Long-term Follow-up of Patients with Acute Posterior Cruciate Ligament Injury Treated Non-operatively with a Physiotherapy-led Exercise and Support Brace Intervention.

Background: Posterior Cruciate Ligament (PCL) injuries can be treated non-operatively with a structured rehabilitation program or by surgical reconstruction. However, while the outcomes of surgically treated PCL injuries are well described, there is a paucity of large prospective studies reporting long-term outcomes of exercise interventions. Purpose: The primary aim was to investigate long-term (after five years) patient-reported outcomes of a physiotherapy-led exercise and support brace intervention in patients with an acute PCL injury. The secondary aim was to report conversion to surgical PCL reconstruction. Study design: Case series study, prospective. Methods: Fifty patients with acute isolated or multiligament PCL injuries (presenting within eight weeks of injury) completed a 16-week exercise intervention, including 12 weeks in a PCL support brace. Patients were followed prospectively, and patient-reported outcomes were assessed using the International Knee Documentation Committee Subjective Knee Form (IKDC), the Knee injury and Osteoarthritis Outcome Score (KOOS) and the Tegner Activity Scale (TAS). In addition, conversion to surgery was retrospectively extracted from medical records. Results: Thirty-six patients completed subjective questionnaires at the five-year follow-up. The mean IKDC score improved from 35 points at baseline to 79 points at the five-year follow-up. All mean KOOS subscale scores increased by a statistically significant amount from baseline to the five-year follow-up: Symptoms: 52/87 points; Pain 56/88 points; Activities of daily living 58/90 points; Sport/Recreation 17/75 points; Quality of life 23/73 points. The TAS improved from level 2 at baseline to level 5 at the five-year follow-up. Seven patients (14%) were converted to PCL surgical reconstruction. The median time from initiation of non-operative treatment to surgery was 13 months (range 10-14 months). Conclusions: The physiotherapy-led exercise and brace intervention showed statistically significant improvements in patient-reported outcomes at long-term follow-up of five years, and the need for conversion to PCL reconstruction for isolated PCL injuries was low with a conversion rate of 7%. Level of evidence: 3b.