Dashboard Knee: Injury Mechanisms, Diagnostic Challenges, and Treatment Outcomes

Introduction: Frontal motor vehicle collisions (MVCs) are the most common crash configuration and are a well-recognized mechanism for posterior cruciate ligament (PCL) injury through direct dashboard impact. These "dashboard knee" injuries may initially present with subtle clinical findings yet progress to persistent pain, instability, and functional limitation if not appropriately identified and managed. Despite the recognized mechanism, early recovery patterns and short-term outcomes following surgical versus conservative management remain incompletely characterized. Methods: A retrospective case series was conducted of patients presenting to a single orthopedic surgeon with magnetic resonance imaging (MRI)-confirmed PCL injury following frontal MVC between June 2022 and January 2024. Ten patients met the inclusion criteria. Five patients underwent arthroscopic PCL reconstruction with treatment of associated intra-articular pathology when indicated, and five patients were managed conservatively with structured physiotherapy. Patient-reported pain scores, measured using a six-point ordinal scale, were collected at 4, 8, and 12 weeks following treatment initiation to evaluate recovery trends. Descriptive and comparative analyses were performed. Results: Nine of 10 patients demonstrated progressive improvement in pain scores over the 12-week follow-up period. One patient in the conservatively managed group experienced worsening symptoms. Patients treated surgically demonstrated lower cumulative pain scores, with an average total score of 8 out of 18, compared with 13 out of 18 in the conservative group. Conservatively treated patients also reported longer symptom duration, increased stiffness, and persistent swelling. Conclusion: Patients with PCL injuries resulting from dashboard mechanisms demonstrated improvement with both surgical and conservative management; however, surgical intervention was associated with greater early pain reduction in this cohort. These findings underscore the importance of early recognition of PCL injury following frontal MVC and suggest that surgical reconstruction may provide improved short-term symptom relief in appropriately selected patients. Larger studies are needed to further define optimal management strategies.