University of Occupational and Environmental Health Wakamatsu Hospital
orthopedics・Sports arthroscopy
Wakamatsu Hospital for University of Occupational and Environmental Health
Orthopedic and Sports Arthroscopy Surgery
ISAKOS approved Teaching Center
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Posterior cruciate ligament tear PCL injury
The posterior cruciate ligament (PCL) is located on the inside of the knee, just behind the anterior cruciate ligament (ACL). It is one of several ligaments that connect the femur (thighbone) to the tibia (shinbone). The posterior cruciate ligament keeps the tibia from moving backwards relative to the femur.
A posterior cruciate ligament injury requires a great deal of force. A common example is a car accident with a bent knee hitting the dashboard or a football player falling onto a bent knee. In addition, PCL injuries can also occur from severe twisting injuries and contact injuries during sports.
Anatomy of PCL
The knee joint is made up of two bones, the femur and the tibia. The kneecap is located in front of the joint and serves to protect the joint.
Bones are connected by ligaments. There are four major ligaments in the knee.
These ligaments connect bone to bone and act like strong ropes to stabilize the knee.
Lateral collateral ligament. These are on the sides of the knee. On the inside is the medial collateral ligament and on the outside is the lateral collateral ligament. It controls the side-to-side movement of the knee and supports the knee against abnormal movements.
Cruciate ligament. A ligament on the inside of the knee joint. The anterior cruciate ligament is anterior and the posterior cruciate ligament is posterior, forming an X (cross). The cruciate ligaments control the forward and backward motion of the knee.
The posterior cruciate ligament is a ligament that prevents the tibia from moving too far posteriorly. It is stronger than the anterior cruciate ligament and is injured much less frequently. The posterior cruciate ligament has two parts that blend together into one structure about the size of a person's little finger.
Posterior cruciate ligament injuries are less common than other knee ligament injuries. In fact, it is often more subtle and difficult to assess than other knee ligament injuries.
Posterior cruciate ligament injuries often occur along with injuries to other knee structures such as cartilage, other ligaments, and bone.
Most posterior cruciate ligament tears are partial tears that have the potential to heal spontaneously. People with only the posterior cruciate ligament injury may be able to return to sports without problems with knee stability.
Cause Cause
Injuries to the posterior cruciate ligament can occur in many ways. It is usually caused by a strong external force.
A direct blow to the front of the knee (for example, a bent knee hitting the dashboard in a car accident or a fall on a bent knee in sports).
Pulling or stretching a ligament (such as a twist or hyperextension injury).
PCL injuries are rarely caused by simple missteps.
Symptoms Symptoms
Typical symptoms of a posterior cruciate ligament injury are:
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Pain with swelling that occurs soon after injury
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The swelling can make the knee stiff and limp.
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difficulty walking
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A feeling of instability as if my knees were falling out Giving way
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I feel pain and anxiety when I get on my knees.
doctor's examination
interview
At your first visit, your doctor will ask you about your symptoms and medical history.
Physical examination
A physical examination checks all structures of the injured knee and compares it to an uninjured knee. When your knees are bent, they may appear to droop backwards. It may be too far backwards, especially when bent over 90 degrees.
imaging test
Other tests doctors use to confirm the diagnosis include x-rays and magnetic resonance imaging (MRI) scans. However, these images may appear normal, especially if the injury occurred more than 3 months before the examination.
X-ray inspection
X-rays cannot show damage to the posterior cruciate ligament, but they can show if the ligament has torn off some of the bone. This is called an avulsion fracture.
Your doctor may also order a stress view to assess how far your tibia can recoil.
Magnetic resonance imaging (MRI)
MRI produces clearer images of soft tissues (such as the posterior cruciate ligament) than X-rays.
Treatment
non-surgical treatment
If only the posterior cruciate ligament is injured, it may heal well without surgery. Your doctor may recommend non-surgical treatment.
PRICE. Initially after injury, the PRICE method (Protection, Rest, Ice, Gentle Compression, Elevation) can help speed recovery.
Fixed. Your doctor will recommend a special brace to keep your tibia from sagging backwards (gravity tends to pull your bones backwards when you're lying down). To further protect the knee, crutches may be used to keep weight off the leg.
physical therapy. Once the swelling subsides, begin an elaborate rehabilitation program. Certain exercises restore knee function and strengthen the leg muscles that support the knee. Strengthening the muscles in the front of the thigh (quadriceps) has been found to be an important factor in successful recovery.
surgical treatment
If you have multiple injuries, your doctor may recommend surgery. For example, if the knee is dislocated and multiple ligaments are torn, including the posterior cruciate ligament, surgery is almost always needed. Additionally, patients with isolated PCL tears may benefit from reconstructive surgery if they have persistent instability or pain that does not improve with nonoperative treatment.
Ligament reconstruction A torn posterior cruciate ligament is usually reconstructed because stitching the ends of the ligament together does not usually heal.
Doctors replace the torn ligament with a tissue graft. This tendon graft is most often taken from another part of your body. It may take several months for the grafted tendon to heal into the bone.
Surgery to reconstruct the posterior cruciate ligament is usually done arthroscopically through a small incision. Arthroscopic surgery is less invasive than traditional open surgery. The advantage of minimally invasive surgery is less pain and faster recovery.
Surgical techniques for repairing the posterior cruciate ligament continue to improve. More advanced technology allows patients to resume a wide range of activities after rehabilitation.
rehabilitation
Rehabilitation, with or without surgery, plays an important role in returning to normal life. A physical therapy program can help you regain strength and movement in your knee. If you have had surgery, rehabilitation will begin the day after surgery.
The time it takes to recover from a posterior cruciate ligament injury depends on the severity of the injury. Complex injuries are often slow to heal, but most patients do well over time.
If surgery is required, it may take weeks, or even months if you exercise a lot, to return to a desk job. Full recovery usually takes 6 to 12 months.
Rehabilitation takes time, but dedication to treatment is the most important factor in finally being able to enjoy all your activities.