Posterior Cruciate Ligament (PCL) Reconstruction Treatment, Surgery
The posterior cruciate ligament (PCL) is one of the most prominent ligaments in the knee. Injuries to the posterior cruciate ligament can occur in a variety of ways, including a hard blow to the shinbone or falling down on a bent knee. These injuries most frequently occur during motor vehicle accidents and participation in contact sports. A PCL injury can also be the result of bending your knee past the normal anatomical position, over-extending it or sustaining a blow to the side of your knee while your leg is twisted. If you have a posterior cruciate ligament injury, some symptoms you may notice are pain in your knee, rapid swelling and tenderness, painful kneeling and squatting, limping or difficulty walking, your knee giving way while active and feelings of instability and pain with running, walking or climbing stairs. The discomfort and inconvenience associated with a PCL injury cause your activity to be limited, and affect your quality of life. Pursuing repair of your posterior cruciate ligament injury, such as PCL reconstruction surgery, will relieve your pain and discomfort and help you get back to your normal life.
Posterior Cruciate Ligament (PCL) Injury Diagnosis
When you present with a PCL injury, your physician will perform a physical assessment, look at your past medical history and current medications, assess the presence of symptoms, cause of the injury and your ability to perform physical activities. Talking with your doctor will provide insight into the extent of your injuries and the appropriate treatment for your condition. Your physician will order diagnostic tests to allow a visual examination of your injuries, enabling them to objectively determine the appropriate treatment. Some examples of diagnostic imagery include:
- X-Ray – A posterior cruciate ligament injury commonly occurs with an avulsion fracture – a fracture where a small piece of your bone that is attached to the ligament is separated from the main bone. An x-ray will not show damage to your ligament, and is therefore alone not indicative for PCL reconstruction, but it will be able to determine if there is a fracture. Your bone will absorb the electromagnetic radiation, causing a black-and-white image to appear. This image will allow the radiologist to determine the presence of any fractures and assist your surgeon in determining the extent of the damage.
- Magnetic Resonance Imaging (MRI) – Using radio waves and a strong magnetic field, an MRI allows visualization of the soft tissue surrounding a bone. Considered the “gold standard” for diagnosing a tear to the posterior cruciate ligament, an MRI will show the extent of the tear and the presence of concurrent damage to other knee ligaments and cartilage, guiding your surgeon’s decision on the appropriateness of PCL reconstruction surgery.
- Arthroscopy – If your surgeon is having a difficult time gauging the extent of your injuries from diagnostic imagery alone, they may decide to perform an exploratory arthroscopy. Arthroscopy is an invasive diagnostic measure, allowing your surgeon to see the inside of your knee and your PCL to determine the appropriate treatment regimen. If indicated, the surgeon can also repair your injuries at the same time with posterior cruciate ligament reconstruction surgery.
Nonsurgical Treatment for Posterior Cruciate Ligament (PCL) Tears and Injuries
In many cases, a partial or isolated PCL tear can be treated in a nonsurgical manner. The posterior cruciate ligament contains a synovial covering which has self-healing abilities, and surgical intervention may not be necessary for recovery. Your orthopaedic specialist will provide instructions on care at home, which may include resting the injured leg to prevent further injury (with or without the use of crutches), anti-inflammatory medications, ice or heat therapy, compression with bandage wraps and elevation to reduce swelling. Joint aspiration, an invasive but nonsurgical technique, may occur to remove the joint fluid if there is significant swelling in the knee that is preventing normal range of motion or ability to use the knee or leg. Following your physician’s orders will allow your injured PCL to heal, without further complications that may require surgical intervention.
Surgery for Posterior Cruciate Ligament (PCL) Reconstruction
Some indications of posterior cruciate ligament reconstruction surgery include injuries that occur with other ligament tears associated with the knee; those that occur as a result of a bone avulsion injury or a peel-off injury; and chronic PCL injuries symptomatic with pain and instability. There are different grafting choices, including autogenous (from the self) patellar or quadriceps tendon with bone blocks and hamstring tendons; and allograft (from a donor) patellar tendon or Achilles tendon. PCL reconstruction procedures are usually performed using one of the following techniques:
- Arthroscopic Procedure – The most common type of posterior cruciate ligament reconstruction surgery, orthopaedic surgeons use this method to allow examination and treatment of the inside of a joint. The orthopaedic surgeon inserts a thin tube – an arthroscope, which contains a light and camera – into a small incision located near the knee. The surgeon will make a few other small incisions to allow the entrance of surgical instruments to insert a graft and repair your torn ligament. Local or general anesthesia may be used, and this procedure usually occurs in an outpatient setting. The average PCL reconstruction surgery using an arthroscopic approach normally takes about two hours.
- Open Knee Posterior Cruciate Ligament (PCL) Reconstruction – If the injuries are more complex in nature than what can be corrected arthroscopically, an open knee PCL reconstruction is a surgical option. There are more risks and longer recovery time associated with this approach; however, it will allow the appropriate manipulation and handling of the injury to ensure recovery to normal function. Speak with your surgeon about the different procedure options and the most appropriate one for your individual posterior cruciate ligament injury.
Posterior Cruciate Ligament (PCL) Reconstruction Procedure Research
Conservative therapy is normally indicated for Grade 1 and 2 PCL injuries (mild and moderate), with surgery normally indicated for Grade 3 (complete PCL tear). The incidence of complications arising after posterior cruciate ligament reconstruction surgery is approximately 1%. Current procedures for PCL reconstruction allow 85-90% of patients to return to full activity.
The Rehabilitation Network of the North Shore-LIJ Health System is dedicated to providing you and your family with result-oriented, comprehensive rehabilitation services. Our goal is to help you and your loved ones find relief from pain and get moving again after an accident, illness, injury or surgery. We’re your partner in a safe, healthy, more rapid recovery.
The multidisciplinary team of orthopaedic experts at North Shore-LIJ Orthopaedic Institute in New York performs posterior cruciate ligament surgery, along with a number of other treatments – both surgical and non-surgical – for bone and joint conditions and injuries.