Movement of the posterior cruciate ligament during knee flexion--MRI analysis

The movement of the posterior cruciate ligament (PCL) during flexion of the living knee is unknown. The purpose of the present study was to analyze the movement of the PCL using magnetic resonance imaging (MRI). The posterior cruciate ligaments in 20 normal knees were visualized using MRI from extension to deep flexion. Sagittal inclination relative to the longitudinal axis of the tibia was measured and analyzed with reference to the patellar tendon (PT) and the anterior cruciate ligament (ACL). Although the PCL was slack in extension, it straightened with anterior inclination (24.1 ± 5.1°) at 90° flexion. At active maximum flexion (129.2 ± 8.1°), the ligament was almost parallel (3.9 ± 7.4° inclination) to the longitudinal axis of the tibia. At passive maximum flexion (158.8 ± 5.8°), the inclination was reversed anteroposteriorly, measuring −23.0 ± 6.7°. The PCL and PT moved in a corresponding manner within 20° of discrepancy. The results of this in vivo study of the PCL have clinical relevance to conservative therapy for PCL knee injuries. The results of this study could also be useful in PCL reconstruction surgery to determine the optimum graft position to allow maximum postoperative motion.