1994 student writing contest winner: nonoperative rehabilitation of an isolated posterior cruciate ligament rupture.

This case study describes the history, diagnosis, rehabilitation, and prognosis of an isolated posterior cruciate ligament (PCL) rupture seen in a collegiate soccer player. The occurrence of an isolated PCL rupture is rare in athletics. An accurate diagnosis is important and can be obtained by using techniques such as: passive tests, active tests, X rays, and magnetic resonance imaging. Rehabilitation from this injury is controversial because of the lack of documentation clearly showing the natural pathology of a PCL-deficient knee. There is research indicating that if chronic joint degeneration occurs, it will most likely be medial compartment or patellofemoral arthritis. Currently, the options are reconstructive surgery or participation in a nonoperative rehabilitation program. Because of this athlete's strength, age, and the nature of his sport, reconstructive surgery was not chosen. The rehabilitation program was progressive and modeled after the five stages of rehabilitation as described by Prentice. It emphasized strengthening the quadriceps and increasing hamstring flexibility. The athlete experienced minimal pain and inflammation after the injury. Results of rehabilitation were outstanding. The athlete was released for return to full contact 4-1/2 weeks postinjury. He demonstrated excellent performance without any abnormal knee symptoms. The ratio of quadriceps to hamstring strength was bilaterally stabilized to 87%, and the ratio of quadriceps strength of the injured knee to the healthy knee was 102% when the athlete returned to sports activities. The athlete will have to wait to see if the chronic damage that may develop will be symptomatic.