Comparison of Outcomes in Pediatric and Adolescent Posterior Cruciate Ligament Injuries With and Without Meniscal Tears: Operative Versus Nonoperative Management

Background: Despite the posterior cruciate ligament (PCL) being an essential stabilizer of the knee, there is a paucity of data regarding injury management in pediatric patients.

Purpose/hypothesis: The purpose of this study was to evaluate differences in outcomes after operative (OP) versus nonoperative (NOP) management of pediatric isolated (single-ligament) PCL tears. It was hypothesized that managing PCL tears operatively would lead to improved functional outcomes compared with NOP management, especially in the setting of an associated meniscal tear.

Study design: Cohort study; Level of evidence, 3.

Methods: Pediatric patients with an isolated PCL injury between 2006 and 2020 were identified and grouped according to whether they had a concomitant meniscal tear (PCL+M) or no meniscal tear (PCL-M). These cohorts were further sorted into OP, NOP, and nonoperative converted to operative (NOP2OP) treatment cohorts. Outcome data collected included Lysholm score, current activity level, and whether the patient returned to sports after treatment.

Results: A total of 48 patients (49 knees) met study inclusion criteria (31 male, 18 female; mean age at injury, 15.6 years; age range, 8.3-18.9 years). There were 37 knees in the PCL-M cohort (30 NOP, 2 NOP2OP, and 5 OP) and 12 knees in the PCL+M cohort (4 NOP, 4 NOP2OP, and 4 OP). The mean duration of follow-up was 6.2 years (range, 2.4-15.7 years). The mean Lysholm scores were not significantly different between the OP and NOP knees in either the PCL-M cohort (P = .582) or the PCL+M cohort (P = .570); however, the PCL-M cohort overall had significantly higher scores compared with the PCL+M cohort (92.7 ± 13.0 vs 82.8 ± 18.8, respectively; P = .019).

Conclusion: The pediatric patients in this series had similar functional outcomes when managed operatively or nonoperatively for their single-ligament PCL tear. When considering concomitant meniscal injury, the results indicated that children with meniscal injury had a worse outcome than those without a meniscal injury. Shared decision-making with patients and their family should take these results into consideration.