The Posterior Cruciate Ligament (PCL) runs through the middle of the knee from front to back, along with the Anterior Cruciate Ligament (PCL). Together they form an 'X' shape crossing over each other (hence the word 'cruciate' which means 'like a cross'). Their main function is to stop the knee from wobbling forwards and backwards and to stop it from twisting too much.
The PCL can be torn or ruptured in a fall where the knee or shin bone takes the weight of a fall when bent. Unlike ACL injuries which can occur without contact, most PCL injuries involve some form of contact or trauma. Like ACL injuries, they are very common in younger people (aged from 15-35) and occur most frequently in sports, motor vehicle accidents and other high energy accidents.
Unlike ACL, the PCL or posterior cruciate ligament has a relatively higher capacity to heal. Isolated PCL ruptures do not always need surgical reconstruction. A supervised physiotherapy program can allow near normal knee function and strength without surgery.
Indications for PCL reconstruction
- PCL injuries in association with other ligament injuries of the knee (ACL, MCL or Postero-lateral corner) often need surgical reconstruction of all the ligaments injured
- High grade PCL tears (grade 3) that fail non-operative management
- PCL bony avulsion injuries.
As with ACL reconstruction surgery, PCL reconstruction surgery is generally performed using arthroscopic (keyhole) surgical techniques. Surgery normally takes less than two hours.
Once the patient is under a general anaesthetic, four small incisions of around 1cm each are made around the knee (these are called 'portals') to allow access for the arthroscopic camera and instruments. Dr Reddy examines the knee to confirm that the PCL has torn and to check if there is any damage to other ligaments in the knee. If the PCL needs repair, then either your own hamstring tendon or an allograft (a donor tendon from a host cadaver) is used.
At this point one of a number of surgical techniques can be employed to fix the replacement ligament. A common technique is for holes to be drilled through the knee from the shinbone (tibia) underneath and into the thigh bone (femur) above, and then the replacement ligament to be channelled through these holes into a position very close to that of the original ligament. Screws and or button hold the new ligament in place.
Dr Reddy will then check that the replacement ligament has the right tension and is stable, and that the knee has the correct range of motion. Once this is all checked to his satisfaction, the incisions are closed and dressed.
Most patients are able to go home the next day.
PCL Reconstruction – Things you need to know
- Unlike postoperative recovery for an ACL reconstruction, patients should wear a hinged knee brace for 4 weeks to protect the new ligament. The brace wear is only when standing and walking and can be removed for exercises, shower and sleeping.
- Dr Reddy will see you the morning after surgery. He and the physiotherapist will advise you the exercise regimen as well as things to do and not to do. Please follow the advise and regularly perform exercises as detailed below.
- You can walk full weight-bearing after surgery once quadriceps strength and leg control are regained. A pair of crutches is required for the first 1-2 weeks. Twisting/Pivoting and cutting movements as well as high level activity should be strictly avoided for 6 months.
- It is normal for the area around the knee to have some swelling and pain for 2-3 weeks. Pain medication will be prescribed. Keeping the leg elevated and using ice packs placed on the knee will help reduce swelling.
- Please follow the advice and exercise regimen given by Dr Reddy and your therapist to give yourself the best chance of recovery.