Evaluating posterior cruciate ligament injury by using two-dimensional ultrasonography and sonoelastography

Lin Yi Wang, Tsung hsun Yang, Yu Chi Huang, Wen Yi Chou, Chung Cheng Huang*, Ching Jen Wang

*Corresponding author for this work

Research output: Contribution to journalJournal Article peer-review

11 Scopus citations


Purpose: This study aimed to elucidate the diagnostic criteria for posterior cruciate ligament (PCL) injury using ultrasonography. Methods: Thirty-three patients with clinically suspected PCL injuries and 30 normal control subjects were recruited. Both groups were assessed using sonographic examination with reliability testing. Patients also underwent posterior stress radiography and magnetic resonance imaging (MRI). PCL thickness on two-dimensional ultrasonography (2D US), pixel intensity on sonoelastography, displacement on posterior stress view, and severity grading using MRI were analysed. Receiver operating characteristic (ROC) curves were plotted using MRI as the gold standard. Correlation coefficients among variables were calculated. Results: Good to excellent reliabilities were noted for 2D US and red pixel intensity on sonoelastography. In injured knees, PCL thicknesses were significantly greater, and red pixel intensities were significantly lower, compared to non-injured knees of patients and healthy controls. This indicates increased swelling and softness in injured PCLs. The area under the PCL thickness ROC curve was 0.917 (p < 0.001), and the best diagnostic criterion was a thickness ≥6.5 mm (90.6 % sensitivity and 86.7 % specificity). Thickness correlated with red pixel intensity, International Knee Documentation Committee examination grade, and MRI severity grading. In addition, effusions were detected on 2D US in all knees with “tears” of other structures on MRI. Conclusions: 2D US is a useful tool to diagnose PCL injury, and PCL thickness ≥6.5 mm is the recommended diagnostic criterion. Level of evidence: II.

Original languageEnglish
Pages (from-to)3108-3115
Number of pages8
JournalKnee Surgery, Sports Traumatology, Arthroscopy
Issue number10
StatePublished - 01 10 2017

Bibliographical note

Publisher Copyright:
© 2016, European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA).


  • Diagnosis
  • MRI
  • Posterior cruciate ligament
  • Sonoelastography
  • Ultrasonography


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