Uncommon Co-Presentation of Posterior Cruciate Ligament Tear and Peroneal Nerve Injury: A Case Report

Case Diagnosis: Concurrent PCL tear and peroneal nerve injury with foot drop, managed with surgery, physical therapy, and OMT

Case Description or Program Description: A 20-year-old patient sustained a rare posterior cruciate ligament (PCL) tear with peroneal nerve injury due to sudden hyperextension and varus force to the left knee while playing basketball. Imaging confirmed a complete PCL tear, an injury significantly less common than anterior cruciate ligament (ACL) tears. Within 24 hours, the patient developed foot drop, a nerve conduction study confirmed peroneal nerve damage. He underwent PCL reconstruction, with plans for specialist evaluation of persistent peroneal nerve dysfunction.
At five weeks post-surgery, the patient exhibited severe foot drop, absent volitional ankle dorsiflexion and eversion, and sensory loss in the peroneal nerve distribution, particularly along the lateral shin below the mid-shin and the medial aspect of the big toe. Rehabilitation included neuromuscular re-education, therapeutic exercise, functional mobility training, and osteopathic manipulative treatment (OMT) to optimize recovery. Modalities were incorporated as needed for symptom management.

Setting: Sports Medicine and Rehabilitation Center

Assessment/Results: Despite persistent sensory and motor deficits, functional improvements were observed in adaptive gait with axillary crutches, transfers, and bed mobility. Serial neurological exams continue to assess nerve recovery progress, with plans for potential surgical intervention if deficits persist.

Discussion (relevance): PCL tears are uncommon and typically result from high-energy trauma. The co-occurrence of peroneal nerve injury is rare, complicating management and prolonging recovery. Peroneal nerve healing is highly variable, requiring multimodal rehabilitation. OMT may offer adjunct benefits by addressing compensatory musculoskeletal dysfunctions, improving circulation, neuromuscular control, and mobility.

Conclusions: This case highlights the complexity of treating concurrent ligamentous and nerve injuries. Given the rarity of this injury pattern, further research is needed to optimize treatment strategies and determine the role of OMT in post-surgical recovery.