Its description, causes, symptoms, diagnosis and treatment (operative and non-operative)
TThe posterior cruciate ligament (PCL) is the other main stabilizing ligament on the inside of the knee. Its main function is to prevent the tibia (shin bone) from sliding backward and rotating on the femur (thigh bone). Tears/ruptures of the ligament results in knee instability. PCL tear is less common than ACL tear.
What are the causes?
PCL tears are typically caused by trauma or a fall on the knee. A direct posterior/backward force on the tibia commonly seen in collision sports or the knee hitting the dashboard in a motor vehicle accident will cause a PCL tear.
What are the symptoms?
PCL tears cause immediate pain and often swelling. You may feel something “pop” inside the knee. An initial inability to bear weight on the leg may subside and walking may be possible after several minutes. The knee may feel loose or that it is going to “give out” and immediate return to sport is impossible. Over time, swelling will increase and motion may be lost. Unlike ACL tears, some patients, even athletes, can return to sport with partial PCL tears (albeit in a knee brace) and never require surgery.
How is it diagnosed?
Your surgeon will perform a thorough history and physical exam with X-rays. On exam, swelling and loss of motion and strength is present. Your surgeon will perform maneuvers to check stability of all the knee ligaments and the meniscus. An MRI is helpful to confirm the diagnosis, showing the PCL tear. The type of tear (partial, complete, avulsion from either the tibia or femur) can be defined, which may assist in treatment planning. The MRI may also show bone bruising secondary to the injury.
How is it treated?
Non-operative - PCL tears do not heal. However, some patients may be able to return to normal activity depending on the type and severity of the tear. Non-operative treatment consisting of anti-inflammatory medication, physical therapy, cryotherapy and activity modification may be prescribed to decrease the swelling, regain motion and strength. A brace may be prescribed to return to sports activities. If symptoms persist (pain, instability), reconstruction surgery may be recommended by your surgeon.
Operative - Operative management of PCL tears depends on the type of tear. PCL repair may be indicated in patients where the PCL is clearly torn off the wall of the femur (thigh bone) or tibia (shin bone. PCL repair is accomplished through a minimally-invasive arthroscopic procedure and sewed back into place and fixed with screws or buttons. The repair may also be supplemented with high-strength suture.
If formal reconstruction is required, a new PCL graft will be fixed in place of the original ligament. A technique for graft placement and graft choice is a shared decision between you and your surgeon. Most techniques are performed through a minimally-invasive arthroscopic procedure. The graft can be taken from around your knee or from a donor. Postoperative rehabilitation, return to daily activities and return to sport depends on the technique and graft chosen, and is at your surgeon’s discretion.