Posterior Cruciate Ligament or PCL injury
When we think of cruciate ligament tears, we usually think of the anterior ACL. However, there is another major ligament within the knee joint known as the posterior cruciate ligament or PCL. The PCL is located right behind the ACL making an X shape. The purpose of the PCL is to attach the femur to the tibia and prevent the shinbone from moving too far backward.
The PCL is injured less often the ACL as it is both thicker and stronger. Further, when it is injured, symptoms tend to be generalized, making a diagnosis more challenging. Further, because of the strength of the PCL, there is often injury to surrounding structures including cartilage and/or bone.
The Signs and Symptoms of PCL Injury
The signs of a PCL injury may be nonspecific including pain, swelling and difficulty walking or getting full range of motion of the knee. Since cartilage and or bone structure may also be damaged alongside the PCL, the symptoms of these injuries may also be present.
Dr. Manning will start with a complete medical history and a physical examination to see the knee’s range of motion along with when and where pain or tenderness occurs. While an x-ray does not allow us to visualize soft tissue problems such as a PCL sprain, it is helpful in seeing whether the ligament has torn some bone along with it. Typically, an MRI is also performed to understand more about the damage to soft structures in the joint.
Types of PCL Injury
PCL sprains are graded on a scale of 1 to 3. Grade 1 sprains include excessive straining stretching of the PCL. This usually does not cause looseness or instability of the knee, symptoms are relatively mild and can be managed with conservative nonsurgical care. This will include rest, ice, light compression and elevation.
Grade 2 sprains to the PCL are also known as partial tears and will cause looseness in the joint. These tears may or may not require surgical intervention, but will involve a greater degree of recovery and management.
Grade 3 sprains are known as a complete tear of the PCL and will most likely require surgical intervention to rebuild the ligament.
Surgical Treatment for PCL Injuries
Surgical PCL treatment typically consists of rebuilding the ligament and repairing any injury to surrounding tissue, cartilage or bone. A suture repair of the PCL ligament is most often unsuccessful, therefore rebuilding the ligament is commonly the best option. Tendon or ligament tissue is harvested from other parts of the body or can be source from a cadaver donor. The torn ligament is removed, and the new tissue is affixed appropriately. Over the course of several weeks and months this new tissue grows to form a fully-functioning, replacement ligament.
Recovery can be slow depending on the severity of the injury and whether other parts of the knee have received extensive damage. Typically, patients will be immobile for a few to several weeks. Physical therapy is a critical part of a full recovery. Resuming normal activity, such as that prior to the injury, can often begin 4-to-6 months after surgery, but again depends largely on the progression of recovery.
Overall, the success rate and safety of a PCL repair is excellent. Most patients will regain the ability to perform normal day-to-day activities, and with special attention paid to their recovery and rehabilitation, can often perform vigorous activity and sports. Most importantly, the patient must be aware of and adhere to their postoperative recovery plan, including spending the appropriate amount of time recovering, going to physical therapy and minimizing excessive strain on the newly repaired ligament.
If you are experiencing knee pain and suspect it may be a ligament, please contact Dr. Manning to schedule a consultation.