Advanced Sports Injury and Shoulder Treatment Clinic

What is Posterior Cruciate Ligament (PCL) Injuries?

Two tough bands of fibrous tissue that link the thighbone (femur) and the broad bone of the lower leg (tibia) at the knee joint are the posterior cruciate ligament (PCL) and anterior cruciate ligament (ACL). Together, the inside of the knee joint is bridged by the ACL and PCL, creating a “X” pattern that stabilizes the knee against front-to-back and back-to-front forces. In particular in relation to the upper leg, the PCL prevents the lower leg from slipping too far back especially when the knee is flexed (bent).

 

PCL injuries are graded according to a traditional rating scale, like all kinds of sprains. A PCL injury is a sprain (stretch or tear of a ligament). During an automotive accident, the PCL is most commonly sprained when the front of the knee strikes the dashboard. The PCL can also tear when an athlete falls forward during sports activities and lands hard on a bent knee, which is common in football, basketball, soccer and especially rugby.

  • Grade I-A minor injury produces only ligament microscopic tears. Although these small tears can stretch the PCL out of shape, they do not greatly impact the capacity of the knee to carry the weight.
  • Grade II (moderate) The PCL is partly broken, and the knee is somewhat unstable, meaning when you stand, walk or have medical tests, it gives out occasionally.
  • The PCL is either completely broken or is split at its end from the bone it typically anchors, and the knee is more unstable. Grade III (severe). Since a serious PCL injury typically needs a substantial amount of force, patients with Grade III PCL sprains quite often have ACL surgery or collateral ligament sprains or other major knee injuries.

 

Overall, some degree of PCL damage in an emergency department is typical among individuals treated for knee injuries. With football players and rugby players getting the most and basketball players close behind, athletes have more PCL injuries than any other category. Since a mild PCL sprain in the injured knee at first does not cause discomfort or mobility complications, many athletes finish a game after their injury. Some have such mild symptoms that they never seek medical attention, and only when they have diagnostic testing for some other form of knee injury is the torn PCL discovered.

Symptoms of PCL

Symptoms of a PCL injury may include:

  • Mild swelling of the knee, with or without the knee giving out when you walk or stand, and with or without reduced mobility
  • A mild pain in the back of your knee that gets worse as you kneel.
  • When you run or try to slow down, pain in the front of the knee. This symptom can begin one to two weeks or even longer after the injury.

 

Since the first signs of a PCL tear do not greatly interfere with the ability of an athlete to play sports, many athletes with PCL injuries wait a few weeks before seeing a doctor. “The athlete may describe vague or nonspecific symptoms at that first clinic visit, for instance, that the injured knee simply does not feel the way it should.

Diagnosis of posterior cruciate ligament (PCL)

We’re going to ask you to explain exactly how your knee hurts. The doctor would like to know whether you have had a recent serious impact on the front of your knee, the type of impact (fall, car collision), the location of your knee (flexed, extended, twisted) at the time of injury, and what symptoms you have now.

Usually, we test both of your knees and compare your wounded knee to your unwounded knee. We will examine the injured knee for swelling, deformity, tenderness, fluid inside the knee joint and discoloration during this test. We can pull against the ligaments to verify their strength after evaluating the range of motion of your knee (how fast it can travel in all directions). When we gently force the leg forward and backward relative to the knee, you will be asked to bend the knee. Your lower leg can be pushed backward in relation to the knee if your PCL is torn.

The more you can move your lower leg away from its usual location, the greater the amount of damage to the PCL and the more unstable your knee will be.

You can need special medical tests if your physical examination indicates you have a PCL injury. This may include regular knee X-rays to confirm if the PCL is separated from the bone, as well as magnetic resonance imaging (MRI) scans for other bone damage.

Treatment of PCL

Initial care meets the RICE law for all grades of PCL sprains:

  • Put the joint to rest.
  • To minimise swelling, ice the injured region.
  • Under an elastic bandage, compress the swelling.
  • Elevate the area that was hurt.

To alleviate any minor discomfort or swelling, we also prescribe a non-steroidal anti-inflammatory drug (NSAID). Further treatment of PCL sprains after initial treatment with RICE depends on the grade of the injury:

Your knee could be splinted in a straight-leg position, and you will begin an intensive recovery programme. Grade I and Grade II PCL sprains. This rehabilitation gradually strengthens the muscles (especially the quadriceps) around the knee, supports the joint of the knee, and helps prevent injury to the knee again.

Grade III PCL sprains. Surgery may be advised to reattach it with a screw if the PCL has been pushed away from the bone. If the PCL is totally torn, you can surgically repair it using a tendon from your own body (autograft). Usually, a portion of your own patellar tendon (the tendon below the kneecap) or a segment of the tendon taken from a broad leg muscle replaces the broken PCL. Nearly all of these procedures are conducted using arthroscopic knee surgery (camera-guided), which uses smaller incisions and causes less scarring than conventional surgery. You will wear a long-leg knee brace after surgery to reconstruct the PCL, and eventually begin a recovery programme to strengthen the leg muscles around the knee.

Recovery posterior cruciate ligament (PCL)

Depending on the seriousness of your injury, your recovery programme and the types of sports you play, how long a PCL injury lasts. Complete recovery takes 4 to 12 months in most cases.

When To Call a Doctor or Orthopedic Surgeon?

If after a serious injury, your knee becomes swollen, deformed, painful or unstable, call your orthopaedic doctor for an immediate examination.

If you experience frontal pain for several weeks after hurting your knee, make an appointment to see your doctor. At the moment of injury, several PCL sprains are missed, so you might have sprained your PCL without realizing it.

PCL prevention

In order to help avoid knee injuries associated with athletics, you should:

  • Before you engage in physical events, warm up and stretch.
  • Workout to strengthen the muscles of the legs around your knee.
  • Do not unexpectedly lift the pace of your training programme. Never push too hard on yourself. Gradually increase your strength.
  • Wear stylish, supportive shoes that suit and fit your sport with your feet.

Forecast

At their pre-injury activity level after recovery, most athletes with PCL injuries who are treated without surgery return to their sport.

Among individuals with posterior cruciate ligament surgical reconstruction, most are able to return to their physical activity level of pre-injury within one to three years after surgery.

Many (but not all) patients with PCL injuries subsequently experience osteoarthritis in the affected knee joint as a long-term complication. On average, 15 to 25 years after the initial PCL injury, the symptoms of arthritis begin.

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