PCL

WHAT IS POSTERIOR CRUCIATE LIGAMENT

• PCL is one of two cruciate ligaments in knee.
• The PCL gets its name because of its posterior insertion on the tibia. Its femoral attachment is on the lateral aspect of the medial femoral condyle.
• The PCL is considered as the strongest knee ligament.

FUNCTION OF PCL

The PCL is the primary restraint to posterior tibial translation at the knee and plays an integral part in knee joint stability

SYMPTOMS OF PCL TEAR

• PCL injury occurs frequently in trauma patients, followed by athletes.
• Mild to severe pain and swelling
• Instability: knee might feel loose, as if it's going to give way.
• Difficulty in walking

HOW TO DIAGNOSE PCL TEAR

• Examination

1. Knee swelling, tenderness.
2. Posterior drawer test positive

• X-RAYS

Posterior Stress radiography presents the golden standard to quantify posterior laxity in posterior cruciate ligament (PCL) insufficiency.

• MRI KNEE: Investigation of choice. This study will show the ligament, extent and location of the tear and associated injuries.

TREATMENT

Nonsurgical Treatment

• PCL avulsion with minimally displaced bony fragment
• Partial tear of PCL
• PCL tear in severely degenerated knee

Advice:

• RICE: Rest, Ice, Compression and Elevation.
• Immobilization: An immobilizer or a brace to prevent your knee from bending. “Rebound knee braces” are state-of-art devices, as they can maintain the joint reduction and simultaneously allow knee movement.
• Walk with walker/ crutch support to avoid weight bearing.
• Physical therapy. As the swelling goes down, a careful rehabilitation program is initiated, to restore function to your knee and strengthen the muscles.

Surgical Treatment

• Muli-ligamentous injury
• Completely torn ligament in active individual
• Unstable knee

Types of surgery:

• Repair: Bony avulsion along with intact ligament and isolated femoral avulsion are amenable repair. Various fixation devices used are screws, suture anchors, sutures etc. Augmentation by fiber tapes can be done as needed.
• Reconstruction: Torn ligaments don’t heal even when stitched together. They need to be replaced by tissue graft taken from another part of your body, The graft will be attached to the recipient bone by available various devices and will take few months to get incorporated.

REHABILITATION

• Plays a vital role in recovery from injury and surgery.
• A physical therapy program will help you regain your knee range of motion and muscle strength.
• Time of recovery depends on the severity of your injury. Combined injuries often have a slow recovery, but most patients do well over time.
• In case of surgery, it may be several weeks before you return to desk job. Full recovery usually requires 6 to 12 months.