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Posterior Cruciate Ligament Reconstruction

Posterior Cruciate Ligament (PCL) injury happens far less often than does injury to the knee's more vulnerable counterpart, the Anterior Cruciate Ligament (ACL). The PCL and ACL connect your thighbone (femur) to your shinbone (tibia). If either ligament is torn, it might cause pain, swelling and a feeling of instability.

Ligaments are strong bands of tissue that attach one bone to another. The cruciate (KROO-she-ate) ligaments connect the thighbone (femur) to the shinbone (tibia). The anterior and posterior cruciate ligaments form an "X" in the center of the knee.

Although a PCL injury generally causes less pain, disability and knee instability than does an ACL tear, it can still sideline you for several weeks or months.

Posterior Cruciate Ligament

Symptoms

Signs and symptoms of a PCL injury can include:

  • Pain: Mild to moderate pain in the knee can cause a slight limp or difficulty walking
  • Swelling: Knee swelling occurs rapidly, within hours of the injury
  • Instability: Your knee might feel loose, as if it's going to give way

If there are no associated injuries to other parts of your knee, the signs and symptoms of a PCL injury can be so mild that you might not notice that anything's wrong. Over time, the pain might worsen and your knee might feel more unstable. If other parts of your knee have also been injured, your signs and symptoms will likely be more severe.

Causes

The PCL can tear if your shinbone is hit hard just below the knee or if you fall on a bent knee.

These injuries are most common during:

  • Motor Vehicle Accidents: A "dashboard injury" occurs when the driver's or passenger's bent knee slams against the dashboard, pushing in the shinbone just below the knee and causing the PCL to tear.
  • Contact Sports: Athletes in sports such as football and soccer can tear their PCL when they fall on a bent knee with their foot pointed down. The shinbone hits the ground first and it moves backward. Being tackled when your knee is bent also can cause this injury.

Risk Factors

Being in a motor vehicle accident and participating in sports such as football and soccer are the most common risk factors for a PCL injury.

Treatment

  • Protecting the knee from further injury
  • Resting the knee
  • Icing the knee for short periods with cold packs
  • Compressing the knee gently, such as with an elastic bandage
  • Elevating the knee
  • A pain-relieving medication may also be needed for knee pain

Nonsurgical Treatment of PCL Injury

You can recover from some PCL injuries without surgery.

Cases that may not require surgery include:

  • Acute grade I or II injuries when no other knee ligaments are injured
  • Newly diagnosed chronic injuries that only affect the PCL and aren't causing symptoms
  • Some people need to go through physical therapy after a PCL injury. This rehabilitation may be necessary with or without surgery.

Rehabilitation may include:

  • Using crutches at first, then gradually walking with more weight on the knee
  • Having a machine or therapist move your leg through its range of motion
  • Temporarily wearing a knee brace for support
  • Strengthening your thigh muscles to help make the knee more stable
  • Walking or running in a pool or on a treadmill
  • Specific training needed for a sport

Surgery for PCL Injury

Patients who may be more likely to need surgery include those who have:

  • PCL injuries in which pieces of bone have torn off and become loose
  • Injuries involving more than one ligament
  • Chronic PCL looseness that causes symptoms, especially in athletes

If a piece of bone is torn off, a surgeon may fasten the bone back into place using a screw. Surgery for a torn PCL requires replacing it with new tissue rather than stitching together the torn ligament.

The ligament may be replaced with:

  • Tissue from a deceased donor
  • Piece of tendon moved from somewhere else in the body, such as the back of the thigh or heel

The operation is sometimes done as an "open" surgery. This requires a large incision in the knee.

PCL

Complications

In many cases, other structures within the knee — including other ligaments or cartilage — also are damaged when you injure your posterior cruciate ligament. Depending on how many of these structures are damaged, you might have some long-term knee pain and instability. You might also be at higher risk of eventually developing arthritis in your affected knee.