What is a PCL (Posterior Cruciate Ligament) Injury?
One of the most common problems involving the knee joint is a posterior cruciate ligament (PCL) tear.
The posterior cruciate ligament is one of four ligaments that are critical to the stability of the knee joint. It originates from the medial aspect of the medial femoral condyle and branches into two bundles (posteromedial and anterolateral) before inserting into the posterior aspect of the tibia. (Margheritini et al., 2002)
The PCL is made of tough fibrous material and functions to control excessive motion by limiting joint mobility. In particular, it resists hyperextension, posterior tibial displacement and provides a rotational axis and stability. It prevents excessive tibial external rotation. (Magee D., 2008)
Of the four major ligaments of the knee, the PCL injury is the least common knee ligament injury. It is responsible for between 3% and 23% of knee injuries. It has a cross-sectional area 1.5 times that of your ACL. (DeBurca N. 2010, Brown JR, Trojian TH. 2004)
What Causes a PCL Injury?
A PCL injury usually occurs by forced hyperextension or a posterior translation of the tibia. It is common in motor vehicle accidents (knee into dashboard) and a sports-related injury (landing in a kneeling position or hyperextension). It can also be injured in high rotational injuries and in association with an ACL and/or MCL injury. (Margheritini et al., 2002)
What are the Symptoms of a PCL Tear?
The diagnosis of a PCL injury is made by several methods. Patients who have a PCL injury can sometimes be unaware and may notice disability rather than instability. Symptoms are often vague. Unlike an ACL injury, when many will hear or feel a "pop" in their knee, PCL injuries can be silent in isolation. (Brown JR, Trojian TH. 2004, Margheritini et al., 2002)
How is a PCL Tear Diagnosed?
On examination, your physiotherapist or sports doctor will look for clinical signs of posterior instability of the knee. These special tests place stress on the PCL and can detect a torn ligament and the extent of the PCL tear.
An MRI may also be used to determine if the posterior cruciate ligament is torn, and also to look for signs of any associated injuries in the knee, such as bone bruising, meniscus damage and other ligament damage.
How is a PCL Tear Treated?
Grade I / II
Researcher consensus is that mild and moderate PCL injuries (grade I and II) normally respond very well to non-operative physiotherapy treatment. Ideally, acute PCJ injuries should commence rehabilitation within 4 days post-injury. (Wind W et al 2004, Cross M et al., 1984)
The prognosis is good for grade I and II PCL injuries who follow a physiotherapist-supervised rehabilitation program. (Voos J et al., 2012)
Grade III PCJ injuries may require surgery if your functional needs eg sport require an intact PCL. Many PCL injuries can go unrepaired if they are not showing signs of constant pain, swelling, instability or disability. Grade III PCL injuries in isolation can usually avoid surgery with the appropriate rehabilitation. (Maclean et al., 2001)
It is important to exclude concomitant injuries such as the posterolateral corner or ACL. Each PCL case differs and professional opinion of your sports physiotherapist or knee surgeon is recommended.
There are several important factors to consider before deciding to undergo ACL surgery.
If you don't do multidirectional sports that require a PCL, and you don't have an unstable knee, then you may not need PCL repair surgery.
Most patients with a PCL tear start to feel better within a few weeks of the injury. These individuals may feel as though their knee is pain-free, but the problems with knee instability and giving way may persist. It is also important to allow at least six weeks for the natural ligament healing process to occur.
Whether or not you require PCL surgery or not, you should undertake a comprehensive knee rehabilitation program that involves strengthening, proprioception and high-level balance retraining, plus sport-specific agility and functional enhancement.
Your physiotherapy treatment will aim to:
Please discuss your individual knee injury after a thorough examination from a knee injury clinician such as a sports physiotherapist, sports physician
or knee surgeon.
PCL Repair Surgery
The usual surgery for a PCL tear is called a PCL repair but they often include repairs to other ligaments if your PCL was not injured in isolation. A common example of this is a posterolateral corner reconstruction.
Post-Surgical PCL Physiotherapy Rehabilitation
Post-operative PCL repair rehabilitation is one of the most important aspects of PCL reconstruction surgery. The most successful and quickest outcomes result from the guidance and supervision of an experienced Sports Physiotherapist.
Your rehabilitation following PCL surgery focuses on restoring full knee motion, strength, power and endurance. While protecting the healing repaired ligament in the early phase. You'll require proprioception, balance and agility training that is individualised towards your specific sporting or functional needs.
As mentioned earlier your sports physiotherapist is an expert in this field. Please contact them for the best advice in your circumstances.
What Sports have a High Incidence of PCL Tears?
Many sports require a functioning PCL to perform common manoeuvres such as landing, jumping, twisting and hyperextension
These high demand sports include AFL, football, rugby, netball, touch, basketball, tennis, volleyball, hockey, dance, gymnastics, skiing and many more.
You may be able to function in your normal daily activities without a normal PCL, but these high-demand sports may prove difficult. Athletes are often faced with the decision to undergo surgery in order to return to their previous level of competition. PCL injuries have been known to curtail many promising sporting careers.
How to Prevent PCL Tears?
Preventing of knee ligament injuries, including PCL tears, has been the focus of recent research for many years. Prevention protocols are being improved and supported by researchers. For the latest advice, please ask your sports physiotherapist for prevention exercises and strategies. Current investigations have focused on strengthening, dynamic, proprioceptive and neuromuscular training to prevent PCL tears. For more advice, please consult with your sports physiotherapist.
Braces for PCL Tears
Some patients will try a PCL brace. The brace required will need to stabilise your knee to avoid hyperextension and possibly multi-directionally if other ligaments are injured. While trialling a PCL brace is understandable, the success lies in the extent of your PCL instability.
In other words, highly unstable PCL’s may give out eventually regardless of the brace. However, mild instabilities may allow you to work and undertake non-directional change sport if you wear a PCL brace.
Return to Sports with a PCL Tear
Most athletes will normally have no significant trouble returning to sport following a PCL injury in isolation. However, the complication of an ACL or posterolateral corner injury will require special consideration depending upon your specific injury and the sport that you wish to resume.
For more information, please ask the advice of your physiotherapist.
Knee Ligament Injuries
Children's Knee Conditions
Other Knee-Related Conditions
Common ACL Injury Treatments
FAQs about PCL Injury
Knee Brace for a PCL Injury
Many patients will try a PCL brace. The knee brace required will need to stabilise your knee multi-directionally. While trialling a PCL brace is understandable, the success lies in the extent of your ACL instability.
In other words, highly unstable PCL tears will give out eventually regardless of the brace unless it is custom made and moulded specifically to your knee. These PCL braces are very expensive. However, mild instabilities may allow you to work and undertake non-directional change sport if your wear a PCL brace.
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