Normally, all of the parts of the knee joint work together and the joint moves easily and without pain. However, disease or injury can disturb the normal functioning of a joint, which can result in knee pain, muscle weakness, and limited movement.
The posterior cruciate ligament, or PCL, is one of the main ligaments in the knee and injury to this ligament may be seen in a variety of settings. In general, most partial or isolated PCL tears can be treated non-operatively because the PCL, with its synovial covering, has some ability to heal. However, surgical reconstruction is often recommended for PCL tears that occur in combination with other ligament tears of the knee.
The posterior cruciate ligament is the strongest ligament of the knee. While the anterior cruciate ligament, or ACL is injured more often than the PCL and is more commonly discussed, PCL injuries account for more than 20% of reported knee injuries.
PCL injuries are classified according to the amount of injury to the functional ligament:
Grade I: partial PCL tear
Grade II: near complete PCL tear
Grade III: a complete PCL tear – the ligament is non-functional
PCL reconstruction on injuries that present themselves as a grade III may be needed. In a higher level athlete, it may be recommended to proceed with a PCL reconstruction sooner because the results of acute reconstructions are much better than chronic reconstructions.
Severe PCL laxity, which results in a knee with significant posterior translation is quite unsettling to the patient, especially athletes due to the shifting of the tibia during running. These patients benefit from a PCL reconstruction, which re-establishes stability to the knee.
As noted in the treatment of ACL injuries, the ruptured ligament cannot be repaired. It must be reconstructed using a graft. This can be from the injuried patients own body or from a donor. The graft is attached through drill holes in the tibia and femur, using arthroscopic techniques, to reestablish the posterior cruciate attachment.
This is an outpatient procedure allowing the patient to walk with crutches and a brace in their home. Return to sports is restricted for 10 to 12 months, allowing the knee to rebuild strength and function.