Posterior Cruciate Ligament Injuries

The posterior cruciate ligament or PCL, is one of the two ligaments inside the knee that stabilizes the knee to posterior translations. The word “cruciate” means cross, and the PCL crosses the anterior cruciate ligament or ACL in the center of the knee.

Injuries to the PCL are much less common as compared to the the ACL. The injury usually occurs from a direct blow to the anterior aspect of the knee, either from the dashboard during a motor vehicle accident, or a fall directly onto the flexed knee, which often occurs during sports. The PCL can also tear with a forceful hyperextension injury to the knee.

The PCL can rupture mid-substance, but can also stretch and tear internally without complete rupture of the fibers. The PCL can also avulse from the posterior attachment and pull off a small fragment of bone.

PCL injuries can occur in isolation but often there are other ligamentous injuries, including injuries to the collateral ligaments and ACL. Isolated PCL tears are usually treated conservatively with physical therapy, bracing, and eventual return to athletic activities. It has been estimated that 3-5% of NFL football players have a PCL injury!

For combined injuries, bony avulsion injuries, and isolated PCL injuries that continue to adversely affect function, surgical options are offered. When the PCL is avulsed with a small fragment of bone, a repair is performed.

Open reduction and internal fixation of a bony PCL avulsion ( other metal hardware was placed for fixation of additional fractures of the femur )

For other types of injury, the PCL cannot be repaired and a ligament reconstruction using a tendon graft ( harvested from the patient or obtained from a cadaver ) is performed.

Arthroscopic image of a PCL reconstruction graft in position in the tunnel in the medial femoral condyle and intercondylar notch. The intact anterior cruciate ligament is noted running obliquely from the bottom of the image

Watch a video of a cadaveric demonstration of an arthroscopic PCL and ACL reconstruction

The rehabilitation following a PCL reconstruction is much longer than the rehabilitation following an ACL reconstruction. The time back to full sports participation is usually 9-12 months.