Posterior Cruciate Ligament - PCL Injury and Treatment Options
What is it?
The Posterior Cruciate Ligament (PCL) and the Anterior Cruciate Ligament (ACL) are two tough bands of fibrous tissue that link the thighbone (femur) and the large bone of the lower leg (tibia) at the knee joint. Both, the ACL and PCL bridge the inside of the knee joint, forming an "X" pattern that eases the knee against front-to-back and back-to-front forces. In particular, the PCL prevents the lower leg from slipping too far back in relation to the upper leg, especially when the knee is flexed (bent). PCL damage is a sprain (stretch or tear of a ligament). The PCL most habitually is sprained when the front of the knee hits the dashboard during an automobile accident. During sports events, the PCL also can tear when an athlete falls frontward and lands hard on a bent knee, which is very common in football, basketball, soccer and specially rugby.
Like other types of sprains, PCL injuries are categorized according to a customary grading system.
Grade I — A mild damage causes only microscopic tears in the ligament. Though these tiny tears can stretch the PCL out of shape, they do not pointedly affect the knee's ability to support your weight.
Grade II (moderate) — The PCL is partly torn, and the knee is somewhat unstable, meaning it gives out occasionally when you stand, walk or have analytic tests.
Grade III (severe) — The PCL is either totally torn or is separated at its end from the bone that it usually anchors, and the knee is more unstable. Because it commonly takes a large amount of force to cause an extremely severe PCL injury, patients with Grade III PCL sprains frequently also have sprains of the ACL or collateral ligaments or other significant knee damages.
Rehabilitation: Physiotherapy is vital after PCL reconstruction. In contrast to ACL reconstruction, gravity tends to expanse the PCL graft. Hence, some precise techniques of physiotherapy (prone position) and a slower pace, associated to the accelerated rehabilitation of ACL damage, has been sustained to permit complete healing of the PCL graft. Return to sport is hardly achieved before 9 months.
Conclusion: The majority of isolated PCL ruptures can be cured conventionally with good results and coming back to sport in a few weeks. In the athletic population, the grade I and II damages are usually treated conventionally with success and we recommend performing a PCL reconstruction in the case of grade III damages. The combined damages, mainly PCL and PLS lesions, must be treated surgically within the first 4 weeks following the damage as the treatment of the chronic posterolateral laxity is perplexing.
