This study compares the clinical outcomes of conservative and surgical treatment for
posterior cruciate ligament (PCL) injuries. The aim is to evaluate both approaches
with respect to knee stability, subjective scores, e.g., patient-reported outcome
measures (PROMs) and return to sport (RTS). Surgical interventions demonstrate superior
objective stability metrics (e.g., reduced residual instability, lower rates of osteoarthritis),
while both treatment strategies yield similarly favorable functional outcomes. Conservative
management of isolated PCL injuries generally results in good to very good PROMs,
e.g., Lysholm, International Knee Documentation Committee (IKDC) and Tegner scores.
Surgical treatment also improves the PROMs, although outcomes vary considerably depending
on injury severity, concomitant injuries and rehabilitation protocols. Following conservative
therapy, a high proportion of athletes are able to return to their preinjury performance
level, particularly in cases of isolated, low-grade injuries. In contrast, surgical
intervention is associated with lower RTS rates and longer rehabilitation periods,
which could be attributable to more severe injuries and delayed surgical timing. Conservative
treatment is often effective for isolated, low-grade PCL ruptures, whereas surgical
reconstruction may be necessary in cases of high-grade or combined injuries. Treatment
decisions should be made on an individual basis. Further high-quality studies are
needed to enhance comparability.
