PCL Tear

The posterior cruciate ligament (PCL) is one of four main knee ligaments. It is a small band found at the back of the knee that links the tibia with the femur. Despite its size the PCL is the knee's strongest ligament, so PCL injuries are usually caused by harsh trauma or sudden damaging motions as opposed to more common sporting injuries. A PCL tear leads to knee instability and can make standing or bearing weight on that leg very difficult.

Symptoms

The symptoms can depend on the individual and the severity of the tear. Some people might experience knee pain or inflammation but this is not generally the case. This can make detecting the injury more difficult; however, the knee regularly feels unstable or unsteady and may collapse or wobble when bearing your weight. Other than this, the most reliable indicator is usually a traumatic incident involving the knee prior to the instability.

Causes

Various abrupt and sharp knee movements can lead to a PCL tear. Common causes include overextension or sudden twisting of the knee, as well as hard strikes to the shin or an impact that forces the knee backwards. These can all arise during fast paced contact sports such as football or rugby, although in many cases the injury is provoked by an incident not involving another athlete. Car accidents and other collisions are widespread causes outside of sport.

Diagnosis

The diagnostic process is the most important because the doctor will need to ascertain whether the PCL damage is isolated or linked to any other ligament injury. Physical exams are rarely enough to fully assess the injury, but an effective test involves the doctor pushing back on the tibia with the knee bent and judging whether the bone moved too far. Otherwise possible tests can include an x-ray, MRI or an arthroscopy procedure (with a small camera). These can help to show whether other ligaments are damaged, which is a common possibility with PCL tears. Fractures also need to be ruled out.

Medical Treatment

If the PCL tear occurs on its own, without any complications, then the treatment is likely to be conservative. This can mean a period of resting from activity and knee or leg immobilisation in order to keep the ligament in place as it heals. Pain medications and any other medicine will be prescribed at the doctor's discretion. A rehabilitation program of physical therapy will then gradually build up flexibility and power in the knee.

Simultaneous damage to the PCL ligament and another knee ligament frequently necessitates a surgical procedure in which the injured ligaments are reconstructed by utilising a graft from an uninjured ligament or tendon. This surgery is often a choice and the doctor can talk you through the options and likely outcomes, but competitive athletes will usually opt for the surgery in an attempt to regain full strength in the knee. The other main option is a strengthening program. This can be arduous and last up to 6 months, but is the right option for some people.