PCL (Posterior Cruciate Ligament) Injury

The PCL has been described as one of the main stabilizers of the knee.  It is broader and stronger than the ACL.  It connects the femur (thigh bone) to the tibia (shin bone).  Its function is to prevent the posterior translation of the tibia relative to the femur. 

It has been reported that there is only a 2% incidence of isolated PCL tears. PCL injury commonly occurs in sports such as football, soccer, basketball, and skiing.  A forceful hyperextension of the knee or a direct blow just below the knee cap will disrupt the PCL and cause knee pain and PCL Injury.  

The physical examination of the knee by a sports medicine specialist will determine the ligamentous structures involved and determine if it is a PCL Injury or another ligament causing the knee pain.  Plain x-rays will be taken to ensure that no fracture has occurred.  An MRI will be ordered to identify the extent of the ligamentous and cartilaginous injuries.  There is usually swelling as well as significant tenderness to palpation of the back of the knee causing considerable knee pain. Knee surgery will usually take place after the swelling has gone down.   The posterior draw test done with the knee at 90 degrees of flexion, will demonstrate a posterior shift of the tibia relative to the femur. 

Severe PCL laxity, which results in a knee with significant posterior translation is quite unsettling to the patient, especially athletes due to the shifting of the tibia during running. These patients benefit from a PCL reconstruction, which re-establishes stability to the knee. As noted in the treatment of ACL injuries, the ruptured ligament cannot be repaired.  It must be reconstructed using a graft. This can be from the injured patients’ own body or from a donor. The graft is attached through drill holes in the tibia and femur, using arthroscopic techniques, to re-establish the posterior cruciate attachment.

This is an outpatient procedure allowing the patient to walk with crutches and a brace in their home. Return to sports is restricted for 10 to 12 months, allowing the knee to rebuild strength and function.

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© 2020 by Rajeev Pandarinath, MD

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