but demonstrates We retrospectively reviewed the results of
significant abnormal signal intensity within the 2,739 consecutive MR imaging examinations of
substance of the PCL or has some fibers that ap- the knee performed at Northwestern University
pear intact and some that appear discontinuous Medical School from January 1 990 through Feb-
(Fig 5). Eosinophilic degeneration can produce ruary 1994. Seventy-one patients (2.6%) met the
MR imaging criteria for a partial or complete
tear of the PCL. The approximate site of a com-
plete or partial tear was subjectively catego-

556 U Scientific Exhibit Volume 15 Number 3

a. b.
Figure 6. Avulsion injury of the distal (tibial) insertion of the PCL. (a) Sagittal TI-weighted image shows sepa-
ration of the tihial spine and the tibial insertion of the PCL, with abnormal signal intensity (arrow) between the
tibia and the avulsed fragment. The PCL itself is intact. (b) Coronal STIR image through the posterior knee dem-
onstrates the separated fragment (large arrow) attached to the PCL (small arrow). Such injuries are most com-
monly due to hyperextension.

Twenty-seven of the 7 1 patients (38’X) had

AssoCiated Findings in Patients with PCL
complete tears of the PCL on the basis of MR
Injury (n = 71)
imaging criteria; 39 patients (55%) had partial
No. of tears or intrasubstance injuries. The majority of
Associated Finding Patients these cases (45 of7i were [63%1)
midsub-
Ligamentous injury 30 (42)* stance injuries; only 19 (27%) were classified as
Anterior cruciate 19 (27) proximal and two (3%) as distal. The five re-
Medial collateral 14 (20) maining patients (7%) had avubsion injury of the
Lateral collateral 5 (7) tibial insertion with the PCL apparently intact.
Meniscal tear 37 (52) A total of 17 patients (24%) had isolated PCL
Medial 25 (35) injuries. The remaining 54 patients (76%) dem-
Lateral 20 (28)
onstrated evidence of some other coexistent
Bone injury 25 (35)
knee injury, such as ligamentous injury (30 pa-
Effusion 46 (65)
tients [42% of the total patient population]),
Note-Numbers in parentheses are percent- meniscal tear (37 patients [52%]), bone injury
ages. (25 patients [35%]), and joint efftlsion (46 pa-
* Totals represent patients who may have sus- tients [65%]) (Table). Of the collateral ligament
tamed more than one type of injury in that cat-
injuries, those involving the medial ligament
egory; thus, the sum of the subcategories does
were most often seen (Fig 7). Meniscal tears
flot equal the total.
were slightly more common medially than later-
ally (35% vs 28%, respectively). The most com-
mon site of fracture or contusion was the ante-
rized as proximal, midsubstance, or distal on rior tibia; injury at this site was usually com-
the basis of the location of abnormal signal in- bined with injury of the anterior lateral femoral
tensity on sagittal images in the proximal, mid- condyle. In most patients with joint effusion,
dle, or distal third of the ligament, respectively. the effusion was relatively small.
Avubsion injuries of the tibiab insertion site of
the PCL were identified Ofl the basis of focal
discontinuity of the tibiab articular surface, with
a discrete bone fragment attached to an other-
wise intact PCL and separated from the remain-
der of the tibia (Fig 6).

May1995 Sonin et a! U RadioGraphics U 557

 r

[‘h. :,
j -

a. b.
Figure 7. Collateral ligament injury associated with PCL rupture. (a) Coronal turbo spin-echo proton-density-
weighted image through the posterior knee shows intermediate signal intensity within the vertical portion of
the PCL, representing an intrasubstance injury (large arrow). The lateral collateral ligament, fibular collateral
ligament, and biceps femoris muscle tendon are ruptured (small arrows). RT = right. (b) Coronal turbo spin-
echo proton-density-weighted image obtained more anteriorly shows that the medial collateral ligament is dis-
rupted (arrowheads).

a. b.
Figure 8. Greater conspicuity of PCL intrasubstance injury on coronal images. (a) Sagittal Ti-weighted image
does not clearly demonstrate a normal proximal (horizontal) portion of the PCL (arrow); adjacent images ap-
peared similar. (b) Coronal turbo spin-echo proton-density-weighted image demonstrates abnormal intermedi-
ate signal intensity within the corresponding horizontal portion of the PCL (arrow), consistent with a partial
tear. Similar advantages are found when axial images are used to visualize the vertical portion of the PCL.

The frequencies of associated ligamentous transbocation injuries. As might be expected

injuries and meniscab tears are similar to those from the differing mechanisms of injury, these
reported by other investigators (1 ,2,7, 14). The adjunctive findings deviate from those seen in
presence and locations of bone contusions and ACL tears (i8): Collateral ligament tears are
fractures correlated with the mechanism of in- more commonly seen in PCL injury, meniscal
jury; the anterior tibial plateau was the most tears are less commonly seen, and bone contu-
commonly affected site, as would be expected sions tend to occur anteriorly in the tibia in-
in cases of hyperextension and posterior tibial stead of posteriorly.

558 U Scientific Exhibit Volume 15 Number 3

Figure 9. Usefulness of a long TRITE sequence in assessing the integrity of the PCL. (a) Sagittal Ti-weighted
image shows a large, amorphous area of intermediate signal intensity in the expected location of the PCL (ar-
row); no intact fibers can be identified. These findings would be consistent with a complete tear of the PCL.
(b) Corresponding turbo STIR image clearly shows continuity of much of the PCL, indicating a partial PCL nip-
ture.

c.t_
4. (-. . ...

i#{149} “

Figure 10. Use of STIR imaging for improved visualization of associated bone contusions in an 18-year.old
man with a partial PCL tear secondary to a hyperextension injury. (a) Sagittal Ti-weighted image demonstrates
amorphous low signal intensity in the marrow of the anterior tibia and femur, consistent with contusions (ar-
rows). (b) On a corresponding turbo STIR image, the contusions are more conspicuous. The linear zone of very
high signal intensity represents a fracture (arrow).

In our experience, sagittab MR images are the detected on sagittab MR images, can often be
most important in the diagnosis of PCL injury. confirmed more readily on coronal or axial im-
Their importance is due primarily to the fact ages (Fig 8). Long TRITE images are often use-
that the majority of PCL injuries occur in the ful for accurate grading of PCL injury (Fig 9),
midsubstance of the PCL, an area not well dem- and Ti-weighted or STIR images are valuable in
onstrated on coronal or axial MR images. The assessment of associated bone marrow injury
horizontal and vertical portions of the PCL are (Fig 10).
better depicted in the coronal and axial planes;
injuries involving these regions, although often

May 1995 Sonin et a! U RadioGrapbics U 559

 Figure 11. Chronic PCL injury and secondary degenerative changes in a 51-year-old man with a history of re-
mote PCL rupture who suffered acute knee trauma. (a) Sagittal Ti-weighted image shows the sequela of a previ-
OUS avulsion injury to the tibial PCL insertion site (arrow). The PCL is flot visualized. There is an acute rupture
of the ACL (arrowheads). (b) Sagittal Ti-weighted image obtained further medially shows degenerative changes
throughout the knee, including the patellofemoral joint (arrows).

No arthroscopic correlation was performed U SUMMARY

in several of our patients because their injuries This article presents our experience with MR
were managed conservatively. In addition, imaging of injury of the PCL. Our findings con-
many of our patients were not studied in the firm that PCL rupture is easily identified with
acute setting after a trauma; the absence of MR imaging by using simple signal intensity and
bone contusions and effusions in such patients structural characteristics. The spectrum of PCL
may be related to the temporal delay (Fig 1 1). injuries is well demonstrated and includes par-
We believe that the diagnostic accuracy of MR tial tears or intrasubstance injuries, complete
imaging in assessment of ligamentous and carti- ligamentous rupture, and avulsion of the PCL
laginous injuries in the knee has been well insertion site on the posterior tibia. The fre-
documented and provides a legitimate standard quency of isolated PCL injury in our series
on which to base our statistical observations (24%) correlates well with results from the or-
(7, I 9,20). thopedic literature.
Although most patients with PCL injury dem-
onstrate some coexistent injury in the other
ligamentous and cartilaginous structures of the
knee, such associated findings are seen with dif-

560 U Scientific Exhibit Volume 15 Number 3

ferent frequencies than in patients with ACL in- ment of acute PCL injuries with associated pa-
jury. The ability to detect associated injuries of thology: long-term results. Orthopedics 1991;
the collateral ligaments and menisci can play an 14:687-692.
important role in clinical decision making. Simi- 10. HughstonJC. The absent posterior drawer
sign in some acute posterior ligament tears of
larly, bone injury in patients with PCL tears oc-
the knee. AmJ Sports Med 1988; 16:39-43.
curs in different locations than those typically
1 1 . Gillquist J, Hagberg G, Oretorp N. Arthros-
seen in ACL tears; this difference in location
copy in acute injuries of the knee joint. Acta
correlates with the differing mechanisms of Orthop Scand 1977; 48:190-196.
PCL injury. Because clinical and arthroscopic as- 12. LysholmJ, GilquistJ. Arthroscopic examina-
sessment of the PCL can be difficult, MR imag- tion of the posterior cruciate ligament. J Bone
ing can be a valuable tool for evaluation of the Joint Surg LAm] 1981; 63:363-366.
acutely injured knee when operative repair of 1 3. Dehaven KE. Arthroscopy in the cruciate-in-
the PCL is being considered. jured knee. In: Feagin JA, ed. The crucial liga-
ments. New York, NY: Churchill Livingstone,
U REFERENCES 1988; 333-337.
1. Hughston J(;, Bowden JA, Andrews JR, Nor- 14. Clancy WG, Shelbourne KD, Loellner GB,
wood LA. Acute tears of the PCL: results of Keene JS, Neider B, Rosenbert TD. Treatment
of joint instability secondary to rupture of the
operative treatment. J Bone joint Surg LAmI
1980; 62:438-450. PCL. J Bonejoint Surg [Am] 1983; 65:310-322.
2. Burger RS, Larson RL. Acute ligamentous in. 15. KennedyJC, Hawkins RJ, Willis RB, Darylcheck
jury. In: Larsofl RL, (,rana WA, eds. The knee: KP. Tension studies of human knee liga-
form, function, pathology, and treatment. ments. J Bonejoint Surg [Am] 1976; 58:350-
Philadelphia, Pa: Saunders, 1993; 513-598. 355.
3. TorgJS, Barton TM, Pavlov H, Stine R. Na- 16. Loos WC, Fox JM, Blazina ME, Del Pizzo W,
tural history of the posterior cruciate ligament- Friedman MJ. Acute PCL injuries. Am J Sports
deficient knee. Clin Orthop 1989; 246:208- Med 198i; 9:86-92.
17. HodlerJ, Haghighi P. Trudell D, Resnick D.
216.
4. Dandy Dj, Pusey RJ. The long-term results of
The cruciate ligaments of the knee: correlation
unrcpaired tears of the posterior cruciate liga- between MR appearance and gross and histo-
ment.J Bonejoint Surg LBrJ i982; 64:92-94. logic findings in cadaveric specimens. AJR
5. Torisu T. Avulsion fractures of the tihial at- 1992; 159:357-360.
tachment of the posterior cruciate ligament: in- 18. Remer EM, Fitzgerald SW, Friedman H, Rogers
dications and results of delayed repair. Clin
IF, Hendrix RW, Schafer MF. Anterior cruci-
Orthop 1979; 143:107-114.
ate ligament injury: MR imaging diagnosis and
6. PournarasJ, Symeonides PP. The results of patterns of injury. RadioGraphics 1992; 12:
901-915.
surgical repair of acute tears of the posterior
cruciate ligament. Clin Orthop 1991; 267:103- 1 9. Lee JK, Yao L, Phelps CT, Wirth CR, Czajka J,
Lozman J. Anterior cruciate ligament tears:
107.
7. GroverJS, Bassett LW, Gross ML, Seeger LL,
MR imaging compared with arthroscopy and
Finerman GAM. Posterior cruciate ligament: clinical tests. Radiology i988; i66:86I-864.
20. Mink JG, Levy T, Crues JV III. Tears of the an-
MR imaging. Radiology 1990; 174:527-530.
8. Sonin AH, Fitzgerald SW, Friedman H, Hoff FL, tenor cruciate ligament and menisci of the
Hendrix RW, Rogers LF. Posterior cruciate knee: MR imaging evaluation. Radiology 1988;
167:769-781.
ligament injury: MR imaging diagnosis and pat-
terns of injury. Radiology 1994; 190:455-458.
9. Barrett GR, Savoie FH. Operative manage-

May1995 Sonin et al U RadioGraphics U 561