Torn Posterior Cruciate Ligament (PCL)

What is the Posterior Cruciate Ligament (PCL)?

The posterior cruciate ligament runs along the back of your knee and connects your thigh bone to the top of your lower leg bone. This particular ligament keeps your bones together and helps your knees move more smoothly.

Anyone can tear their PCL, but it’s most commonly an injury found in athletes who play contact sports like football, baseball, or soccer.

Soccer player in pain with a PCL injury

What are the symptoms of a torn PCL?

A torn PCL can impact your normal range of mobility because of the symptoms it causes. The most common symptom associated with a torn PCL is knee pain. The pain can be mild to moderate, but generally causes a limp or difficulty walking.

Other torn PCL symptoms include:

  • Swelling: A PCL injury will lead to knee swelling, occurring rapidly and within hours of the injury.
  • Instability: Individuals with a torn PCL may experience a knee that feels loose as if it's going to give out.

If you suspect that you have a torn PCL, it's important to seek medical attention as soon as possible to prevent further problems.

What causes PCL tears?

Your PCL can tear if your shinbone is hit hard right below the knee. It can also occur if you fall on a knee that's bent. The most common causes of a PCL tear are:

  • Motor vehicle accidents: "Dashboard injuries" are a common cause of PCL tears. This occurs when the driver's or passenger's bent knee slams against the dashboard. The harsh contact pushes the shinbone just below the knee and causes a tear in the PCL. If you’re recovering from a car accident, you may be experiencing a range of injuries that require medical attention, in addition to a torn PCL. There are quite a few reasons why you need to consider visiting an orthopedic specialist.
  • Contact Sports: It's common for individuals to tear their PCL while playing contact sports, like football or soccer. This generally happens when the athlete falls on a bent knee with their foot pointed down. In this scenario, the shinbone hits the ground first. This causes it to move backward. Being tackled when your knee is bent can also cause you to tear your PCL. If you’re an athlete experiencing the symptoms of a torn PCL, it’s critical to work with experts in sports medicine.

How are PCL injuries diagnosed?

If you suspect you have a PCL injury, your healthcare provider will examine the knee and check your range of motion there. They’ll also ask you about the symptoms you may be experiencing.
In addition to the examination, your physician may request imaging tests to see the extent of your damage. These tests help them classify your torn PCL, should they determine you have this type of injury. Imaging tests may include:

  • X-rays
  • MRI
  • CT Scan

Once diagnosed, PCL injuries are classified by the following grading system:

Grade I There is a partial tear in the PCL.
Grade II The ligament is partially torn and looser than Grade I.
Grade III The ligament is torn completely and becomes unstable.
Grade IV The PCL is damaged in addition to other knee ligaments.

What are the treatment options for PCL Injuries?

A PCL injury can cause discomfort and make it difficult to perform daily activities. For those with a PCL tear, it's essential that you schedule an appointment with a healthcare provider, especially if the pain continues to persist. Left untreated, the injury can get worse.

A healthcare provider will recommend the best course of treatment for your PCL injury, though there are two options: nonsurgical and surgical.

Nonsurgical treatment

A PCL tear should be able to heal without surgery. But this will ultimately depend on the nature of the tear. Here are a few options to consider.

  • R.I.C.E Method: This method involves using rest, ice, compression, and elevation to allow the tear to heal. Rest is needed to take pressure off of the knee. Ice and compression can help reduce pain and swelling. Elevation keeps the knee supported and also aids in reducing swelling.
  • Take non-steroidal anti-inflammatory drugs (NSAIDs): NSAIDs, like ibuprofen and naproxen, can help relieve pain and swelling.
  • Wear a knee brace: A knee brace is beneficial for individuals with a torn PCL because it provides support and stability. It also restricts side-to-side movement. It's common for individuals to wear a functional knee brace to continue providing support once they get back to normal activity.
  • Use crutches: Since added weight can make a torn PCL worse, it may be recommended that you use crutches.
  • Physical Therapy: A physical therapist can help individuals with a torn PCL improve their mobility, strength, flexibility, and balance. Physical therapy can also help speed up recovery time and improve a person's performance once the torn PCL has healed.
  • Regenerative medicine: In some instances, a physician may recommend regenerative medicine. This medicine is designed to repair tissue or organs that have been damaged due to disease, congenital issues, and in the case of PCL injury, trauma. One particular medicine that may be used for PCL tears is platelet-rich plasma treatment. PRP may be injected or applied during surgery.

Surgical treatment

Surgery may also be an option for those with a torn PCL. However, surgery for these tears is generally only recommended for those who have a Grade III tear, have multiple ligament injuries, or those with a knee instability that hasn't responded to non-surgical treatment options.

Qualifying candidates may receive something called PCL Reconstruction Surgery. PCL surgery uses a graft to reconstruct the ligament.
There are two types of grafts:

  • Autograft: This uses a piece of tissue elsewhere on the body such as the patellar tendon.
  • Allograft: This uses a piece of tissue from a donor or cadaver.

PCL surgery uses a minimally invasive technique that includes special surgical tools and a video camera, which is inserted through a small incision in the knee joint.

How long does PCL surgery take?

In general, PCL Reconstruction Surgery takes anywhere between 45 minutes and 2 hours. This will depend on the complexity of the surgery.

Four incisions are made around the knee to place the camera and surgical incisions into the joint, harvest the graft, and pass into the knee. These incisions are approximately 5mm-20mm in length.

PCL Injury Recovery Time

After surgery, patients will only be able to put as much weight on their knee as their comfort will allow. Crutches are a great option to take pressure off of the knee and are usually required for 2-3 days after surgery. Most individuals are able to walk with relative comfort about 2 weeks after surgery and should be able to run in a straight line 6 weeks after surgery.

It’s critical to work with experienced providers — doctors, surgeons, and physical therapists — when you have a torn PCL. Getting the most advanced techniques, tools, and treatments to ensure optimal PCL recovery. At Alexander Orthopaedics, we strive to provide our patients with world-class care. We have an expert team working in our cutting-edge outpatient orthopedic surgery center. No matter what your PCL needs, our medical and therapy teams will provide you with personalized care that gets you back on track.

Schedule an appointment today and a member of our team will contact you within 24 hours to begin your torn PCL recovery.