PCL Injury | Posterior Cruciate Ligament Injury

What is a PCL injury?

The Posterior Cruciate Ligament (PCL) is the strongest ligament in the knee.  The PCL runs through the middle and back of the knee and keeps the femur (thigh bone) from sliding toward the tibia (shin bone) and the tibia from sliding back into the femur. You’re more likely to suffer a PCL injury if you endure a major sports collision or accident, such as a car crash.  Dr. Prem N. Ramkumar, orthopedic knee specialist, treats patients in Long Beach and serves Los Angeles, Orange County, CA, and surrounding areas who are experiencing the symptoms of a PCL injury.

How did I injure my Posterior Cruciate Ligament?

PCL injuries make up less than 20% of all knee injuries, but it does happen. If you have suffered a PCL injury, something might have hit your knee with tremendous force. Examples include falling on a bent knee, hitting the dashboard during an automobile accident, or getting tackled on the football field. Construction workers and landscapers experience more PCL sprains and tears due to squatting and heavy lifting. Age is also a risk factor – with older adults suffering more PCL tears.

What are the symptoms of a PCL injury?

If you suffer a PCL injury, you may experience mild to moderate knee pain and swelling of the knee (usually mild). PCL pain has been described as deep within the knee and dull. There is not usually a sharp pain described with an isolated PCL tear. In some circumstances, such as with football lineman, the dull ache can be difficult to determine from wear and tear from normal sports activity contact and the PCL tear may go unrecognized for some time. Other symptoms may include:

• Difficulty walking downstairs
• Problems twisting, pivoting, or turning the knee
• Problems decelerating
• Feeling like the knee will collapse
• Trouble bearing weight on the knee with pain over the anterior aspect

How is a PCL injury diagnosed?

Dr. Ramkumar will assess signs of a torn PCL with a detailed history, physical exam, x-rays, kneeling posterior knee stress x-rays, and almost always, an MRI scan to determine the extent of the injury and concurrent injuries to determine the recommended course of posterior cruciate ligament tear treatments. In general, many isolated PCL injury will heal over time; it is important to diagnose this particular ligament tear early to attempt to get them to heal in a stable position rather than in an elongated and nonfunctional position. While the results of an MRI scan are helpful for an acute injury evaluation, they are not very useful in the case of a chronic injury to evaluate for a PCL tear because they can show an intact posterior cruciate ligament, which may be unstable because it has healed in an elongated position. In this case, stress x-rays are required to diagnose the extent of the tear. Visiting a knee specialist like Dr. Ramkumar is critical to receiving the proper diagnosis.

How is a PCL injured graded?

Dr. Ramkumar will use the following grading system to classify the PCL injury:

• Grade 1: Ligament has a small or partial tear with minimal knee instability
• Grade 2: Ligament is torn, but it’s not a complete tear
• Grade 3: Ligament is completely torn – other ligaments are most likely injured as well

What is the Best Treatment for a Posterior Cruciate Ligament injury?

If you have a strained or sprained PCL (grade 1 or 2) it will usually heal on its own if you follow the proper non-surgical treatments. Dr. Ramkumar may recommend a surgical procedure if the non-surgical treatments don’t offer relief or if the ligament is torn (grade 3). However, PCL injuries require case-by-case attention to understand the exact nature of your injury and your goals.

Non-surgical treatment of a PCL injury:

The first course of treatment for a PCL injury follows the standard RICE method:

• Rest the knee
• Ice the knee to reduce swelling
• Compress swelling with a bandage
• Elevate the knee

Non-steroidal anti-inflammatory medicine (NSAIDs) may also help ease pain and swelling. Physical therapy will be essential to strengthen muscles around the knee and improve range of motion. Crutches and a brace may also be offered to keep the leg straight and reduce weight on the joint while the PCL heals.

Surgical treatment of a PCL injury:

In most patients who have 8 mm or more of increased posterior knee translation, there is a much higher likelihood than not that these patients will need a posterior cruciate ligament reconstruction surgery to improve their knee function and stability, as well as decrease their risk of developing knee arthritis. In a high-level athlete, PCL reconstruction may be recommended sooner because results of acute reconstructions are much better than chronic reconstructions.

When a patient does need a PCL reconstruction, a thorough assessment is performed to assess for any concurrent injury. Approximately 90% of patients who have persistent PCL tear symptoms have a coexisting injury.

The PCL is surgically reconstructed using either a:

• piece of your own tissue (autograft)
• tissue from a donor source, typically a cadaver (allograft).

Allografts allow for a quicker recovery time, while autografts ensure you won’t have any rejection issues. Whichever graft is chosen, Dr. Ramkumar will attach it to the outer surface of the femur and then thread it behind the knee and out the front of the tibia. Surgical screws and sutures will be used to permanently secure the ligament in place.

If you follow Dr. Ramkumar’s post-surgical protocol after PCL reconstruction surgery you should do very well and can expect a full recovery.