A posterior cruciate ligament (PCL) tear is an injury to one of the four major ligaments of the knee. The PCL is a ropelike structure that helps maintain the normal relationship between the femur (thigh bone) and tibia (leg bone), preventing the tibia from slipping backward over the femur.
The PCL is the largest and strongest ligament within the knee. When torn, it may heal in a lengthened, or stretched-out, position or attach to other structures of the knee through scar tissue.
What Is a PCL Injury?
A PCL injury is a sprain or tear of the posterior cruciate ligament, one of the four major ligaments of the knee. The PCL helps keep the femur (thigh bone) and tibia (leg bone) in their normal relationship so the tibia does not slip backward over the femur.
When torn, the ligament may heal in a lengthened position or attach to other structures in the knee through scar tissue.
Causes and Risk Factors
PCL tears occur when a force exceeds the strength of the ligament. Causes may include:
- A non-contact injury that excessively straightens the knee
- A direct blow to the knee, such as being tackled
- Forced bending of the knee
- Landing directly on the knee
Risk factors include:
- Contact sports that may cause forced bending or excessive straightening of the knee, including football, volleyball, basketball, soccer, and rugby
- Poor physical conditioning, including strength and flexibility
Symptoms
Signs and symptoms may include:
- A pop heard or felt at the time of injury
- Inability to continue activity after the injury
- Significant knee swelling within six to eight hours after injury
- Inability to straighten the knee
- Walking with a limp
- Giving way or buckling of the knee, particularly during the first several months after injury
- Occasional locking when there is an associated meniscus injury
- Diffuse knee pain, including pain in the front of the knee, behind the kneecap, or in the back of the knee
- Pain that worsens with prolonged sitting, rising from a seated position, going up or down stairs or hills, kneeling, squatting, or wearing shoes with heels
- Pain with jumping
- Achy pain that may sometimes be sharp
- Difficulty running backward or backpedaling
Treatment
Initial treatment includes medications and ice to reduce pain and swelling. Walking with crutches until the patient can walk without a limp is often recommended, although full weight may be placed on the injured leg.
Range-of-motion, stretching, and strengthening exercises may be performed at home, although referral to a physical therapist or athletic trainer usually is recommended. A knee brace may occasionally be recommended, especially when other ligaments also are injured.
For most isolated PCL injuries, surgery is not recommended, and rehabilitation is the treatment of choice. Rehabilitation usually focuses on:
- Reducing knee swelling
- Regaining knee range of motion
- Regaining quadriceps muscle control and strength
- Functional training
- Bracing when needed
- Education
For severe PCL injuries, particularly those associated with other knee injuries, surgical reconstruction using a graft may be recommended. Surgery also may be recommended for patients with chronic PCL tears who continue to have symptoms six to 12 months after injury.
If the ligament pulls off a sufficiently large piece of bone that is no longer in its proper position, surgery may be performed to replace and secure the bone using a screw, staples, stitches, or pins.
Nonsteroidal anti-inflammatory medications such as aspirin and ibuprofen, or other pain relievers such as acetaminophen, are often recommended as directed by a physician. Stronger pain relievers may be prescribed when necessary.
Cold can be used to relieve pain and reduce inflammation. It may be applied for 10 to 15 minutes every two to three hours and immediately after activities that aggravate symptoms. Heat may be used before prescribed stretching and strengthening exercises.
Recovery and Outcomes
The expected outcome of a PCL injury is not completely known.
Usually, three to eight months of conservative treatment and an appropriate rehabilitation program are needed before functional adaptation occurs and return to sports is possible.
Arthritis may develop 20 years after the injury, and it is not known whether surgery changes this outcome.
Surgical reconstruction rarely restores complete knee ligament tightness.
When to See Dr. Chudik
Contact Dr. Chudik’s office if symptoms become worse or do not improve after six weeks of treatment, or if new, unexplained symptoms develop.
Call 630-324-0402, request an appointment online, or email contactus@chudikmd.com.