What Is the Posterior Cruciate Ligament?

The PCL (posterior cruciate ligament) is one of the four major ligaments that helps to stabilize and support the knee. The PCL works along with the ACL (anterior cruciate ligament) and the medial and lateral collateral ligaments (on the sides of your knee) to stabilize the knee joint. The PCL connects the femur (thigh bone) to the tibia (shin bone). Although the PCL is larger and stronger than the ACL, it can still be torn.

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What Is a Posterior Cruciate Ligament Injury?

A PCL injury results from overstretching or tearing this ligament. Immediately after a PCL injury, your knee may swell, feel unstable, and become painful to bear weight. Unlike with an ACL injury, many people do not report a “popping sensation” in their knee when this type of injury occurs. People usually feel like they only have a minor knee problem and may even be able to continue with their day-to-day activities.

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Common Causes

The PCL can be injured in several different ways. Causes of injuries can include striking the knee against the dashboard in a motor vehicle accident or falling on the knee while it is bent. Sports such as football, soccer, baseball, and skiing are also a common cause of this injury.

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Diagnosis

A physical examination and patient history with a qualified musculoskeletal expert is the first step. A physician will compare a patient’s non-injured knee with the injured knee. Most injured ligaments can be diagnosed after an examination using special manual tests. Imaging tests such as MRI or x-rays may be needed to see if there are additional injuries such as broken bones or additional tissue injuries (to muscle, tendons, ligaments, or cartilage).

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Treatment

There are both non-surgical and surgical options available. Non-surgical treatment could be effective for patients that have a low activity level or who are elderly.

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Non-Surgical

Bracing and physical therapy are two non-surgical treatment options. A brace may be recommended to protect the knee from instability or buckling. To keep from putting weight through the knee joint, you may be given crutches. Specific exercises will help restore function and strengthen the leg muscles as directed by a physical therapist.

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Surgical

The ligament must be reconstructed to restore knee stability. Usually surgery is not performed right away, to give inflammation a chance to resolve. Prior to surgery, your doctor may also suggest that you see a physical therapist to try and regain as much normal range of motion as possible at the knee joint. Arthroscopic surgery (a small incision) is performed to rebuild the PCL using a new ligament for the damaged one (allograft) or using tendons from other parts of the body to substitute as the PCL (usually a part of the patella tendon or hamstring muscle).

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Rehabilitation

After surgery, you will use crutches or a walker at first. You will gradually increase the amount of weight you can put on your repaired leg. You will likely be wearing a brace to give you support while the knee is healing and regaining strength. You may initially have a machine that moves your leg to help you progress with range of motion. Physical therapy will be a very important part of your recovery. A physical therapist will guide you in many stretches and exercises to help you restore your range of motion, strength, and stability.