Posterior Cruciate Ligament (PCL) Tears
What is the PCL?
The posterior cruciate ligament (PCL) is the strongest ligament in the knee. It helps to stabilize the knee and prevents the shinbone (tibia) from moving backwards with respect to the femur.
The PCL is located in the back of the knee and connects the thigh bone (Femur) with the shinbone. The PCL and the Anterior Cruciate Ligament (ACL) control back and forth knee movement. It also keeps the femur and tibia in their correct positions.
How do PCL injuries occur?
Given the PCL’s size and strength, it takes a potent force to cause injury. Most isolated PCL tears occur as a result of a blow to a bent the knee. However, injury can result from a simple misstep, a hard fall on a bent knee while playing sports, skiing, slipping on ice, and a direct hit during an auto accident.
Most PCL tears occur in combination with other knee injuries. A PCL tear by itself, called an isolated PCL tear, is not that common and is usually associated with other ligamentous injuries (MCL, LCL or ACL).
What are the symptoms of PCL tears?
Symptoms can depend on the extent of injury. Common symptoms of a tear include pain, tenderness in the back of the knee, knee instability, swelling, and stiffness, and difficulty walking or bearing weight. When combined with other knee injuries, symptoms will be more severe.
Severity of PCL tears
- Grade 1 is mild damage. The PCL has a partial tear.
- Grade 2 is a partial tear with ligament laxity.
- Grade 3 is a complete tear in which the ligament is non-functional and causes knee instability.
- Grade 4 is a complete PCL tear with damage to another knee ligament.
However, PCL injuries are often undiagnosed and untreated, and patients present for care months after the initial injury with symptoms of pain, altered gait and knee instability which creates a risk of further joint damage.
Do PCL injuries of the knee heal on their own?
Most Grade I and II injuries without other injuries can heal on their own with conservative measures including protecting the knee from more injury, rest, icing, compression and elevation plus anti-inflammatory medications. Bracing and physical therapy may be recommended.
What is the most accurate way to diagnose a PCL injury?
A combination of a detailed history, comprehensive physical examination, stress x-rays, and MRI (magnetic resonance imaging) are keys to accurate diagnosis of acute injury.
What is the treatment for a PCL injury?
For patients with grades three and four injuries, surgery will usually be necessary. The primary symptom of a PCL injury is knee instability. Failure to treat knee instability can lead to arthritis and knee replacement surgery. In fact, knee instability is frequently the reason a patient will elect to undergo surgery.
Arthroscopic knee surgery will be recommended when a PCL injury is combined with other ligament injuries, when there is chronic PCL deficiency and when conservative treatment fails to relieve symptoms including instability. Surgery involves PCL reconstruction with a graft.
What are the outcomes of PCL injuries?
Outcomes for surgery are variable depending on technique and surgeon. For PCL tears, given their relative rarity, it is important find a surgeon like Dr. Jonathan Godin at the renowned Vail Steadman Clinic. He has the skills, knowledge and experience optimize your chance at success. Contact Dr. Godin to schedule a consultation to receive the correct diagnosis and treatment options that are best for you.