PCL Tear

WHAT IT IS ?

The posterior cruciate ligament (or PCL) is one of the four major ligaments of the knee. It connects the posterior intercondylar area of the tibia to the medial condyle of the femur. This configuration allows the PCL to resist forces pushing the tibia posteriorly relative to the femur. The function of the PCL is to prevent the femur from sliding off the anterior edge of the tibia and to prevent the tibia from displacing posterior to the femur. Common causes of PCL injuries are direct blows to the flexed knee, such as the knee hitting the dashboard in a car accident or falling hard on the knee, both instances displacing the tibia posterior to the femur.

SIGNS AND SYMPTOMS :

The posterior drawer test is one of the tests used by doctors and physiotherapists to detect injury to the PCL.

An additional test of posterior cruciate ligament injury is the posterior sag test, where, in contrast to the drawer test, no active force is applied. Rather, the person lies supine with the leg held by another person so that the hip is flexed to 90 degrees and the knee 90 degrees. The main parameter in this test is step-off, which is the shortest distance from the femur to a hypothetical line that tangents the surface of the tibia from the tibial tuberosity and upwards. Normally, the step-off is approximately 1 cm, but is decreased (Grade I) or even absent (Grade II) or inverse (Grade III) in injuries to the posterior cruciate ligament.

Patients who are suspected to have a posterior cruciate ligament injury should always be evaluated for other knee injuries that often occur in combination with an PCL injuries. These include cartilage/meniscus injuries, bone bruises, ACL tears, fractures, posterolateral injuries and collateral ligament injuries

INVESTIGATIONS REQUIRED :

Though clinical examination in experienced hands can be accurate, the diagnosis is usually confirmed by MRI, which has greatly lessened the need for diagnostic arthroscopy and which has a higher accuracy than clinical examination. It may also permit visualization of other structures which may have been co-incidentally involved, such as a meniscus, or collateral ligament, or posterolateral corner of the knee joint.

TREATMENT POSSIBLE :

Surgery is usually required in complete tears of the ligament. Surgery usually takes place after a few weeks, in order to allow swelling to decrease and regular motion to return to the knee. A grade III PCL injury with more than 10mm posterior translation when the posterior drawer examination is performed may be treated surgically. Patients that do not improve stability during physical therapy or develop an increase in pain will be recommended for surgery.

A procedure called ligament reconstruction is used to replace the torn PCL with a new ligament, which is usually a graft taken from the hamstring or Achilles tendon from a host cadaver. An arthroscope allows a complete evaluation of the entire knee joint, including the knee cap (patella), the cartilage surfaces, the meniscus, the ligaments (ACL & PCL), and the joint lining. Then, the new ligament is attached to the bone of the thigh and lower leg with screws to hold it in place.

REHABILITATION AND RECOVERY :

It is possible for the PCL to heal on its own without surgery when it is in Grades I and II. PCL injuries that are diagnosed in these categories can have their recovery times reduced by performing certain rehabilitative exercises. Fernandez and Pugh (2012) found that following a PCL grade II diagnosis, a multimodal[disambiguation needed] treatment that spanned over the course of 8 weeks consisting of chiropractic lumbopelvic manipulation, physiotherapy, and implementing an exercise program that emphasized in eccentric muscle contraction (lunges, 1-leg squats, and trunk stabilization) which proved to be an effective way to recover from the PCL injury. For Grades III and IV, operative surgery is recommended or is usually needed. Grafts is the method when addressing PCL injuries that are in need of operative surgery. With grafts, there are different methods such as the tibial inlay or tunnel method.