Current standards for the objective assessment and management of posterior cruciate ligament tears: a narrative review.

Background and Objective: The posterior cruciate ligament (PCL) is the primary restraint to posterior tibial translation (PTT) and injury typically occurs during knee flexion when an external force to the tibia causes PTT. PCL injuries are often overlooked and require a comprehensive exam including a thorough history, physical examination, and imaging. This narrative review aims to review the literature on objective assessments and management of PCL tears. Methods: A narrative review of PubMed and SCOPUS-indexed relevant literature (no date restrictions, English only, up to October 2025). Studies including reference to the PCL, PCL reconstruction, PCL imaging, and current PCL management were included. Key Content and Findings: Within the literature there are multiple reported physical examination tests with varying sensitivities and specificities that aid in the diagnosis of PCL tears such as the posterior drawer, posterior sag, and quadriceps activation tests. PCL stress radiography accompanies the physical exam to provide an objective assessment of PTT while magnetic resonance imaging (MRI) is the gold standard for visualizing acute PCL tears. Nonoperative management with dynamic bracing can promote physiologic healing in grade I, isolated partial PCL tears while grade II, complete PCL tears have demonstrated improved outcomes with both non-operative and operative management. Surgical intervention is typically recommended for grade III, combined PCL injuries and the double-bundle PCL reconstruction technique has demonstrated significantly improved objective stability when compared to the single-bundle reconstruction technique. Conclusions: Both isolated and combined PCL tears may be difficult to diagnose from other ligamentous knee injuries due to overlapping symptoms and similar physical exam findings. This may lead to misdiagnosis and the sequalae of long-term functional disabilities and future osteoarthritis. The diagnosis and determination of proper PCL tear management requires a comprehensive history, multiple physical examination tests with concomitant imaging such as PCL stress radiographs and MRI. Surgical intervention is often recommended when a grade II or higher PCL injury is demonstrated during the physical examination, or ≥8 mm of PTT (grade II) is visualized when evaluating the side-to-side differences through PCL stress radiography.