PCL Injury and Reconstruction
Unlike ACL injuries, injuries to the PCL or Posterior Cruciate Ligament are relatively uncommon because the PCL is stronger and larger than the ACL. However, PCL injuries do occur and make up about 20% of all reported knee injuries. Damage to the PCL occurs primarily from a powerful force to the knee: most commonly in car accidents or in football but other athletes can also be susceptible to this type of injury. PCL injuries usually occur in conjunction with injury to the meniscus, cartilage, bone surfaces, or other ligaments, and it is often these injuries that are precursors to long-term damage of the knee if left untreated.
The PCL is one of four major ligaments of the knee, which connect the femur to the tibia. The PCL helps to stabilize the knee joint by preventing the tibia from shifting backwards. The PCL and ACL work as opposites and act balance to the knee.
Diagnosis of these injuries is often made clinically. However, X-rays and magnetic imaging studies (MRI) can also be helpful in confirming the diagnosis. The severity of damage to the PCL will be evaluated to determine whether the ligament is completely or partially torn. Based on these findings, along with patient history a treatment plan can be developed.
Conservative treatment involves muscular strengthening and often bracing to help stabilize the knee. This option is optimal for patients who sustain partial injuries to the PCL or those who are older, less active, and not planning on returning to cutting sports. It is an effective form of treatment for those not experiencing recurrent instability from normal activities. In patients where stability is not obtained after a thorough rehabilitation program for isolated injuries or those who have multiple ligament injuries involved, surgical reconstruction offers a better alternative in preventing recurrent instability and return to function.
Surgical management of these injuries involves reconstruction of the torn PCL. This is typically performed after knee motion has returned and swelling has dissipated. Reconstruction is performed arthroscopically using either an autograft or allograft that the body then utilizes to incorporate over time into a functioning PCL. An autograft is the patient’s own tissue harvested at the time of surgery, where as an allograft is cadaver tissue from a donor. The benefits of each graft can be discussed with the surgeon prior to surgical reconstruction although the surgical technique and rehabilitation programs are similar. At the time of surgery, other damage or injuries to the knee can be identified and addressed. The goal of this procedure is for the patient to successfully return to full athletic activity at 6 – 9 months. A general guideline of PCL rehabilitation can be found within the Rehabilitation Protocols. As these injuries differ from “patient to patient,” your individual case will be discussed with the surgeon prior to surgery and the best rehabilitation program and surgical technique can be utilized.