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Clin Orthop Relat Res. 2013 Apr;471(4):1299-304. doi: 10.1007/s11999-012-2707-7. Epub 2012 Nov 21.

The intact posterior cruciate ligament not only controls posterior displacement but also maintains the flexion gap.

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  • 1Osaka City General Hospital, 2-13-22, Miyakojima-hondori, Miyakojima-ku, Osaka City, Osaka, 534-0021, Japan.



The PCL is a strong stabilizer of the knee and provides posterior stability to the tibia. However, sagittal alignment of the PCL with the knee at 90° flexion suggests the PCL might play a role not only in posterior stabilization but also in maintaining the flexion gap.


We determined whether the intact PCL helps maintain the flexion gap.


We examined axial radiographs and gravity sag views of 17 patients with chronic isolated unilateral PCL injury. The flexion gap was defined as the mean value of the medial and lateral distances between the femoral and tibial bones on the axial radiograph. Increase in the flexion gap and posterior laxity were determined by comparing the patients' injured and contralateral uninjured knees.


The flexion gap of PCL injured knees (median, 7.5 mm; range, 5.3-11.5 mm; medial median, 6.2 mm; medial range, 3.7-8.3 mm; lateral median, 7.9 mm; lateral range, 5.3-11.5 mm) was larger than that seen in uninjured knees (median, 5.0 mm; range, 4.0-7.6 mm; medial median, 4.6 mm; medial range 3.4-7.1 mm; lateral median, 5.6; lateral range, 4.5-11.2 mm). The increment in the medial distance was similar to that in the lateral distance. Posterior laxity of injured knees was 9.1 (median); 5.4 to 15.2 (range) mm greater than that of uninjured knees. We found no correlation between posterior laxity and the flexion gap increment.


Our data suggest the intact PCL controls posterior displacement and maintains the flexion gap.

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