{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T17:58:39Z","timestamp":1785347919130,"version":"3.55.0"},"reference-count":44,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2025,8,31]],"date-time":"2025-08-31T00:00:00Z","timestamp":1756598400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2025,8,31]],"date-time":"2025-08-31T00:00:00Z","timestamp":1756598400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["esskajournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Knee surg. sports traumatol. arthrosc."],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>This study aimed to determine the most reliable and precise method for measuring the buckling phenomenon of the posterior cruciate ligament (PCL) in skeletally immature patients on magnetic resonance imaging (MRI). The posterior cruciate ligament (PCL)\u2010line sign, PCL angle (PCLA), PCL inclination angle (PCLIA) and PCL\u2010posterior cortex angle (PCL\u2010PCA) were considered. Secondary aims were to (1) compare PCL buckling between healthy and ACL\u2010injured patients to establish a discrimination threshold, (2) assess its validity against other MRI parameters. The hypothesis was that the PCL\u2010PCA is the most reliable and precise method to detect knee decompensation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Fifty\u2010five ACL\u2010injured patients with open physes were matched with 51 controls by gender and skeletal age. The PCL buckling phenomenon was measured on MRI using four methods, each repeated after two weeks. The presence of a lateral collateral ligament (LCL) sign, medial\/lateral anterior tibial translation (ATT) and meniscal bone angle (MBA) were considered. Intra\u2010 and inter\u2010observer reliability were assessed using Cohen's Kappa and intra\u2010class correlation coefficients (ICCs). Standard error of measurement (SEM) and minimal detectable change (MDC) were calculated. Group comparisons used\n                      <jats:italic>t<\/jats:italic>\n                      \u2010tests and chi\u2010square tests; receiver\u2010operating characteristic curves identified optimal thresholds, and Pearson correlations assessed relationships between PCL measures and knee decompensation indicators.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      PCL\u2010line, PCLA and PCL\u2010PCA showed excellent intra\u2010 and inter\u2010observer reliability (ICCs\u2009&gt;\u20090.90), while PCLIA was rated good (ICC\u2009=\u20090.75\u20130.90). PCL\u2010PCA showed the highest precision (SEM\u2009=\u20092.0\u00b0) and best discrimination between healthy and ACL\u2010injured patients (sensitivity: 80%, specificity 74.1%, cut\u2010off\u2009\u2264\u200931.5\u00b0) It correlated with medial\/lateral MBA (0.36;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001, 0.37;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001, respectively) and ATT (\u22120.59;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001, \u22120.52;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001, respectively), yet did not differ between positive and negative LCL signs (n.s.).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>PCL\u2010PCA showed the highest reliability\/precision to measure the PCL buckling phenomenon. Its correlation with other indicators of knee decompensation confirms that PCL\u2010PCA can be used to detect knee decompensation in children.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>Level III.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ksa.70032","type":"journal-article","created":{"date-parts":[[2025,8,31]],"date-time":"2025-08-31T09:01:05Z","timestamp":1756630865000},"page":"2710-2720","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["The posterior cruciate ligament\u2010posterior femoral cortex angle (PCL\u2010PCA): A precise indicator of knee decompensation in skeletally immature anterior cruciate ligament\u2010injured patients"],"prefix":"10.1002","volume":"34","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9089-1668","authenticated-orcid":false,"given":"Robin N. J.","family":"Voskuilen","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery &amp; Trauma M\u00e1xima Medical Centre Eindhoven\u2010Veldhoven the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martijn","family":"Dietvorst","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery &amp; Trauma M\u00e1xima Medical Centre Eindhoven\u2010Veldhoven the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marieke C.","family":"van der Steen","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery &amp; Trauma M\u00e1xima Medical Centre Eindhoven\u2010Veldhoven the Netherlands"},{"name":"Department of Orthopaedic Surgery &amp; Trauma Catharina Hospital Eindhoven the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annika B.","family":"Ito","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery &amp; Trauma M\u00e1xima Medical Centre Eindhoven\u2010Veldhoven the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maximiliano","family":"Iba\u00f1ez","sequence":"additional","affiliation":[{"name":"ICATME, Hospital Universitari Dexeus, UAB Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joan Carlos","family":"Monllau","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Hospital del Mar Universitat Pompeu Fabra (UPF) Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Romain","family":"Seil","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery Centre Hospitalier Luxembourg \u2010 Clinique d'Eich Luxembourg Luxembourg"},{"name":"Luxembourg Institute of Research in Orthopaedics Sports Medicine and Science (LIROMS) Luxembourg Luxembourg"},{"name":"Human Motion, Orthopaedics, Sports Medicine and Digital Methods (HOSD) Luxembourg Institute of Health (LIH) Luxembourg Luxembourg"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caroline","family":"Mouton","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery Centre Hospitalier Luxembourg \u2010 Clinique d'Eich Luxembourg Luxembourg"},{"name":"Luxembourg Institute of Research in Orthopaedics Sports Medicine and Science (LIROMS) Luxembourg Luxembourg"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rob P. A.","family":"Janssen","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery &amp; Trauma M\u00e1xima Medical Centre Eindhoven\u2010Veldhoven the Netherlands"},{"name":"Orthopaedic Biomechanics, Department of Biomedical Engineering Eindhoven University of Technology Eindhoven the Netherlands"},{"name":"Department of Paramedical Sciences Fontys University of Applied Sciences Eindhoven the 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