Posterior Cruciate Ligament Tear (PCL)

The Posterior Cruciate Ligament (PCL) is one of the two main ligaments that connect the Tibia (shinbone) and the Femur (Thigh Bone) behind the knee to stabilize it, along with the Anterior Cruciate Ligament (ACL). While ACL tears are far more common than a PCL tear, they still do occur. The PCL is a strong ligament that is actually almost double the size of the ACL and works to resist backwards motion of the lower leg. In contrast to the ACL which is most functional during high risk physical activity, the PCL uses its full functionality at all times, even when just walking.

A PCL tear is an injury that occurs when the ligament experiences contact trauma that results in the stretching, or tearing, of the ligament. It can result in subtle pain, swelling, and feelings of instability in the knee. The most common PCL injuries occur during contact sports such as: soccer, rugby, or football. In addition to sports related PCL injuries, it is often called the “dashboard injury” due to its common recurrences after car wrecks. This can happen when the driver or passengers knee is forced against the dashboard and the shinbone is pushed behind the knee, causing the PCL to tear.

Symptoms

Symptoms of a PCL tear may include:

Swelling: Mild to severe swelling can occur, usually within hours of the injury.
Pain: Moderate pain may occur depending on the severity of the injury, more pain may relate to a possible fracture in the bone connecting to the ligament.
Instability: You may experience trouble walking, and find yourself unable to put weight on the knee.

Doctors commonly diagnose PCL injuries in different grades:

Grade l: A mild injury can result in micro-tearing of the ligament, this may become more progressed through time without proper treatment, but this does not always affect the mobility of the knee.

Grade ll: The ligament is partially torn and causes pain and instability while walking or participation in activity. Patients with Grade II PCL tear may need more intensive rehabilitation than those with a Grade l tear.

Grade lll: This is a more severe injury meaning the PCL is completely torn or is separated from the bone, and the knee is more unstable. Due to the severity of this injury, there are most likely more knee injuries relating to this, including but not limited to, an ACL tear or breakage of the bones connected to the ligaments.

If no other injuries are present during the time of this injury, it may go unnoticed. Over time, the pain might worsen and the injury may progress into something more. Immediately following the injury, there may be swelling and/or bleeding into the knee from the torn ligament.

What should you do when you have a PCL tear?

If you find yourself experiencing any of these symptoms, go see your primary care doctor to seek further attention. While there he or she may ask some questions regarding how you got this injury, then will proceed with testing if necessary. Before testing your doctor will provide a physical examination to compare your injured knee to the non injured one, during this, your doctor will check its range of motion, and if there is any fluid surrounding the injury. One common test is to be asked to bend your knee and while you are bending it the doctor will attempt to push your lower leg back towards the knee, if it is able to go behind it, your PCL is most likely torn.

If there are signs of a PCL injury, you will need more inclusive testing done. These may include:

MRI: Magnetic resonance imaging uses a strong magnetic field to show images of the soft tissues in your body, this will give a more in depth picture as to where the ligament is torn. This can also help determine if there is tearing in any of the other surrounding ligaments.

Arthroscopy: This is a camera guided surgery through a small incision in your knee, this is used to see inside the knee joint if it is unclear how extensive the injury is.

X-ray: Although this test cannot be used to see if there is any tearing in the PCL itself, an x-ray can be used to see if there is any breakage of the bones connecting to the ligaments.

How to Prevent a PCL Tear

Prevention of a PCL tear is capable with a few different steps:

Practice proper stretching techniques before participating in activities such as working out or any sports. While stretching, try to focus on stretches that engage your quadriceps and hamstrings.
Increasing strength in the quadriceps and the hamstring muscles can aid in the prevention of a future injury
1. When working on strength training, do not attempt any sudden increases of intensity, this can strain the muscles. Instead, gradually increase intensity over time.
2. While participating in any physical activity, make sure to wear the proper shoes with good supports.

It is very difficult to ensure that ligament injuries will not happen due to the nature of how they come about, these injuries are usually the result of some unanticipated accident. However, these are not a guarantee that an injury will not occur. These steps are all very good preventative measures that can be taken to help minimize the risk of injury.

How can a PCL tear be repaired without surgery?

With Grades l and ll PCL tears, it is possible to recover without having surgery. Both of these cases will need rehabilitation. As stated above, Grade ll injuries will experience a more intense rehabilitation than Grade l injuries. Here are a series of steps that will take place in the rehabilitation process:

The first step following the diagnosis of the PCL tear will be the immobilization with a splint, brace, or in more extreme cases, a cast. This allows the ligament to maintain stabilization and gives it a chance to recover before attempting to bring back its full mobility. This step is extremely important because the patient needs the area to be fully repaired before attempting to exercise the area again and risk further injury. Usually your doctor will prescribe a mild anti-inflammatory (NSAID) pain medication such as ibuprofen, or naproxen (Aleve). The goal of this step is to heal the injury and reduce swelling as much as possible by properly resting, applying ice, compression, and elevating. Also known as the RICE sequence.
After the injury has gotten a chance to heal, you should follow up with physical therapy. This will include various exercises that work to strengthen the muscles surrounding your knee in order to improve mobility and increase function. Some of these exercises include but are not limited to:
1. Hamstring and calf stretches, with the goal to increase elasticity in the muscles, not flexibility.
2. Simple quad, and hamstring focused strengthening exercises.
3. Squats and lunges. (These should be performed in the later stages of physical therapy)

Important things to know while participating in physical therapy is to have an understanding that every case is different and you may progress slower or faster than someone else; despite this, do not attempt to stop or rush your rehabilitation process. Stopping or rushing this process may result in a recurring injury.

Contact Us

If you are in need of a PCL reconstruction surgery don’t wait and contact us now. We have the best orthopedic surgeons in Tampa, Ocala, Lakeland, Lakewood Ranch and Gainesville. Our staff is dedicated to helping you get better with the fastest time possible. Come and schedule an appointment to meet with one of our board certified orthopedic surgeons today.