The posterior cruciate ligament (PCL)is one of the four main ligaments of the knee. It is not as well publicized as the more common anterior cruciate ligament (ACL) injury. Whereas an ACL injury usually/ almost always requires surgery in an athlete, especially an athlete who plays cutting and pivoting sports, the vast majority of PCL injuries do not require surgery.
Generally speaking, PCL injuries can be rehabbed with conservative treatment. Some of the best known athletes who still had tremendous careers with PCL injuries include Barry Sanders of the Detroit Lions and Marshall Faulk of the St. Louis Rams. They were able to perform at a very high level despite tearing their PCLs.
The PCL is one of the cruciate ligaments in the center part of the knee. It crisscrosses (hence the name cruciate) with the ACL and starts on the front (anterior) part of the end of the thigh (femur)bone and attaches to the back (posterior) part of the shin (tibia)bone. It prevents the tibia from sliding backwards or posteriorly on the femur. It does have a part in preventing twisting and turning of the knee with cutting and pivoting sports but not as great a role as the ACL does in that regard.
Most of the time, just like an ACL tear, a PCL tear can be diagnosed on physical exam but sometimes it is a little trickier and that is where an MRI scan can also help. Unlike the ACL, however, the PCL can sometimes heal and actually “tighten up” a little bit. Once the ACL tears, usually it is not going to heal. Although partial ACL tears/stretching out are possible, they are much less common than complete tears. The PCL more commonly will stretch out/partially tear than the ACL does.
Sometimes on an MRI it will look like it is completely torn (white abnormal signal and no normal black signal) but later on down the road, a repeat MRI scan often times can actually show the normal black signal of the PCL has reconstituted itself.
The normal treatment for an isolated PCL tear is physical therapy and rehab. The quadriceps muscles, which are the muscles on the front part of the thigh, are very, very important for preventing the tibia from sliding back on the femur as well. By strengthening the quadriceps muscle (and all the muscles in the leg) it can help “stabilize” the knee and not require surgery. Sometimes a brace is helpful and rarely is surgery needed.
If a patient fails physical therapy and bracing and the knee is still giving out, buckling or significantly painful, that is when we will more strongly consider a PCL reconstruction. If a patient has multiple ligaments injured i.e. the ACL and the PCL plus or minus one or both the collateral ligaments, the ligaments on the inner (medial) and outer (lateral) sides of the knee, then a PCL reconstruction will often be done in conjunction with a reconstruction/repair of the other ligament(s). That is the more common reason to perform a PCL reconstruction early on after someone has been injured rather than trying to rehab the knee first.
One of the other reasons that PCL reconstructions aren't nearly as common as ACL reconstructions is not only because of the fact that they numerically are less common but also because we, as sports medicine specialists still have not developed a technique that is nearly as reproducible and works as well as an ACL reconstruction does. The PCL is a little bit more complicated ligament. It is a larger ligament and it definitely has two sections to it so it is often reconstructed with two grafts (two-graft ACLs are also becoming more and more vogue but that is more controversial).
Many times the PCL reconstruction will feel solid and the knee will feel very stable right after the surgery but then several months later it “stretches out” and becomes “looser,” basically ending up similar, if not the same, as it was prior to the surgery. Therefore, with an isolated tear - since we can't definitively predict the results will end up better than not doing surgery, we often times treat these conservatively with good results.
The main risks to the knee long term after a PCL tear are that it tends to develop arthritis in the patellofemoral (kneecap) and medial (inner) parts of the knee joint. We are somewhat unsure at this time whether or not a reconstruction early on would “prevent” that, but for the time being, the treatment of isolated PCL tears and the standard of care is conservative treatment initially.
Dr. Marc P. Pietropaoli is a board certified/fellowship trained orthopedic surgeon/sports medicine specialist and is president of Victory Sports Medicine & Orthopedics in Skaneateles
The PCL is one of the cruciate ligaments in the center part of the knee. It crisscrosses (hence the name cruciate) with the ACL and starts on the front (anterior) part of the end of the thigh (femur)bone and attaches to the back (posterior) part of the shin (tibia)bone. It prevents the tibia from sliding backwards or posteriorly on the femur. It does have a part in preventing twisting and turning of the knee with cutting and pivoting sports but not as great a role as the ACL does in that regard.
Most of the time, just like an ACL tear, a PCL tear can be diagnosed on physical exam but sometimes it is a little trickier and that is where an MRI scan can also help. Unlike the ACL, however, the PCL can sometimes heal and actually “tighten up” a little bit. Once the ACL tears, usually it is not going to heal. Although partial ACL tears/stretching out are possible, they are much less common than complete tears. The PCL more commonly will stretch out/partially tear than the ACL does.
Sometimes on an MRI it will look like it is completely torn (white abnormal signal and no normal black signal) but later on down the road, a repeat MRI scan often times can actually show the normal black signal of the PCL has reconstituted itself.
The normal treatment for an isolated PCL tear is physical therapy and rehab. The quadriceps muscles, which are the muscles on the front part of the thigh, are very, very important for preventing the tibia from sliding back on the femur as well. By strengthening the quadriceps muscle (and all the muscles in the leg) it can help “stabilize” the knee and not require surgery. Sometimes a brace is helpful and rarely is surgery needed.
If a patient fails physical therapy and bracing and the knee is still giving out, buckling or significantly painful, that is when we will more strongly consider a PCL reconstruction. If a patient has multiple ligaments injured i.e. the ACL and the PCL plus or minus one or both the collateral ligaments, the ligaments on the inner (medial) and outer (lateral) sides of the knee, then a PCL reconstruction will often be done in conjunction with a reconstruction/repair of the other ligament(s). That is the more common reason to perform a PCL reconstruction early on after someone has been injured rather than trying to rehab the knee first.
One of the other reasons that PCL reconstructions aren't nearly as common as ACL reconstructions is not only because of the fact that they numerically are less common but also because we, as sports medicine specialists still have not developed a technique that is nearly as reproducible and works as well as an ACL reconstruction does. The PCL is a little bit more complicated ligament. It is a larger ligament and it definitely has two sections to it so it is often reconstructed with two grafts (two-graft ACLs are also becoming more and more vogue but that is more controversial).
Many times the PCL reconstruction will feel solid and the knee will feel very stable right after the surgery but then several months later it “stretches out” and becomes “looser,” basically ending up similar, if not the same, as it was prior to the surgery. Therefore, with an isolated tear - since we can't definitively predict the results will end up better than not doing surgery, we often times treat these conservatively with good results.
The main risks to the knee long term after a PCL tear are that it tends to develop arthritis in the patellofemoral (kneecap) and medial (inner) parts of the knee joint. We are somewhat unsure at this time whether or not a reconstruction early on would “prevent” that, but for the time being, the treatment of isolated PCL tears and the standard of care is conservative treatment initially.
Dr. Marc P. Pietropaoli is a board certified/fellowship trained orthopedic surgeon/sports medicine specialist and is president of Victory Sports Medicine & Orthopedics in Skaneateles
