The posterior cruciate ligament (PCL) is one of the four main ligaments in the knee joint that stabilizes the knee. The PCL runs between the upper leg bone (femur) and the shinbone in the lower leg. Together with the anterior cruciate ligament (ACL), the PCL controls and stabilizes the knee joint, preventing it from moving too far back and forth. Certain injuries can cause PCL tears. The role of this ligament in stabilizing the knee is to control posterior displacement of the tibia as well as external rotation relative to the femur.
The PCL originates from the central portion of the tibia posteriorly and inserts on the medial wall of the femoral intercondylar notch. The diameter of the ligament varies based upon the size of the knee but generally averages in the range of 10mm. Incidence and Pathophysiology PCL tears are common sports related injuries. The injury typically occurs as a result of a hyperextension force/load or posterior force at the level of the tibia which is applied to the knee. Under these conditions the tensile strength of the ligament is superseded by the energy of the applied stress and the ligament ruptures. The tear pattern can be a rupture of the ligament at its tibial or femoral attachment or a midsubstance rupture of the ligament.
Posterior cruciate ligament tears, or PCL tears, are a partial or complete separation of the posterior cruciate ligament. A partial PCL tear means that the ligament is still attached to the upper and lower leg bones, but it has become stretched loose and partially ripped (like making a small nick in a wide rubber band). The diagnosis of a PCL tear can often be made based on history and clinical findings, however, an MRI is the diagnostic imaging test of choice for confirmation. An MRI scan can also give information regarding associated injuries as mentioned above which can be important for planning optimal treatment.
A complete posterior cruciate ligament tear is, as the name implies, a complete separation of the ligament —one part of ligament is still attached to the femur while the other part is attached to the shinbone (tibia). The PCL is generally sturdier than the ACL is. Consequently, most ACL injuries are complete tears while a typical PCL injury only causes a partial PCL tear. A PCL injury doctor will be able to determine what type of PCL tear has occurred using physical examination techniques and tests.
The symptoms and causes of PCL injuries are best understood by knowing what the PCL does in the first place. The PCL keeps the shinbone (tibia) from moving too far backwards in relation to the upper leg at the knee joint. So any trauma to the leg that moves the lower leg backwards more than the upper leg can result in a PCL injury and likely a PCL tear. Therefore, the causes of PCL injuries involve trauma to the lower leg specifically, such as an athlete falling on a bent knee (particularly the shinbone) or someone riding in the front seat during an automobile accident whose lower legs strike the dashboard.
The typical symptoms of a PCL tear are pain and swelling that occur immediately after the PCL injury and reach their peak over a short period. People with PCL tears often have difficulty walking, and the leg may “give out” at the knee. Knee joint swelling may make the knee stiff. In fact, a PCL injury doctor will usually be able to find limited range of motion in the knee during examination, along with the stiffness and swelling. A result of the instability episode and the knee partially dislocating, not infrequently the bones are contused or in some cases even fractured. In addition the medial and or lateral meniscus can be torn. In some cases there can be damage to the articular cartilage surface of either the femoral condyles and or the tibial plateaus. Finally, additional ligaments can be injured along with the ACL, most commonly the MCL (medial collateral ligament).
Non-surgical treatment is appropriate when there are no associated injuries that require repair, the age range is > 30 and there is no plan to participate in high PCL demand activities. Under these circumstances, the knee can be treated symptomatically initially and then participate in a rehabilitation program to strengthen muscles that also work to dynamically stabilize the knee in the same way that the PCL does.
These would be the gastrocnemius muscles and the biceps femoris, semimembranosis, semitednonosis and gracilis muscles. PCL braces are also available and these can be used during participation in low PCL demand sports and the occasional participation in moderate PCL demand activity.
A local PCL tear doctor in New York City, Staten Island, or Jersey City can evaluate and determine if your PCL injury will require surgical or nonsurgical treatment. Initial treatment should focus on reducing the severity of the inflammatory response as well as taking precautions so as not to cause further injury to the knee. Since most PCL injuries result in partial PCL tears, many people may be able to avoid surgery. Nonsurgical treatments for PCL tears include first aid interventions, immobilization, pain medications, and physical therapy.
The typical first aid intervention for a PCL tear is PRICE: protection, rest, ice, compression, and elevation. If PRICE is performed soon after the PCL injury, the treatment can relieve pain and help the torn PCL to heal. Over-the-counter pain medications such as ibuprofen are usually enough to control pain after the first 24 hours, but your PCL injury doctor may prescribe more potent pain medications. After the initial swelling has subsided, your PCL tear doctor can recommend a physical therapist in New York City, Staten Island, or Jersey City to direct a thorough rehabilitation program that will help reduce pain and improve knee function.
A PCL surgery is generally considered advisable when the individual is likely to return to high demand PCL activities. These can include sports such as football, soccer and basketball or work such as heavy construction or police enforcement. Under these circumstances, the PCL deficient knee will may subluxate (partially dislocate) during high stress activities and cause further and often more serious knee injuries.
Age is also a factor and a younger person may be more likely to benefit from a surgical reconstruction given the propensity for PCL deficient knees to develop osteoarthritis as a result of abnormal kinematics that develop as a result of PCL deficiency. In regard to the types of surgical reconstruction that are available, there are many. At Regional Orthopedics our current preference is an anatomic reconstruction using the native footprint for the femoral and tibial attachment of the PCL.
Tunnel preparation is performed independently to allow for matching the natural footprint of the reconstructed PCL. Graft fixation preference on the femoral side is cortical fixation so that there is no hardware inside the knee and the graft and tunnel and incorporate fully without a potential osseous deficiency if the graft ever suffered a subsequent tear and the procedure had to be done again. An interference screw and/or cortical fixation on the tibial side. Graft options include allograft and the type is matched to the patient.
A complete PCL tear will not heal without surgery. While you can live without a PCL, a completely torn PCL will greatly limit your ability to compete in competitive sports and may increase your risk for knee arthritis in the future. Young, otherwise healthy individuals, especially athletes, may wish to pursue surgical treatment for PCL tears.
An experienced PCL tear doctor can repair or rebuild the torn ligament. A partially torn PCL can be repaired by suturing the torn ligament, while a completely torn PCL must be replaced. Tunnel preparation is performed independently to allow for matching the natural footprint of the reconstructed PCL. Graft fixation preference on the femoral side is cortical fixation so that there is no hardware inside the knee and the graft and tunnel and incorporate fully without a potential osseous deficiency if the graft ever suffered a subsequent tear and the procedure had to be done again. An interference screw and/or cortical fixation on the tibial side.
Your PCL injury doctor may use a tissue graft taken from another part of your body or use a donor graft harvested from a cadaver. Remember that while people initially recover quickly after PCL replacement surgery, rehabilitation and full return to activity may take several months, as the PCL takes many months to fully heal.
If you have sustained injury to your knee and think you may have a PCL tear or other PCL injury, contact the PCL injury doctors at Regional Orthopedics today for a consultation.