PCL
Posterior Cruciate Ligament
Phone +971-2-4446600
Anatomy
The posterior cruciate ligament, PCL, is located in the center of the knee joint behind the ACL and acts as the backbone of the knee. It’s primary job is to prevent the lower leg from translating backwards and together with the ACL it stabilizes the knee in rotation.
Injury
PCL tear can occur in multiple ways, most commonly in traffic accidents, falls directly on the knee or in sports. The patient can feel the instability as hyperextension and rotational instability and usually complains of pain in the back of the knee and inability to properly bend the knee. As with an ACL tear, the pain and swelling usually subsides, but the main remaining symptom is instability to the knee, specifically when trying to go back to jumping, twisting or sports.
Evaluation
Understanding the trauma helps to suspect a PCL tear and physical examination with “posterior sag and drawer”, meaning the lower leg sits further back than normal and a lack of stop when forcing it even further back, increases the suspicion. As with most knee injuries, X-rays and MRI is very helpful in diagnosing these injuries and since an isolated PCL-injury is rare, we also must have high suspicion for other injuries.
Positive PCL stress X-ray
To the right: Positive Posterior Drawer Test and Quadriceps Active Test
Treatment
PCL tears are graded 1-3, depending on the severity of the instability. Grades 1-2 are generally treated with a brace and physical therapy and have a high chance of going back to a good activity level without any surgery.
However, grade 2 injuries with persistent instability or grade 3 injuries can be treated very well with surgery, a PCL reconstruction.
The development of the surgical techniques during recent years have shown very good results and this is now a surgery with high success and low complication rates.
PCL Reconstruction
This needs to be individualized!
There are multiple ways of performing a PCL reconstruction, with different techniques, one or two bundles and different grafts.
Patient factors, such as activity level, other injuries and grade of instability all influence what kind of surgery that needs to be done.
Just as with the ACL, the best possible surgery for you is the one that takes into account your life, your knee and your injury, not just your PCL.
Double Bundle PCL Reconstruction from the front (B) and from the back (A)
Rehabilitation
With or without surgery, a physical therapy program needs to be completed to be able to use the knee to its potential. To evaluate when your knee is ready to go back to certain activities, strength testing is done and certain thresholds are used to determine if you are ready.
In broad terms, it can be divided into three stages.
0-3 months is recovery after injury/surgery to get back to normal walking, climbing stairs and living a hassle-free everyday life.
4-6 months is about getting back to activities, such as biking, swimming, gym-training and eventually running. A brace is used until 4-6 months after the injury/surgery to support the healing and making sure the new ligament doesn’t stretch out.
7-10 months is all about preparation for sports. This includes jumping, turning, twisting, sprinting and specific sports-drills to get ready to get back to compete.