Posterior cruciate ligament (PCL), one of the four major ligaments of the knee are situated at the back of the knee. It connects the thighbone (femur) to the shinbone (tibia). The PCL limits the backward motion of the shinbone.
PCL injuries are very rare and are difficult to detect than other knee ligament injuries. Cartilage injuries, bone bruises and ligament injuries often occur in combination with PCL injuries. Injuries to the PCL can be graded as I, II or III, depending on the severity of injury. In grade I, the ligament is mildly damaged and slightly stretched, but the knee joint is stable. In grade II, the ligament is partially torn. In grade III, the ligament is completely torn and divided into two halves, making the knee joint unstable.
The PCL is usually injured by direct impact, such as in an automobile accident when the bent knee forcefully strikes the dashboard. In sports, it can occur when an athlete falls to the ground with a bent knee. Twisting injuries or overextending of the knee can cause the PCL to tear.
Patients with PCL injuries usually experience knee pain and swelling immediately after the injury. There may also be instability in the knee joint and knee stiffness, which causes limping and difficulty in walking.
The diagnosis of a PCL tear is made based on your symptoms, medical history and by performing a physical examination of the knee. Other diagnostic tests such as X-rays and MRI scan may be ordered. X-rays are useful to rule out avulsion fractures wherein the PCL tears with a piece of bone with it. An MRI scan is ordered to better view the soft tissues.
The treatment options may include nonsurgical and surgical treatment. Nonsurgical treatment consists of rest, ice, compression and elevation (RICE protocol); all assisting in controlling pain and swelling. Physiotherapy may be recommended to improve knee motion and strength. A knee brace may be needed to help immobilise your knee. Crutches may be recommended to protect your knee and avoid bearing weight on your leg.
Generally, surgery is considered in patients with a dislocated knee and several torn ligaments, including the PCL. Surgery involves reconstructing the torn ligament using a tissue graft that is taken from another part of your body or from a cadaver (another human donor). Surgery is usually carried out with an arthroscope, using small incisions. The major advantages of this technique include minimal postoperative pain, short hospital stay and a fast recovery. Following PCL reconstruction, a rehabilitation program will be started that helps you resume a wider range of activities. Usually, a complete recovery may take about 6 to 12 months.