Posterior Cruciate Ligament (PCL)
The Posterior cruciate ligament lies in the back of the knee and forms a cross with the ACL. It prevents backward motion of the tibia on the femur. It is less commonly injured than the ACL and injury usually results from a direct blow to the front of the knee. Isolated PCL injuries can usually be treated conservatively in a brace. When injured in combination with the other knee ligaments, surgical reconstruction of the PCL is usually required.
PCL injuries are graded as to the amount of laxity compared to the other normal knee.
Grade 1 represents a partial tear with less than 5 mm of movement. This is normally an isolated injury and is treated in a brace for 6-8weeks. The brace is worn for 24 hours a day and has a pad to push the tibia forward and aid healing of the PCL.
Grade 2 represents an isolated complete tear with between 6-10mm of movement. These injuries are treated on an individual basis in discussion the knee surgeon. In general, most can be treated non-operatively in a brace but the high level athlete may chose surgery.
Grade 3 tears represent a complete tear of the PCL combined with either a capsular injury or injury to one of the other ligaments and there is increased laxity of greater than 10mm. Surgical reconstruction is normally recommended.
If a PCL reconstruction is needed, I do an arthroscopic reconstruction using hamstring graft to reconstruct the PCL. Patellar tendon or quadriceps graft maybe used, especially when hamstring is not available. A PCL brace, as described above, is then used for 8 weeks to protect the reconstruction after which rehabilitation is continued. Return to sports usually occurs around 9 months post reconstruction.