Posterior cruciate ligament reconstruction

The PCL is the primary stabilizer of the knee preventing backward shift of the tibia over the femur. If the tibia moves too far back, the PCL can rupture.More recent research has shown us that the PCL also prevents medial-lateral (side-to-side) and rotatory movements. So the PCL´s effect on knee joint function is more complex than previously thought.

Mode of PCL injury

PCL injuries can occur with low-energy and high-energy injuries. The most common way for the PCL alone to be injured is from a direct blow to the front of the knee while the knee is bent. Since the PCL controls how far backward the tibia moves in relation to the femur, if the tibia moves too far, the PCL can rupture.

The most common cause of PCL injury is road traffic accident. This can happen if a person slides forward during a sudden stop or impact and the knee hits the dashboard just below the kneecap. In this situation, the tibia is forced backward under the femur, injuring the PCL. The same can happen if a person falls on a bent knee. Again, the tibia may be forced backward, stressing and possibly tearing the PCL.

Other parts of the knee may be injured when the knee is violently hyperextended/dislocated (multi-ligamentous injury). But other ligaments are usually injured or torn before the PCL. This type of injury can happen when the knee is struck from the front when the foot is planted on the ground.

Symptoms

Pain is a most common presenting symptom during stepping in the ramp. But the patient may have instability during turning movements or stepping.

Diagnosis

The history and physical examination is probably the most important tool in diagnosing a ruptured or deficient PCL.The doctor will place your knee and leg in various positions and then apply a load or force to the joint. Any excess motion or unexpected movement of the tibia relative to the femur may be a sign of ligament damage and insufficiency.

The doctor may ask for X-rays of the knee to rule out a fracture. The magnetic resonance imaging (MRI) scan is probably the most accurate test to detect the ligament status.

Treatment

Conservative Treatment

Less severe PCL tears are usually treated with a good rehabilitation program. Patients intending to return to high-demand activities may require a functional knee brace before returning to these activities. Most patients receive physical therapy treatments after a PCL injury. Exercises are used to help you regain normal movement of joints and muscles. Exercises are also given to improve the strength of the quadriceps muscles on the front of the thigh. As your symptoms ease and strength improves, you will be guided in specialized exercises to improve knee stability.

Surgical Treatment

Most surgeons prefer reconstruction of the PCL using a piece of tendon or ligament to replace the torn PCL. In a typical surgical reconstruction, the torn ends of the PCL must first be removed. Once this has been done, the type of graft that will be used is determined. The gracilis and semitendinosus tendons can be taken out without really affecting the strength of the leg because bigger and stronger hamstring muscles will take over the function of the two tendons that are removed. After preparation these grafts are used for reconstruction of PCL done arthroscopically.

Other parts of the knee may be injured when the knee is violently hyperextended/dislocated (multi-ligamentous injury). But other ligaments are usually injured or torn before the PCL. This type of injury can happen when the knee is struck from the front when the foot is planted on the ground.