Posterior Cruciate Ligament (PCL) Tear

The knee joint is a complex structure made up of three main bones: the femur, the tibia, and the kneecap (patella). The patella moves within a groove at the end of the femur. Strong muscles in the thigh, particularly the quadriceps at the front and hamstrings at the back, provide the knee with strength and stability.

The knee is stabilized by four main ligaments: the anterior cruciate ligament (ACL), the posterior cruciate ligament (PCL), the medial collateral ligament (MCL), and the lateral collateral ligament (LCL). The ACL and PCL intersect within the knee joint, working together to keep the joint aligned and prevent excessive forward and backward movement. They also control the rotational movement of the tibia, which is important for activities like skating, running, or entering a car.

PCL injuries typically occur when a force impacts the shinbone just below the knee, or when the knee is twisted beyond its normal range. Common scenarios include falls onto a bent knee, contact in sports like football or soccer, or injuries resulting from automobile accidents.

Initial symptoms of a PCL injury can be vague, leading some individuals to remain unaware of the injury until pain intensifies. Symptoms may include:

• Mild to moderate knee pain
• Rapid swelling and tenderness around the knee
• Pain during kneeling, squatting, running, or navigating stairs
• Difficulty walking or a noticeable limp
• A sensation of instability in the knee, as if it might "give out"

If you suspect a PCL injury, it’s important to see a healthcare professional. A doctor will evaluate your knee through a physical examination, a review of your symptoms, and possibly imaging tests. X-rays are typically ordered to assess the condition of the bones and check for fractures, while MRI scans are more effective for visualizing soft tissue injuries, including ligament tears.

Immediately after a PCL injury, follow the R.I.C.E. method: Rest, Ice, Compression, and Elevation. Avoid putting weight on the injured knee and consider using crutches. Ice can help reduce swelling and pain, and keeping your knee elevated above heart level is beneficial.

Over-the-counter or prescription pain medications may be recommended. Some individuals might benefit from wearing a knee brace for additional support. As swelling subsides, physical therapy will focus on strengthening the quadriceps and surrounding muscles, aiming to restore knee function.

Surgery is often required for PCL injuries that coincide with other knee injuries, such as tears of the cartilage or other ligaments. An orthopedic surgeon may advise physical therapy before surgery to enhance muscle strength around the knee. PCL repair is typically an outpatient procedure aimed at restoring the PCL's function to ensure stability and mobility.

During the procedure, the damaged PCL is removed and replaced with a graft, which may be taken from the patient’s own body or a donor. The surgery is performed arthroscopically, using a thin instrument equipped with a camera that allows for small incisions and minimized disruption to the joint, leading to quicker recovery and less post-operative pain.