The posterior cruciate ligament (PCL) is injured much less often than the ACL. Isolated injuries are most often due to a direct blow on the front of the knee from a fall or from the dashboard in a car accident. They can occur during falls onto the knee or a direct front tackle during rugby and other contact sports.
Many isolated PCL injuries are treated without operation and do very well with physiotherapy rehabilitation concentrating on strengthening of the quadriceps muscles.
Sometimes they require surgical reconstruction of the ligament. The main symptom of a PCL tear is forwards instability most often noticed going down stairs or down hill. There is an increased risk of developing arthritis of the patellofemoral (kneecap) and medial (inside) part of the knee in unstable PCL injuries.
Reconstruction is performed under a spinal or general anaesthetic using arthroscopic (key hole) techniques to re create the ligament using a graft from your self (hamstrings or quadriceps tendon) or a cadeveric achilles tendon allograft.
Complex injuries to the PCL with other knee ligaments are considered a knee dislocation and will normally require surgery to repair or reconstruct the knee.
Intra operative xray of PCL reconstruction
Posterior view of PCL reconstruction graft
You normally spend one night in hospital and are fully mobile with crutches straight away in a specialised knee brace. Following surgery the knee is swollen and painful for around 2-4 weeks. Normal day to day activities are resumed at around 6 weeks. The rehabilitation is prolonged building up gradually under the supervision of a physiotherapist. Initially you work to regain your full range of motion, then start to build up muscle strength. By 3 months you can begin straight line exercise (cycling, jogging on a treadmill) and you can return to contact sports at 6-9 months post surgery.