Posterior Cruciate Ligament injury

Together with the other three main ligaments of the knee (the Anterior Cruciate Ligament (ACL) and the two collateral ligaments), the Posterior Cruciate Ligament (PCL) has the paramount function of providing stability to the knee joint, primarily preventing the posterior translation of the tibia on the femur and secondarily assisting in resisting varus, valgus and rotational forces. Compared to the ACL, the LCP is almost twice as thick and strong, making it less prone to injury. Due to its function and resilience, the injury of the Posterior Cruciate Ligament (LCP) is usually due to high-energy impacts in which an external force is applied to the tibia when the knee is flexed, such as during a vehicle collision (classic dash injury), falling on flexed knees, or during sports (e.g., soccer, basketball, skiing, etc.) in which a hyperextension (± rotation) mechanism is most commonly identified. Patients with LCP injury often report pain (usually in the back of the knee), swelling, reduced mobility, instability, and limited function. Ligament injuries are graded according to the severity of the reported injury using a 3-grade scalar system. Grade I, often referred to as distraction, is the mildest injury, while grade III, characterized by full-thickness ligament rupture, is the worst outcome. As with any other condition, the management of these injuries depends on the specifics of theposterior cruciate ligament injury however, due to its inherent high healing capacity, ACL injuries are often successfully treated nonsurgically.

Non-surgical management

Conservative management of LCP injuries is generally recommended in patients with a grade I-II injury, mild to moderate laxity, no associated damage to surrounding structures, and is more likely to be successful in relatively acute/recurrent injuries. Nonsurgical management generally involves facilitating the ligament’s natural healing process by positioning it in a “relaxed” state and limiting its lengthening, goals that are usually achieved with the implementation of a brace (designed specifically for LCP injuries) combined with the use of crutches. The use of the brace, crutches the degrees of knee motion and the percentages of loading allowed to the patient, can vary greatly depending on the protocol implemented and are usually at the discretion of the medical team.

Surgical management

In cases of high degrees of injury involving significant laxity and instability, associated damage of surrounding structures, or a chronically damaged ligament, surgical management is the preferred route. Similar to the ACL, ACL reconstruction is the most implemented procedure, and the specifics of the surgery are always discussed in detail between the patient and the medical-surgical team. As with conservative management, the postoperative period is characterized by the use of a brace and crutches to limit ligament tension. Gradual and progressive recovery of mobility is recommended, and this should be carefully monitored by trained medical personnel to promote the optimal biological healing process of the ligament.

Management

Regardless of the management implemented (surgical vs non-surgical), LCP rehabilitation should be started as early as possible to optimize the recovery process and reduce the risk of complications. Especially with cruciate ligament injuries, we strongly recommend that patients be guided and assisted by a specialized medical team that can take care of the entire recovery process from start to finish. After being seen by one of our doctors, you will be prescribed the best recovery program tailored to your condition. Your progress through the recovery pathway will be guided by various tests (e.g., isokinetic testing, threshold testing, motion analysis testing, etc.) to ensure safe and effective progression. Your rehabilitation will take place in different environments, gym and pool where you will minimize your symptoms and regain mobility, gym where you will improve your strength, movement analysis room where you will optimize your ability to move, and finally you will return to your activities and sport after completing your field rehabilitation.