Posterior Cruciate Ligament (PCL)

The posterior cruciate ligament (PCL) is one of the four main ligaments stabilizing the knee. The PCL is responsible for providing resistance to posterior (or backward) movement of the tibia bone in relation to the femur bone. Posterior cruciate ligament injuries are rather infrequent; however they usually occur from either a direct blow to the front of the knee or a hyperflexion injury when the athlete falls to the ground with the knee flexed. Injuries to the PCL are categorized into three main types based on the degree of severity: grade I – mild; grade 2 – moderate; and grade 3 – complete. This classification is based on the amount of knee laxity exhibited with a backward stress applied to the flexed knee.

Conservative treatment is typically recommended for grade 1 and grade 2 injuries which represent the majority of injuries. This consists of physical therapy with strengthening of the quadriceps muscle and gradual resumption of athletic activity over the next several weeks. Surgery is recommended only for complete grade 3 injuries. Surgical reconstruction of the PCL involves the placement of a reconstructive graft taken from either the patient’s knee or from a donor graft (allograft). The procedure is done in an arthroscopic fashion on an out-patient basis and takes less than two hours to perform. The incidence of complications following PCL reconstruction is approximately 1%.

Physical therapy is prescribed postoperatively with emphasis on re-establishing knee range-of-motion, followed by strengthening the thigh muscles and progression to a functional rehabilitation regimen. Return to sports activities is usually allowed at approximately 6 to 8 months following surgery. Modern methods of PCL reconstruction result in 85% to 90% return to full activity.

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