The posterior cruciate ligament (PCL) is a ligament that connects the femur (thighbone) to the tibia (shinbone) at the back of knee and keeps your bones aligned so that your knee can move smoothly. A PCL tear or sprain occurs when the PCL is damaged. Most PCL tears occur in skiers and athletes who play soccer, football, or baseball. However, they are far less common than ACL tears and usually occur along with other ligament injuries. Nonsurgical or surgical treatments can be performed to mend the knee and help you return to all (or at least most) normal physical activities after rehabilitation.
In most cases, a PCL tear or sprain is the result of a direct injury, such as a blow to the knee, falling on a bent knee, landing improperly from a jump or fall, dislocating the knee, or hyperextending the knee. Symptoms will usually present immediately or shortly after the injury occurs. Symptoms can include:
- Pain that builds steadily and quickly after the injury
- Swelling that builds steadily and quickly after the injury
- Knee stiffness
- Difficulty walking, or walking with a limp
- Knee instability or buckling feeling that the knee will give way
- Decreased range of knee motion
Treatment for PCL injuries depends on the severity of the injury and whether other ligaments are also affected. Surgery is not always necessary; in some cases, patients can heal very well without it.
- RICE: Immediately after the injury, the RICE method (Rest, Ice, Compression, and Elevation) should be employed to help the tissues heal. To rest, avoid activities that place stress or weight on the knee. To ice, apply a cold compress to the knee in 15-minute intervals 4 times a day. To compress, wrap the knee in an elastic bandage to reduce swelling and inflammation. To elevate, prop your knee up on a pillow so that it is above the level of your heart.
- Anti-Inflammatory Medication: Non-steroidal anti-inflammatory medications can decrease inflammation and pain due to a PCL tear. Patients undergoing physical therapy may benefit from taking anti-inflammatory medications (over-the-counter or prescription strength) to reduce pain while they work to regain strength and mobility.
- Physical Therapy: If surgery is not needed, PT will usually be recommended to restore knee function, support, and strength after the swelling subsides. If surgery is needed, PT will also be recommended to help with range of motion and recovery after surgery.
- Immobilization: A knee brace and crutches may be recommended to prevent the tibia from falling backward and to reduce the weight and pressure on your knee.
- PCL Surgery: If a PCL injury is severe, if a multi-ligamentous injury has occurred, or if the ligament has broken loose a piece of underlying bone, surgery may be needed to reconstruct the knee. Reconstructing the knee is usually done arthroscopically and involves replacing the torn ligament with grafted tissue. This arthroscopic procedure typically takes under 2 hours, and patients can usually go home the same day.
Frequently Asked Questions
Recovery from a PCL tear can vary greatly from person to person. Mild injuries may heal on their own in as little as 10 days, while more serious PCL injuries requiring surgery can take 6 to 12 months for a full recovery.
A PCL tear usually occurs with a definitive injury and is usually accompanied by severe pain, swelling, and a feeling of instability. The symptoms themselves are a strong indicator that ligaments in the knee may have been damaged, and a diagnosis can be confirmed with a detailed history and exam, including x-rays, MRIs, and CT scans. These additional tests also determine whether there are any accompanying fractures and whether any other parts of the knee have also been damaged.
PCL reconstruction surgery is a minimally invasive procedure that begins with two small incisions around the knee joint. Through these incisions, a small camera may be inserted to allow visualization, and tools may be inserted to provide repairs. Tissue grafts will be used to restore knee functionality. Bone tunnels will be made in the femur and tibia to make room for the graft, and metal screws will be used to secure the graft and allow for bone-to-bone healing. Usually, the procedure is performed under general anesthesia with a nerve block, and dressings and a knee brace will be placed before the patient wakes up after the surgery. Patients can usually return home the same day to begin their recovery.
A minor PCL injury may heal without surgery and without complications. However, a more severe PCL injury will show signs of weakness and vulnerability to re-injury. If you have pain, swelling, instability, or coldness/numbness in the leg or foot, you may have a serious PCL injury and should see a healthcare provider. They can conduct the appropriate tests to determine whether you may need surgery or nonsurgical treatment.
Without surgery, a severe PCL tear may leave the knee permanently weak and prone to repetitive injuries. PCL surgery generally leads to improved stability and mobility following the recovery. Depending on the severity of the injury and factors such as age, physical activity, and health, some individuals may still need to wear a knee brace during certain physical activities to protect the knee joint.