Early Return to Sports after Isolated Posterior Cruciate Ligament Reconstruction Using Peroneus Longus Graft in Young Athletes: A Case Series

Case seriescompartments, contributing to cartilage degeneration and meniscal overload (Table 1)With advances in surgical technique-including arthroscopic approaches, improved fixation methods, and diverse graft options- BackgroundPosterior cruciate ligament (PCL) injuries account for approximately 3-20% of all acute knee ligament injuries and are often underdiagnosed due to subtle clinical presentation. 1,2In contrast to anterior cruciate ligament (ACL) injuries, isolated PCL injuries tend to receive less attention, and their optimal treatment remains a topic of ongoing debate.Conservative management has traditionally been the firstline treatment for isolated PCL injuries, particularly in low-grade or asymptomatic cases.Early studies, such as Shelbourne et al. 1 demonstrated that patients managed nonoperatively could achieve satisfactory subjective stability and functional outcomes.However, long-term follow-up revealed concerning rates of degenerative joint changes.In a cohort of 68 nonoperatively managed patients, radiographic osteoarthritis developed in 23% of patients by year 7 and in 41% by year 14, with 11% developing moderate to severe osteoarthritis.These findings have shifted the paradigm in recent years toward considering surgical reconstruction, particularly in symptomatic patients with high-grade laxity, persistent instability, or functional limitations.Biomechanical studies by Schulte and Harner 2 showed that PCL deficiency leads to increased posterior tibial translation and elevated contact pressure in the medial and patellofemoral 1,