The posterior cruciate ligament (PCL) is both the largest and the strongest ligament in the knee, and functions as one of the knee’s main stabilizers. Functionally, the PCL serves to restrain posterior translation of the tibia. The PCL also serves to restrain internal rotation of the knee at 90 degrees of flexion. PCL tears are typically produced via an external force resulting from a posteriorly directed force to the anterior aspect of the proximal tibia during knee flexion (for example, hitting your knee against the dashboard of your car during a car collision). If you believe you may have a PCL injury, you may require reconstructive surgery to regain functioning of the ligament prior to returning to physical and/or daily activities. Although, there are non-surgical treatments available that may help alleviate pain.
PCL injuries are most prevalent amongst athletes that participate in football, soccer, rugby and skiing, with injury occurring during a traumatic event. It is possible for the PCL to become injured in a non-contact setting, although these injuries are much less common.
When the PCL is injured, orthopaedic surgeons will classify the injury and grade it depending on the severity. Although a thorough physical examination many times provide adequate information to determine the severity of a PCL injury, additional imaging such as X-Ray or MRI may be required to more confidently illustrate degree of the injury.
If you have a PCL injury, you may experience one or several of the following symptoms:
- Difficulty walking downhill or down a set of stairs
- Pain (may range from mild to severe)
- Swelling or effusion of the knee joint
- Instability (a feeling that the injured knee may give away; knee locks or “catches”)
Determination of treatment is extremely dependent on the severity of the PCL injury. Although some grade I and grade II PCL injuries are treated conservatively with early rehabilitation, strength training, and range of motion exercises, in severe cases PCL injuries treated non-operatively may lead to instability and/or arthritis and other degenerative changes.
Due to the inherent healing capacity of the PCL, non-operative treatment is an option for isolated acute PCL injuries. With the use of a PCL brace, the tibia can remain in a reduced position to aid healing.
Surgical treatment is many times advised for complete (grade III) PCL tears, and tears where surrounding structures are damaged as well in order to restore joint stability and improve functioning of the knee joint. With multiple techniques for PCL reconstruction, the differences between techniques will typically be found regarding the number of “bundles” reconstructed, and graft type used.
In any case of treatment, rehabilitation and physical therapy play a critical role in helping you return to your daily activities. Physical therapy programs help restore knee strength and motion. In the case of PCL reconstruction, physical therapy focuses on returning movement to the surrounding muscles and knee, which is followed by a strengthening treatment to maintain and protect the new ligament. Finally, in the last step of rehabilitation the methods are customized for a safe return to the athlete’s sport.