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Posterior Cruciate Ligament Tear (PCL Tear)

Summary:


The Posterior Cruciate Ligament (PCL) extends from the thigh bone to the shin bone. Its role is to prevent the shin bone from shifting backward from the thigh bone. Therefore, a partial or total PCL tear results in sensations of the knee giving way or buckling during sporting activity.




Contents

What is the function of the Posterior Cruciate Ligament (PCL)?

The PCL is one of the four major ligaments of the knee. It connects the thigh bone (femur) to the shin bone (tibia). Its main role is to prevent the tibia from traveling backwards from the femur, known as a ‘posterior glide’. It also provides rotational stability to the knee


What are the common causes?

  • Injury to the PCL normally occurs with direct trauma to the shin bone when the knee is slightly bent
  • This impact causes the shin bone to move backwards from the thigh bone
  • A common example is during a soccer game when the foot gets caught on the ground and the body falls forward.
  • Other common causes are dashboard injuries during road traffic accident and industrial accidents

What are the signs and symptoms?

  • Injury to the PCL leads to instability in the knee, with the shin bone having a tendency to ‘sag’ backwards when the knee is bent at about 90 degrees
  • The initial moment of injury is usually accompanied by a ‘pop’ sound with intense pain, gradual swelling and loss in range of knee movement
  • There might be sensations of ‘giving way’ in the knee

What are the risk factors?

Sports

  • Being involved in contact sports (e.g. rugby, soccer) or involved in sports that require jumping, cutting, pivoting (e.g. netball, basketball, soccer)

Landing technique

  • Poor landing technique when landing from a jump due to:
    • Poor core stability
    • Poor hip stability
    • Poor shock absorption

Biomechanics

  • Structural malalignment (e.g. bow legged, knock knees, flat foot)

Gender

  • Females are 2-8 times more likely to injure their PCL than males

What types of treatment are available?

A PCL injury will result in knee instability and buckling. This is due to knee muscles weakening secondary to pain or muscle disuse. First line treatment is to go for conservative management in order to achieve the following goals:

Physiotherapy

  • The above goals are achieved using a range of physiotherapy treatment techniques including electrophysical agents such as ultrasound and exercise therapy. Treatment is progressed over a period of 3-6 months, depending on the severity of the injury and the improvements achieved by each individual patient. Independence with home exercises is necessary to enable early return to sports
  • Most PCL injuries can be treated non-operatively. There is a possibility that following a period of conservative management, the knee may still buckle or give way. This usually occcurs if you intend to participate in contact sports such as soccer or rugby. Failure to respond successfully to conservative management is one of the criteria for PCL reconstruction surgery

Surgical

  • Involves replacing the torn PCL with a graft take from a tendon around the knee
  • Commonly harvested tendons are the patella tendon and the hamstring tendon. This graft is then attached to run in a similar direction as the PCL
  • Often, the PCL tear is accompanied by another ligamentous tear of the knee i.e. ACL. In such cases, the surgeon might suggest an allograft tendon (donor graft) for reconstruction of both ligaments
  • Following the surgery you will be encouraged to undergo 6-9 months of physiotherapy to return to sporting activity

What can I do to help myself?

  • Stick to your home exercise program as prescribed by your physiotherapist
  • Modify your training regime as necessary with advice from your therapist

FAQs

1. How long do I need to rest from sports?

  • Depending on the stage of your condition, you may either continue or modify your activity or you may need to rest from the activity altogether for at least 6 months

2. What can I expect following PCL reconstruction surgery?

  • Following the surgery, you will be required to wear a knee brace, usually for a period of 6 weeks (depending on the surgeon's discretion and therapist's suggestion)
  • In the initial 1-2 weeks, you may be required to walk with crutches. You will experience some knee pain, swelling and reduced movement in the operated knee. All these symptoms are normal and will ultimately subside

3. Why do I need to attend physiotherapy after PCL reconstruction surgery?

  • Physiotherapy after the surgery is required to help you reduce pain and swelling, regain your full range of movement, strengthen the muscles around your knee and ultimately return to sports
  • The exercises provided will include flexibility, strength, balance and endurance exercises as well as power and agility exercises which are important for sports participation
  • You will be required to attend physiotherapy for a period of 6-9 months. Doing so, will ensure that you can return to sports safely without tearing the graft or injuring the knee again
- Last updated 4 Jul 2011,9:47 am




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